CHAPTER 4: ASSESSMENT, DIAGNOSIS AND TREATMENT

1) CLINICAL ISSUES:
 Here we emphasize the clinical strategies/methods used to assist children with
psychological and behaviour problems.

1.1) THE DECISION-MAKING PROCESS:

 Clinicians have to systematically consider many important questions to
understand a child’s problem and to make a diagnoses and devise a treatment
plan.
 the decision-making process is aimed at finding answers to immediate and long-
term questions about the nature and course of the child’s disorder and the
treatment.

 Clinical assessments: use systematic problem-solving strategies to understand

children and their disturbances, their family and environments.
- these strategies include an assessment of their emotional, behavioural, and
cognitive functioning and their environmental factors.
- these strategies form the basis of hypothesis testing (nature of problem, causes
and likely outcomes if it is treated/untreated).

 goal of clinical assessments: to achieve an effective solution to the problem and

to promote and enhance their well-being.

 Idiographic case information: a detailed understanding of the individual

child/family as a unique entity.
 Nomothetic formulation: emphasises broad general hypothesis that apply to large
groups of individuals (e.g. children with a depressive disorder).
- a knowledge about nomothetic information (normal/abnormal child and family
development, and childhood disorders) results in a better hypothesis to test at the
idiographic level.

 you must know fundamental information about childhood disorders

(depression/learning disorder) to integrate and make it applicable to the problem.
 the decision-making process begins with an assessment (clinical interview,
behavioural assessment or psychological testing).
- it is a collaborative process with the child/family, thus its important to build a
rapport.
1.2) DEVELOPMENTAL CONSIDERATIONS:
 We must consider the child’s age, gender and cultural background as well as
normative information about typical/atypical child development
Age, Gender, and Culture:
 recognizing diversity is crucial for assessment and treatment.

 Age: a child’s age has an implication for selecting the most appropriate
assessment and treatment method and judgements about deviancy.
 Gender: there are gender differences in the rates and expression of childhood
disorders which may result in referral biases based on gender/gender differences
(ADHD and conduct disorder more common in boys; anxiety and depression
more common in girls).
- relational aggression: girls show aggression through verbal insults, gossip,
ostracism, revenge or 3rd party retaliation.
- relational and physical aggression is a strong predictor of future psychological-
social adjustment problems in girls.
- children who display forms of aggression not common for their gender, are more
maladjusted (e.g. girls who are physically aggressive and relationally aggressive
boys).
 Culture: culture and demographics are constantly changing.
- the DSM-5 provides a framework for cultural formulation of a child’s disorder
based on their and their family’s cultural identity, their cultural concept of distress,
psychosocial stressors and cultural aspects of their relationships.
- must have a culturally appropriate plan for treatment
- gather information about impact of culture on child’s problem and its implications
in treatment).
- cultural patterns show learned behaviour and shared values that are transmitted
over time.
- it is required for clinicians to examine their own belief systems and the culturally-
based assumptions that guide them.

- Cultural syndromes: a pattern of co-occurring symptoms associated with a

particular cultural group/community/context (e.g. Latino’s ‘evil eye’ that cause
illness)
- they don’t easily fit in Western diagnostic categories but it is important to asses
the extent to child the child’s culture and context affects the expression of
symptoms and the disorder.
 - abnormal child behaviour may be considered differently between cultural groups
(e.g. parents see mental health issues at taboo, or don’t trust strangers regarding
personal family matters, or the cause of the illness may be seen as
psychical/spiritual).
- an individuals acculturation level can impact assessment and interventions.
- it is important to recognize diversity that exists.
Normative Information:
 Knowledge, experience and basic information about the norms of child
development and behaviour is crucial to understanding problems.
 the age-appropriateness, severity and pattern of symptoms normally define
childhood disorders (not individual symptoms).
 the extent to which symptoms cause impairment in function is crucial to consider.

