Assessment

Adnan Adil
Framework for Clinical Decision Making
• What are the primary clinical characteristics that best describe child’s
problems?
• What is the best way to obtain information and conduct an in-depth
evaluation of the problem?
• What are the most important, relevant, and appropriate interventions
for the child, given the nature of his/her problem, developmental age,
and level of cognitive functioning?
Goals of Diagnosis and Assessment
• Assessment involves discerning the unique functional characteristics
of the individual child and to diagnose signs and symptom
presentations that are suggestive of specific mental disorders.
• The purpose of diagnosis is to classify the problem within the context
of other known behavioral clusters or disorders to draw on clinical
knowledge regarding potential etiology, course, and treatment
alternatives.
• Case Formulation
• The nature of the problem;
• How the behavior came to be (precipitating factors);
• Why the behavior is continuing (maintaining factors).
• The three stages of case formulation include:
1. Problem identification, clarification and classification;
2. Problem interpretation and understanding through problem evaluation;
3. Treatment formulation

• Mash and Wolfe (2002) suggest three goals of assessment: diagnosis,

prognosis and treatment planning.
Issues in Diagnosis: Systems of Classification
• Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA, 2013)
• The empirical or dimensional system used by such instruments as the Achenbach
System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2001)
• The federal regulations of the educational system used for classification of
disorders that impact learning, the Individuals with Disabilities Education
(Improvement) Act (IDEA, 2004).
• The fundamental goal of these classification systems is to provide an overall
organizational framework for understanding disorders, the systems differ in terms
of:
• How the systems were developed;
• How the disorders are conceptualized;
• The methods used by each system to determine how a disorder is classified.
• The DSM I (DSMI) considered only two childhood disorders: Adjustment Reaction
and Childhood Schizophrenia
• The previous version (DSM-IV-TR, APA, 2000) contained over 20 disorders under
the category of Disorders Usually First Diagnosed in Infancy, Childhood or
Adolescence.
• The DSM-IV-TR (APA, 2000) also updated descriptions of many other disorders
throughout the manual to include specific culture, age and gender features to
indicate how these disorders manifest in childhood or adolescence (mood
disorders, anxiety disorders, panic and post-traumatic stress disorder, eating
disorders, sleep disorders, etc.).
• In an attempt to realign more with a developmental perspective, the DSM-5 has
attempted to present disorders as they might appear developmentally, beginning
with a chapter on neuropsychological disorders that have onset primarily in early
childhood.
Attribution Bias Context Model (ABC Model)
• Based upon the actor-observer phenomenon, The ABC Model (DeLos
Reyes & Kazdin, 2005) suggests that discrepancies in attributions and
perspectives of different informants in clinical settings may influence
their perceptions of:
• The causes of behaviors;
• Which behaviors should be the focus of treatment;
• Whether treatment is required.
Changes in DSM-5
1. Use of dimensional measures of cross-cutting symptoms to support
diagnoses
2. Recognition of externalizing and internalizing dimensions
3. Reclassification of childhood disorders and unique criteria for PTSD
in early childhood
4. Developmental and Life Span Considerations
5. Risk and Prognostic Factors
The Educational Classification System
• IDEA (2004) mandates special education and related services for children
with disabilities who qualify for services if they meet criteria in 1 of 13
categories, including intellectual disability, hearing impairments (including
deafness), speech or language impairments, visual impairments (including
blindness), serious emotional disturbance, orthopedic impairments,
autism, traumatic brain injury, other health impairments and specific
learning disabilities.
• The educational classification system uses many of the same disorder
categories (e.g., learning disability, intellectual disability, emotional
disturbance) found in the DSM, and dimensional system, however, the goal
of the classification system under the Individuals with Disabilities Education
Improvement Act (IDEA, 2004) is to determine whether the disorders
impact on educational goals and whether a child with disabilities will
require special education and related services in order to receive an
appropriate education.
• Discrepancy approach vs Response to Intervention Approach (RTI)
Potential Reasons for Assessment
• 1. Diagnosis and case formulation;
• 2. Screening (identification of at-risk children);
• 3. Prognosis (prediction of course of disorder);
• 4. Treatment planning and design (target identified problems);
• 5. Monitoring of treatment (tracking symptom change);
• 6. Treatment evaluation (pre–post assessment, consumer
satisfaction)
The Assessment Process and Methods of Assessment

