Discussion: Comprehensive Integrated Psychiatric Assessment
A comprehensive psychiatric evaluation is needed to diagnose emotional, behavioral, or developmental disorders. An evaluation of a child, adolescent, or adult is made based on behaviors present and in relation to physical, genetic, environmental, social, cognitive (thinking), emotional, and educational that may be affected because of these behaviors (Comprehensive Psychiatric Evaluation, 2021). After watching the video, I think the practitioner did well. She asked good questions and she seemed genuinely concerned about the patient’s well-being. Although she asked if he had thoughts of harming himself, I would ask if he had thoughts of harming his ex or others.
Assessing children and adolescents is challenging. The central goal of a clinical assessment is to come to a case formulation that would guide management decisions specifying signs and symptoms through detailed clinical history and examination to help ascertain key areas of concern and presence or absence of a mental health disorder (Srinath et al., 2019). Clinical assessments with children and adolescents are elaborate and require the practitioner to be astute and conscientious in obtaining information from multiple sources and settings (Srinath et al., 2019).
Two rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent are the Adolescent Psychopathology Scale (APS) and the Reynolds Adolescent Adjustment Screening Inventory (RAASI). The Adolescent Psychopathology Scale (APS) was designed to evaluate the presence and severity of symptoms of psychological disorders and distress in children and adolescents ages 12-19 years and is written at a third grade reading level (Williams, 2008). It takes approximately 45 to 60 minutes to complete, and the software calculates scores for all scales and automatically generates a Clinical Score Report (Williams, 2008). The Reynolds Adolescent Adjustment Screening Inventory (RAASI) was designed to quickly identify adolescents who show significant adjustment problems in the areas of antisocial behaviors, anger problems, and emotional distress that may be at risk for psychological adjustment problems and in need of psychological evaluation and services (Williams, 2008). Both screenings are a self-report measure and RAASI can be completed in approximately 5 minutes, and it includes 32 items derived from the Adolescent Psychopathology Scale (APS). It is also, written at a 3rd grade reading level and includes 4 scales: Antisocial Behavior, Anger Control Problems, Emotional Distress, and Positive Self that yields Total Adjustment score (Williams, 2008).
Counseling or working with children and adolescents is different from counseling adults. Two psychiatric treatment options for children and adolescents that may not be used when treating adults are play therapy, which uses creative media to engage children in therapeutic conversation and using puppet and figures (Bhide & Chakraborty, 2020). Play therapy works within a designated play therapy room that has access to sand and water play, painting and artwork, dress-up materials, dolls, puppets, and construction play materials (Bhide & Chakraborty, 2020). As a professional working in a different context, you may not have access to a designated room or an elaborate range of materials, however, it is still important to have access to some creative activities to complement verbal conversation fully to engage children and adolescents (Bhide & Chakraborty, 2020). Interviewing the child and parent together or separately is a clinical judgment call (Srinath et al., 2019).
In conclusion, it is vital to get a narrative account of the clinical history from both parents and child. Parents and children come from their own personal histories and their understanding and expression of the “problem” is colored by their own developmental, familial, and other salient experiences (Srinath et al., 2019). Practitioners should not be surprised when the stories from the parent and the child do not match. Parents are more likely to report externalizing symptoms and children and adolescents are more likely to report internalizing symptoms (Srinath et al., 2019). The parent’s account is about what they “see” the child do. Additional layers of emotion thought, experience and context help to truly understand the origins and implications of a child\’s behavior (Srinath et al., 2019). The articles used were published in peer-reviewed journals.
Bhide, A., & Chakraborty, K. (2020, January). General principles for psychotherapeutic
interventions in children and adolescents. National center for biotechnology information,. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001347/
Comprehensive psychiatric evaluation. (2021). The Johns Hopkins Medicine.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019, January). Clinical practice guidelines for
assessment of children and adolescents. National center for biotechnology information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345125/
Williams, S. (2008). Mental Health Screening and Assessment Tools for Children.
YMH Boston. (2013, May 22). Vignette 5 – Assessing for Depression in a Mental Health
Appointment [Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU
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Response to my colleague NO 1 discussion post
Hello Angela. I find your discussion very educative, with great insight on the importance of conducting comprehensive psychiatric assessment among children and adolescents. The discussion is well structured, with all questioned comprehensively addressed. I agree with your opinion that the practitioner did well in assessing the patient in the provided video, with keen interest addressed towards promoting the patient’s well-being. However, I feel like the practitioner should have initiated the conversation by introducing herself, and confirming the identity of the client to promote trust and collaboration from the client (Radez et al., 2021).
In addition to the Adolescent Psychopathology Scale (APS) and the Reynolds Adolescent Adjustment Screening Inventory (RAASI) scales that you have mentioned, I would like to add Conners’ Rating Scales-Revised (CRS-R) and the Achenbach System of Empirically Based Assessment (ASEBA). The tools are crucial in assessing the symptoms of different health complications to children, comprising of age-specific scores for every symptom (Guerrera et al., 2019). Given that psychiatric disorders cannot be conclusively diagnosed based on physical findings, the adoption of the most appropriate scale is crucial to promote accurate diagnosis of the patient’s mental condition and reduce incidences of misdiagnosis.
Lastly, play therapy is one of the most common therapeutic interventions for children with mental disorders just as you have mentioned. However, the use of puppets and figures is part of play therapy, and cannot be considered a therapeutic approach by itself. I would like to add Mentalization Based Therapy (MBT)as the second option, which is specific to adult populations. MBT is designed for children and teens having difficulties understanding themselves, and what is expected of them (Collyer et al., 2020). It is effective in helping children grow into mentally healthy individuals.
Collyer, H., Eisler, I., &Woolgar, M. (2020). Systematic literature review and meta-analysis of the relationship between adherence, competence and outcome in psychotherapy for children and adolescents. European child & adolescent psychiatry, 29(4), 417-431. https://doi.org/10.1007/s00787-018-1265-2.
Guerrera, S., Menghini, D., Napoli, E., Di Vara, S., Valeri, G., &Vicari, S. (2019). Assessment of psychopathological comorbidities in children and adolescents with autism spectrum disorder using the child behavior checklist. Frontiers in psychiatry, 10, 535. https://doi.org/10.3389/fpsyt.2019.00535
Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European child & adolescent psychiatry, 30(2), 183-211. https://doi.org/10.1007/s00787-019-01469-4