1.3) PURPOSE OF ASSESSMENT:

 There are 3 purposes of assessment – description and diagnosis, prognosis, and
treatment planning.
Description and Diagnosis:
 Clinical description: summarizes the unique behaviours, thoughts and feelings
that make up the features of the child’s disorder.
- it aims to establish basic information about the child’s concerns, and how their
behaviour and emotions differ from other similar children.
 process of evaluation:
1. How does her behaviour differ from normal behaviour of children their age
− assess the intensity, frequency and severity of her problem.
2. Describe the age at onset and the duration of her difficulties
− is it spontaneous or does it persist over time, what is considered normal
for a given age.
3. Convey a full picture of her different symptoms and their configurations
− you must know the full range of her strengths and weaknesses to make an
informed choice about the likely course, outcome and treatment of their
disorder.
- Next you must determine whether this description meets the diagnosis for 1 or
more psychological disorders.
 Diagnosis: analysing information and drawing conclusions about the nature/cause
of a problem and assigning a formal diagnostic label for a disorder.
 2 meanings of diagnosis:
1. Taxonomic diagnosis – focuses on the formal assignment of cases to specific
categories drawn from a classification system (e.g. DSM-5).
 2. Problem-solving analysis – a process of gathering information used to
understand the nature of a child’s problem, its possible causes, treatment
options and outcomes (most comprehensive picture).
- comorbidity: when certain disorders among children/adolescence are likely to co-
occur within the same individual (especially disorders that share common
symptoms).
Prognosis:
 Prognosis: the formulation of predictions about future behaviour under specified
conditions (what would happen if the child’s problem is left untreated)
- the decision to treat a child’s problem must be based on an informed prognosis
(you must weigh the probability that circumstances will stay the same, improve or
deteriorate without treatment and what treatment should be followed).
Treatment Planning and Evaluation:
 using assessment information to generate a plan to address the problem and to
evaluate the effectiveness of the treatment.
 it may involve further specification and measurement of possible contributors to
the problem, determining the resources and motivation for change and
recommendations of treatments.

2) ASSESSING DISORDERS:
 Psychological tests experts work with others do generate the most complete
picture of a child’s mental health needs.
 Multidisciplinary teams include a psychologists physician, educational specialist,
speech pathologist and a social worker.
- a physician can help determine if depression is related to drug use or a medical
condition (e.g. hypothyroidism).
- Multimethod assessment approach: emphasizes the importance of obtaining
information from different informants and using many methods (interviews,
observations, questionnaires, and tests).
- to decide which assessment is best is based on whether the problem is
observable (e.g. aggression) or internal (e.g. anxiety) and on the child’s and
family’s characteristics and abilities.
- Clinical interviews: help establish a good working relationship with the child and
family and help in obtaining information about concerns and direction.
- Behavioural assessments, checklists, rating scales and psychological tests are
used with a decision-making approach (obtain complete picture to find
appropriate treatment plan).
1.4) CLINICAL INTERVIEWS:
 It usually involves parents and the children; it allows them to gather information in
a flexible manner over sessions (then can be integrated into family observations
and psychological testing).
 can provide an insight into the parent-child relationship and an idea of the child’s
impression of their internal states, behaviour and circumstances.
Developmental and Family History:
 Developmental/family history: obtains information from the parents regarding
developmental milestones and historical events that may impact the child’s
current difficulties.

 these background questionnaires cover:

- Child’s birth and related events (birth complications, use of drugs/alcohol/cigs)
- Child’s developmental milestones (age when walking, use of language, bladder
control, self-help skills)
- Family characteristics and history (age, occupation, cultural background, marital
status, and medical, educational and mental health history of family).
- Child’s interpersonal skills (relations with adults, children, and social activities)
- Child’s educational history (schools attended, academic performance, attitude
towards school, and relations with teachers/peers)
- Child’s work history and relationships (relationships with same/opposite sex)
- Description of the presenting problem (details of problem and surrounding events
and how parents have tried to deal with it in the past)
- Parent’s expectations for assessment and treatment of their child and themselves
Semi-structured Interviews
 Semi-structured interviews: used to address the problem of the lack of
standardisation that result in low reliability and biased gathering of information.
- include specific questions to obtain significant information consistently.
- criticism: loss of spontaneity may lead to child’s reluctance to volunteer
information.