• Mental Measurements Yearbook (the Buros Institute of Mental

Measurements)
• Evidence-based assessments: Besides strong psychometric evidence,
the assessment tools must demonstrate clinical utility, which provides
psychologists with the kinds of information that can be used in ways
that will make a meaningful difference in relation to diagnostic
accuracy, case formulation considerations and treatment outcomes.
• There has been an increasing trend toward disorder-specific
assessment and less emphasis on a generic test battery.
• Specificity as a process
Assessment Methods
• Interviews
• Observations
• Behavioral Rating Scale and Multi-Rater Scales
• Personality Assessment
• Intelligence Assessment
• Projective Tests
Achenbach System of Empirically Based Assessment
• Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla,
2001): This most recent revision of the Achenbach scales includes updated versions of
the original three scales: Child Behavior Checklist, Teacher’s Report Form, and Youth Self-
Report (available for youth 11 years or older) in what Achenbach refers to as “an
integrated system of multi-informant assessment.” The various rater forms and age
ranges for the ASEBA are available in
• The ASEBA scales yield profiles for eight syndrome scales:
• Anxious/Depressed; Withdrawn/Depressed; Somatic Complaints; Social Problems; Thought
Problems; Attention Problems; Rule-Breaking Behavior; Aggressive Behavior
• In addition to the syndrome scales, there are also scores provided for the composite
scales:
• Internalizing, Externalizing and Total Problems. Informants respond to questions (113
questions on the parent and teacher version; 112 questions on the youth form) using a 3-
point scale to indicate whether the statement is not true (0 points), somewhat or
sometimes true (1) or very true or often true (2).
• Another important change was the addition of a set of DSM-Oriented Scales that were
developed by a panel of clinicians who rated the items based on their consistency with
the DSM categories, and results yielded six DSM-Oriented Scales:
• Affective Problems; Anxiety Problems; Somatic Complaints; Attention Deficit/Hyperactivity
Problems; Oppositional Defiant Problems; Conduct Problems
Ethical Issues
• Issues of Informed Consent and Assent
• Emancipated minor
• Mature minor
1. Testing that is mandated by law;
2. Testing that is routinely administered (education, job application);
3. If the assessment is to determine decision-making capacity (issues of
competency).
Test Security, Scoring, Interpretation and Release of Test Data
Issues in Child Treatment and Intervention
• General effectiveness of treatment for childhood disorders
• Specificity of treatment: Are some treatments more effective for
certain problems?
• K-3 Paradigm
• Knowledge of developmental expectations;
• Knowledge of sources of influence (child characteristics and
environmental characteristics);
• Knowledge of theoretical models and perspectives.
• How to measure treatment success;
• How to measure improvement;
• How to account for variations among complex problems in therapy;
• How to account of variations in therapist approach within disciplines;
• How to measure treatment fidelity;
• Analogue versus ecological treatments
Developmental Issues in Treatment and Intervention

• There are minimal guidelines anywhere for adapting treatment programs

to various developmental levels.
• Most clinicians recognize the need to scrutinize cognitive aspects of a
treatment program as to developmental level, other areas of child
functioning (behavioral, emotional, social) have all but been ignored in
treatment planning.
• Increased understanding of developmental levels, norms, tasks and milestones;
• Increased understanding of what constitutes psychopathology, at a given level of
development (risk factors, equifinality, multifinality, trajectories) and how specific
disorders appear at different levels of development;
• Increased understanding of the role of context and context inclusion in therapeutic
interventions;
• Increased parent and teacher understanding of development, its nature and course.
• Conceptualize the disorder from a developmental perspective.
• Include measures of developmental moderator variables, such as
cognitive–developmental level, motivation, social skills, emotion
regulation and self-control.
• Evaluate mediator effects, such as developmental level (tasks to be
mastered) or level of cognitive appraisal (problem solving).
• The use of combined and multimodal treatment methods