1.5) BEHAVIOURAL ASSESSMENT:

 Behavioural assessment: a strategy for evaluating the child’s thoughts, feelings
and behaviours in specific settings, and using it to form a hypothesis about the
nature of the problem and what can be done.
- this involves observing the child’s behaviour directly.
 Target behaviours: are the primary problems of concern and the specific factors
that may be influencing this behaviour (identified using behavioural assessment).
 Functional Analysis of behaviour (ABCs of assessment): used to organize
findings in behavioural assessment
- A: Antecedents (events that immediately precede the behaviour)
- B: Behaviours of interest
- C: Consequences (events that follow a behaviour)
  Aim: to identity as many factors that could be contributing to a child’s problem
behaviours, thoughts and feelings and to develop a hypothesis for them
- hypothesis can be confirmed/denied by changing an antecedent/consequence to
see if the behaviour changed.
Checklists and Rating Scales:
 Checklists and rating scales can be used to provide reports concerning child
behaviour and adjustment.
 Checklists used to ask parents, teachers and the child to rate the
presence/absence of a variety of child behaviours and the frequency/intensity.
- checklists are standardized and are used to compare an individual’s score with a
known reference group of children (similar age and same gender).
- differences in reports by parents, teachers and children inform us of the possible
range of behaviours portrayed, and the circumstances that increase/decrease
target behaviours, and the unrealistic expectations on the child.
 the Child Behaviour Checklist (CBCL) is known for its reliability and validity and
gives an overall picture
of the variety and
degree of the child’s
behaviour problem.

 Rating Scales: focus

mainly on specific disorders (ADHD/depression) or areas of functioning (social
competence)
- they look at specific problems that are more focused.
Behavioural Observation and Recording:
 clinicians keep records of specific target behaviours and on baseline data (prior to
intervention) on problems they wish to change.
 portable electronic devices help parents record and rate the intensity of specific
symptoms/behaviours ‘in the moment’ (provides ongoing information).
 Parental monitoring can provide secondary benefits (teaching them better
observation skills etc).
 Role-play simulation may also be used to assess how the child and family behave
in daily situations.
1.6) PSYCHOLOGICAL TESTING:
 Psychological Test: a set of tasks given under standard conditions that assess
aspects of the child’s knowledge, skills and personality (standardised on norm
group - comparable to see how their score deviates from the norm).
- some say these test are culturally biased, thus, Code of Fair Testing Practices
(fair to all test takers regardless of race, culture, ethnicity, religion etc).
Developmental Testing:
 Developmental tests: used to assess infants and young children for the purpose
of screening, diagnosis, and evaluation of early development.
 Screening: identifying children at risk of developing later mental health problems
and then further evaluating it.
- there is an importance of early identification, intervention and prevention.
Intelligence Testing:
 Clinical assessment includes evaluating a child’s intellectual and educational
functioning.
 impairments in thinking/learning may be due to their behavioural/emotional
problems.
 some with intellectual disabilities/learning disorders may have problems in
thinking and learning as a part of the disorder.
 Intelligence: the overall capacity to understand and cope with the world around
you.
 intellegience tests: used to identify children who have difficulty succeeding in a
regular classroom and to plan an intervention for them.
 The Wechsler Intelligence Scale for Children (WISC-V): intelligience test that
places emphasis on reasoning abilities, higher-order reasoning and information-
processing speed.
 other examples: Stanford-Binet Intelligence scale (SB5).

 the WISC-V produces a full scale IQ (FSIQ) score from 5 scales/Index:

- Verbal Comprehension: measures abilities of verbal conception formation, verbal
reasoning, and knowledge through experiences and learning.
- Visual Spatial Index: measures spatial processing, attention to detail, visual
perception and organisation and visual-motor integration.
- Fluid Reasoning: Measures the ability to engage in problem solving and
interpreting patterns and sequences.
- Working Memory: measures attention, concentration and mental control.
 - Processing Speed: measures the ability to complete a series of tasks involving
motor coordination, visual processing and search skills quickly and accurately.

 these 5 domains represent indicators of cognitive strengths and weaknesses

important to the assessment of learning disabilities.
 the WISC-V provides a good prediction of academic performance and must be
used to determine the treatment and educational plan.
Projective Testing:
 Projective tests present the child with ambiguous stimuli such as inkblots or
pictures of people and the child is asked to describe what she or he sees.
 The hypothesis is that the child will “project” his or her own personality—
unconscious fears, needs, and inner conflicts—onto the ambiguous stimuli of
other people and things.
 Without being aware, the child discloses his or her unconscious thoughts and
feelings to the clinician, thus revealing information that would not be shared in
response to direct questioning.
 Some clinicians believe that projective tests provide a rich source of information
about the child’s coping styles, affect, self-concept, interpersonal functioning, and
ways of processing information.
 Other clinicians see them as inadequate with respect to meeting minimum
standards for reliability and validity.
 Projective testing is a window to child’s unconscious processes and one of the
most frequently used clinical assessment methods:
 these methods include human figure drawings, Rorschach inkblot test and
thematic picture tests
In which children are asked to tell a story in response to pictures of children in everyday
situations with their families, peers, or alone.
 Clinicians may also attempt to assess the child’s inner life through play:
- puppets
- storytelling
- other material
Personality Testing:
  Personality is usually considered an enduring trait or pattern of traits that
characterize the individual and determine how he or she interacts with the
environment
- Example: children who withdraw from social contact may be characterized by
their parents as shy, others who are socially busy are characterized as outgoing.
 Big 5 Factors of dimensions of personality:
- whether a child or adolescent is timid or bold
- agreeable or disagreeable
- dependable or undependable
- tense or relaxed
- reflective or unreflective
 Information about a child’s personality is provided by interviews, projective
techniques, and behavioral measures
 Two personality inventories frequently used with children:
- Minnesota Multiphasic Personality Inventory—Adolescent (MMPI-A)
- Personality Inventory for Children, Second Edition (PIC-2)

Neuropsychological Assessment:
 Neuropsychology: the study of brain–behavior relations.
 Neuropsychological assessment attempts to link brain functioning with objective
measures of behavior known to depend on an intact central nervous system:
- try closing your eyes and then touching the tip of your nose with your ring finger,
first with your right hand and then with your left (For children with certain brain
injuries or dysfunctions, carrying out this or other tasks may prove difficult.)
 Behavioral measures can be used to make inferences about central nervous
system dysfunction and the consequences of this dysfunction for the child.
 Neuropsychological assessments use this information clinically for determining:
- a diagnosis
- planning treatment
- documenting the course of recovery
- measuring subtle but significant improvements
- performing follow-up care with children who have neurological impairments or
learning disorders
 Neuropsychological assessment assesses multiple psychological functions:
- verbal and nonverbal cognitive functions (language, abstract reasoning and
problem solving).
- perceptual functions (visual, auditory and tactile-kinesthetic)
- motor functions (strength, speed of performance, coordination and dexterity)
- emotional/executive control functions (attention, concentration, frustration
tolerance, and emotional functioning).

3) CLASSIFICATION AND DIAGNOSIS:

 Classification: a system for representing the major categories or dimensions of
child psychopathology and the boundaries and relations among them.
 Diagnosis: refers to the assignment of cases to categories of a classification
system.
 Treating every child as unique has its drawbacks because research into the
causes and treatments of childhood disorders would be impossible to conduct,
and we would have little direction about how to proceed in treating an individual.
 2 strategies in for determining the best plan in clinical assessment and diagnosis:
 1. An idiographic strategy
- highlights a child’s unique circumstances, personality, cultural background, and
other features that pertain to his or her situation
- Each child who comes in for an assessment has unique strengths and challenges
that make his or her problem.
2. Nomothetic strategy
- as part of our assessment in order to benefit from all the information accumulated
on a given problem or disorder and to determine the general category for the
presenting problem.

 We attempt to name or classify the problem using an existing system of

diagnosis:
- DSM-5
- ICD-10
- Classification of Mental and Behavioural Disorders

 Classifying the problem leads to:

- a foundation of knowledge from which we can draw to understand the child and
family
- helping us communicate with others and to select an intervention, preferably one
shown by research to be effective for children with similar difficulties.
 There is no single, agreed-upon, reliable, and valid worldwide classification
system for childhood disorders.
 The DSM brings up concerns about:
- Limited coverage of childhood disorders
- The overlap in symptoms across different childhood disorders
- Insensitivity to the developmental complexities that characterize these problems
particularly for very young children.
1.7) CATEGORIES AND DIMENSIONS:
The first approach to diagnosing child psychopathology involves the use of categorical
classification systems.
  Categorical classification systems: such as DSM-5 are based primarily on
informed professional consensus, an approach that has dominated and continues
to dominate the field of child (and adult) psychopathology.
 A classical (or pure) categorical approach: assumes that every diagnosis has a
clear underlying cause (e.g. an infection or a malfunction of the nervous system)
and that each disorder is fundamentally different from other disorders
- Therefore, individual cases can be placed into distinctive categories.
- The disadvantage to this approach is that children’s behavior seldom falls neatly
into established categories, so a certain degree of confusion remains.
 Categories of behavior (as opposed to some medical diseases) do not typically
share the same underlying causes, therefore the mental health field has had to
modify the classical categorical approach to accommodate the current state of
knowledge.
 Children given the same diagnosis don’t necessarily share the same etiology
neither do they respond to the same treatment.
 It is crucial to understand that current diagnostic categories represent only our
current knowledge about how symptoms cluster together.
The second approach to describing abnormal child behaviour involves empirically based
dimensional classification.
 Dimensional classification approaches: assume that many independent
dimensions or traits of behavior exist and that all children possess them to
varying degree.
- Depression, anxiety and other traits or dimensions are typically derived using
statistical methods from samples drawn from both clinically referred and non-
referred child populations to establish ranges along each dimension
 Limitations of dimensional approaches:
- The derived dimensions are dependent on sampling, method, and informant
characteristics
- he derived dimensions are dependent on the age and sex of the child
- Integrating information obtained from different methods, from various informants,
and over time or across situations can be challenging.
- Dimensional approaches may also be insensitive to contextual influences.
  Dimensions provide a useful estimate of the degree to which a child displays
certain traits and not others, yet they often must be tailored to the child’s unique
circumstances and developmental opportunities.
 2 Dimensions of child psychopathology:
- externalizing behavior (reflect aggressive/rule-breaking behaviour)
- internalizing behavior (reflect anxious/withdrawn/depressed behaviour).
 DSM-5 includes dimensional ratings of severity for categorical diagnoses (ADHD
and ASD) and includes items drawn from empirically derived dimensions
respectively (depressed or anxious)used to develop rationally derived DSM-
oriented scales identified by experts from different cultures.
 Depending on whether the purpose is clinical diagnosis or research, one
approach may be more useful than the other.
1. A dimensional approach:
- conceptualizes psychological factors such as behavior, affect, and cognitive
abilities among children to determine the degree of association between two or
more variables.
- it is often preferred by those conducting psychological research.
2. A categorical approach:
- more compatible with clinical purposes where the objective is to incorporate the
whole pattern of the child’s behavior into a meaningful diagnosis and treatment
plan.
- Categories are useful for communicating among clinicians and categorical
diagnoses are required for clinical decisions.

1.8) THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

(DSM-5):
DSM-5 DISORDERS:
  These early occurring neurodevelopmental disorders continue into adolescence
and adulthood for many of those affected.
 Neurodevelopmental disorders frequently have overlapping symptoms and that
they often co-occur in the same individual (e.g. ASD and ADHD).
 Under the DSM-5 guidelines, diagnostic criteria for nearly all disorders can apply
to children and adults, and both groups can be diagnosed using the same criteria
with some adjustment for developmental factors such as age and context.
 A child can (and often does) receive more than one DSM-5 diagnosis with the
principal diagnosis first.
DSM-5 SPECIFIERS:
 After assessment using DSM-5 diagnostic criteria, specifiers are used to describe
more homogeneous subgroupings of individuals with the disorder who share
features and to communicate information that is relevant to treatment of the
disorder.
 Specifiers are used to rate subtypes of the disorder, co-occurring conditions or
the course or severity of the disorder.
- Co-occurring specifier: language impairment or intellectual impairment for a child
with ASD
- Course specifier: onset prior to age 10 years for a child with conduct disorder
- Severity specifier: mild, moderate, severe or profound for a child with ID
 Specifiers may also be used to note general medical conditions relevant to the
understanding or management of the individual’s mental disorder.
- General medical conditions can be related to mental disorders in a variety of
ways.
 In some cases, the disorder may play a direct role in the development of physical
problems (such as a disruption in sleep due to depression)
  In other cases, a child’s clinical disorder (anxiety) may be a psychological
reaction to a medical condition (being diagnosed with childhood cancer or
diabetes)
- It is important to document the co-occurrence and temporal order of problems to
gain an overall understanding and to develop an appropriate treatment plan for
an individual.
Other Considerations:
 In making a diagnosis, it is also important to consider psychosocial and
environmental problems that may affect the diagnosis, treatment, and prognosis
of clinical disorders:
 these problems include negative life events, environmental disruptions or
deficiencies, family or other interpersonal stress, and a lack of social support or
personal resources.
 Typically, clinicians note only the problems that have been present over the past
year, unless prior events that have likely contributed to the mental disorder.
 Contextual factors (child abuse or parental unemployment) are potentially
important for understanding an individual’s behavior and emotions.
Pros and Cons of Diagnostic Labels:
 Moron, imbecile and idiot were neutral terms (in the past) to describe lower levels
of intellectual functioning but became insults when they began to be used in
common language.
- As a result, they gave way to terms such as mental deficiency and then mental
retardation which has now given way to the term intellectual disability for much
the same reason.
 On the positive side, labels help clinicians summarize and order observations
which can facilitate communication among professionals and sometimes aid
parents by providing more recognition and understanding of their child’s problem.
 Descriptive labels are consistent with the natural tendency to think in terms of
categories.
 The use of descriptive terms or labels assists clinicians in:
- locating a relevant body of detailed research and clinical data
- facilitating research on the causes, epidemiology, and treatment of specific
disorders.
  On the negative side are criticisms as to whether current diagnostic labels are
effective in achieving any of the aforementioned purposes.
 There are also concerns about negative effects and stigmatization associated
with assigning labels to children
- Public stigma and media messages allow negative attitudes to grow around
children who are labelled (then others perceive and react to a child differently).
- Equally disturbing is that labels can negatively influence children’s views of
themselves and their behavior.
4) TREATMENT AND PREVENTION:
 Interventions today combine the most effective approaches to particular problems
in an ongoing developmentally sensitive manner.
 A thorough clinical assessment and diagnosis constitute a critical first step in
helping children who have psychological problems and their families.
 The most useful treatments are based on what we know about the nature,
course, associated characteristics, and potential causes of a particular childhood
disorder.
 Interventions that zoom in on a specific problem with clear guidelines for
treatment appear to be the most effective.
1.9) INTERVENTION:
 Intervention is a broad concept that encompasses many different theories and
practices directed at helping the child and family adapt more effectively to their
current and future circumstance.
 Clinical assessment and diagnosis are usually followed by efforts to select and
implement the most promising approach to intervention.
  Prevention: directed at decreasing the chances that undesired future outcomes
will occur (promote health and prevent problems before they occur).
 Treatment: corrective actions that permit successful adaptation by
eliminating/reducing the impact of an undesired problem/outcome that has
already occurred.
 maintenance: efforts to increase adherence to treatment over time to prevent a
relapse/recurrence of a problem.

1.10) CULTURAL CONSIDERATIONS:

 Parents from different ethnic groups and cultures have different parenting values
and use different child-rearing practices. T
 They also have different beliefs about childhood problems, how mental health
services are provided, how to describe their children’s problems when they seek
help, and preferred interventions
 The cultural compatibility hypothesis: states that treatment is likely to be more
effective when it is compatible with the cultural patterns of the child and family.
- The importance of cultural sensitivity in treatment is reflected in the finding that
for some problems and treatments, ethnic similarity between a child’s caregiver
and the therapist is associated with better treatment outcomes for the child.

 In helping families establish effective rules and forms of discipline for their
children, the clinician must be aware of these important cultural practices and find
methods that each parent is comfortable using.

1.11) TREATMENT GOALS:

  Treatment goals: focus on building children’s adaptation skills to facilitate long-
term adjustment, rather than on merely eliminating problem behaviors or briefly
reducing subjective distress.

 Other treatment goals and outcomes are also of crucial importance to the child,
family, and society
 These include:
- Outcomes Related to Child Functioning: Reduction or elimination of symptoms,
reduced degree of impairment in functioning, enhanced social competence,
improved academic performance
- Outcomes Related to Family Functioning: Reduction in family dysfunction,
improved marital and sibling relationships, reduction in stress, improvement in
quality of life, reduction in burden of care, enhanced family support

- Outcomes of Societal Importance: Improvement in the child’s participation in

school-related activities (Increased attendance, reduced truancy, reduction in
school dropout rates), decreased involvement in the juvenile justice system,
reduced need for special services, reduction in accidental injuries or substance
abuse, enhancement of physical and mental health, reductions in mental health
care costs

 The interlocking network of physical, behavioral, social, and learning difficulties

that characterizes most childhood disorders often requires a multidisciplinary
approach to attain these treatment and prevention goals.

 Children often require medication/medical intervention that must be coordinated

with psychosocial interventions (like with ADHD, ASD, or eating disorders).
 Therefore, the use of combined treatments is common.
1.12) GENERAL APPROACHES TO TREATMENT:
 Practicing clinicians who work with children and families identify their approach as
eclectic.
- means that they use different approaches for children with different problems and
circumstances and that they see most of these approaches as having value.

Psychodynamic Treatments:
 Psychodynamic approaches view child psychopathology as determined by
underlying unconscious and conscious conflicts.
  The focus is on helping the child develop an awareness of unconscious factors
that may be contributing to their problems.
- This awareness can occur through play therapy with older children and it occurs
through verbal interactions with the therapist.
 Therapist helps the child resolve the conflicts and develop more adaptive ways of
coping.
Behavioural Treatments:
 Behavioral approaches assume that many abnormal child behaviors are learned.
 Behavioral treatments often focus on changing the child’s environment by
working with parents and teachers.
 The focus of treatment is on re-educating the child, using procedures derived
from theories of learning or from research.
 Such procedures include:
- positive reinforcement
- time-out
- modelling
- systematic desensitization
Cognitive Treatments:
 Cognitive approaches view abnormal child behavior as the result of deficits
and/or distortions in the child’s thinking, including perceptual biases, irrational
beliefs and faulty interpretations.
 For example: For an attractive girl who gets A grades but thinks she is ugly and is
going to fail in school, the treatment emphasis is on changing these faulty
cognitions (as cognitions change, the child’s behaviors and feelings are also
expected to change).
Cognitive-Behavioural Treatments:
 Cognitive–behavioral approaches view psychological disturbances as the result
of both faulty thought patterns and faulty learning and environmental experiences.
 Combining elements of both the behavioral model and the cognitive model, the
cognitive–behavioral approach grew rapidly as behavior therapists began to focus
on the important role of cognition in treatment for both the child and the family.
  Faulty thought patterns that are the targets of change include distortions in both
cognitive content (e.g. erroneous beliefs) and cognitive process (e.g. irrational
thinking).
 Cognitive distortions and biases have been identified in children with a variety of
problems (e.g. depression, conduct disorder, and anxiety disorders).

 The major goals of cognitive–behavioral treatment is to

- identify maladaptive cognitions and replace them with more adaptive ones
- teach the child to use both cognitive and behavioral coping strategies in specific
situations
- help the child learn to regulate his or her own behavior.
 Treatment may also involve how others respond to the child’s maladaptive
behavior.
Client-Centered Treatments:
 Client-centered approaches view child psychopathology as the result of social or
environmental circumstances that are imposed on the child and interfere with his
or her basic capacity for personal growth and adaptive functioning.
 The interference causes the child to experience a loss or impairment in self-
esteem and emotional well-being, resulting in even further problems.
 The therapist relates to the child in an empathic way, providing unconditional,
non-judgmental and genuine acceptance of the child as an individual (through the
use of play activities with younger children and verbal interaction with older
youths)
 The therapist respects the child’s capacity to achieve their goals without the
therapist serving as a major adviser or coach—the therapist respects the child’s
self-directing abilities.
Family Treatments:
 views child psychopathology as determined by variables operating in the larger
family system.
 Treatment involves a therapist (and sometimes a co-therapist) who interacts with
the entire family or a select subset of family members, such as the parents and
child or the husband and wife.
 Therapy typically focuses on the family issues underlying problem behaviors.
- The therapist may focus on family interaction, communication, dynamics,
contingencies, boundaries, or alliances.
 It is also essential to adapt family interventions to the cultural context of the
family.
Combined Treatments:
 Combined treatments: refer to the use of two or more interventions, each of which
can stand on its own as a treatment strategy.

 The use of combined treatments for the framework of 5 core principles of

therapeutic change:
- Feeling Calm: Using muscle relaxation or other calming techniques to reduce
tension and emotional arousal.
- Increasing Motivation: Using environmental contingencies such as differential
attention, praise or tangible rewards to increase adaptive behaviors.
- Repairing Thoughts: Identifying and changing biased or distorted cognitions such
as overly pessimistic or self-blaming thoughts in depression.
- Solving Problems: Building problem-solving skills such as problem identification,
goal setting and generating and selecting solutions.
- Trying the Opposite: Engaging in activities that directly counter the problem
behavior, such as activity scheduling or breaking activities into smaller more
manageable steps in depression.

 Youths who participate in school-based universal social and emotional learning

programs have been found to show significantly improved social and emotional
skills, attitudes, behavior, and academic performance.