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Child/Adolescent assessment and treatment

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  • 1. Techniques of Child and Adolescent Counseling dr. tracy mallett
  • 2. Clinical Disorders Axis I
  • 3. Main categories of clinical disorders
    • Mood (depressive, bipolar)
    • Anxiety (panic, PTSD, phobias, general)
    • Adjustment (with or without mood or anxiety)
    • Sexual (dysfunctions, paraphilias)
    • Impulse control (intermittent explosive, pyromania)
    • Substance-related
    • Cognitive (delirium, dementia, amnestic)
    • Dissociative (amnesia, fugue, identity)
    • Somatoform (pain, hypochondriasis, body dysmorphic)
  • 4. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
  • 5. Mental Retardation
    • Mild Mental Retardation
    • IQ 50-55 to 70
    • Moderate Mental Retardation
    • IQ 35-40 to 50-55
    • Severe Mental Retardation
    • IQ 20-25 to 35-40
    • Profound Mental Retardation
    • IQ Below 20-25
  • 6. Learning Disorders
    • Reading
    • Mathematics
    • Disorder of Written Expression
  • 7. Motor Skills Disorders
    • Developmental Coordination Disorder
  • 8. Communication Disorders
    • Expressive Language Disorder
    • Mixed Receptive-Expressive Language Disorder
    • Phonological Disorder
    • (formerly Developmental Articulation Disorder)
    • Stuttering
  • 9. Pervasive Developmental Disorders
    • Autistic Disorder
    • Rett’s Disorder
    • Childhood Disintegrative Disorder
    • Asperger’s Disorder
  • 10. Attention-Deficit and Disruptive Behavior Disorders
    • ADHD
    • Conduct Disorder
    • Oppositional Defiant Disorder
  • 11. Feeding and eating disorders of infancy or early childhood
    • Pica
    • Rumination Disorder
    • Feeding disorder of infancy or early childhood
  • 12. Tic Disorders
    • Tourette’s Disorder
    • Chronic Motor or Vocal Tic Disorder
    • Transient Tic Disorder
    • (less than one year duration)
  • 13. Elimination Disorders
    • Enuresis
    • Encopresis
  • 14. Others
    • Separation Anxiety Disorder
    • Selective Mutism
    • Reactive Attachment Disorder
    • Stereotypic Movement Disorder
  • 15. Personality Disorders Axis II
  • 16. Eccentric disorders
    • Paranoid personality disorder
    • Schizoid personality disorder
    • Schizotypal personality disorder
  • 17. Paranoid
    • Consistent suspiciousness, distrust in others
    • Others’ motives are interpreted as attempts to harm
    • Preoccupied with unjustified doubts about the truthfulness of others
    • Reads demeaning/threatening meanings into the innocent actions of others
    • Persistent grudge-bearing
    • Frequent unjustified suspicions about the faithfulness of a domestic partner
  • 18. Schizoid
    • Pervasive pattern of detachment from social relationships
    • Restricted expressed emotion
    • Does not desire or enjoy close relationships
    • Usually chooses solitary activities
    • Little interest in sexual interaction
    • Limited ability to take pleasure in activities
    • Appears indifferent to others’ praise or criticism
    • Demonstrates emotional coldness
  • 19. Schizotypal Pnality Disordersoer
    • Social and interpersonal deficits, marked by discomfort with and reduced capacity for close relationships
    • Cognitive or perceptual distortions (such as extreme superstitiousness, belief in clairvoyance, telepathy, magical thinking)
    • Eccentric or peculiar behavior
  • 20. Dramatic disorders
    • Antisocial personality disorder
    • Borderline personality disorder
    • Histrionic personality disorder
    • Narcissistic personality disorder
  • 21. Anxious disorders
    • Avoidant personality disorder
    • Dependent personality disorder
    • Obsessive-compulsive personality disorder
  • 22. Assessment of suicide risk (Juhnke & Granello, 2005)
  • 23. Risk Factors
    • Demographics
    • Depression/Hopelessness
    • DSM disorders
    • Substance use
    • Recent previous suicide attempts
    • Suicidal ideation
    • Challenges to clear thinking
    • Family dysfunction
    • Access to lethal means
    • Recent and chronic stressors
  • 24. Demographics
    • Gender: Women attempt more; men succeed more
    • Gender and ethnicity:
    • Most likely groups:
    • Caucasian males
    • Caucasian females
    • African American males
  • 25. Depression/Hopelessness
    • Strong association between depressed mood and eventual suicide
    • Assessment tool to determine level of hope:
    • “ When do you believe things will get better for you?”
    • The client’s response suggests whether hope for improvement exists.
  • 26. Hopelessness, continued
    • Ask, “What number between 0 and 10 best reflects how you see your current concerns over time?”
    • A response of 0 to 4 indicates a high degree of hopelessness; this client is at greater risk of suicide.
  • 27. DSM Disorders
    • There is a high correlation between completed suicide and co-existing Axis I or Axis II disorders
    • Predominant are affective disorders and substance abuse disorders
    • People with personality disorders with coexisting impulse control disorders are also at high risk.
  • 28. Substance use
    • Clients who abuse substances or binge on substances are at increased risk
    • Note that such clients are not necessarily diagnosable as substance dependent
    • Many clients present as more impulsive, reckless and daring when under the influence
    • Suicide risk should ALWAYS be assessed when you realize a client abuses substances.
  • 29. Recent suicide attempts
    • One of the best predictors for suicide risk, particularly when the attempt was highly lethal.
    • When people attempt suicide and live, they may become less fearful of their own death.
    • They may also learn to be more successful in their attempt (they may learn from their “mistakes”)
  • 30. Suicidal ideation
    • Suicidal thoughts may escalate, and become central to their daily lives
    • Ultimately, everything they do revolves around suicide.
  • 31. Challenges to clear thinking
    • If a client is impeded in adaptive problem solving or clear thinking, they are at increased risk
    • Examples: Experiencing strong emotions such as anger or betrayal; symptoms of a DSM disorder; being out of touch with reality
  • 32. Family dysfunction
    • Physical, emotional or sexual abuse
    • Previous suicidal modeling
    • Poor problem solving
  • 33. Access to lethal means
    • Can the client get access to a potentially lethal method?
    • Examples: firearms, hanging, self-asphyxiation (car exhast), overdose
  • 34. Recent and chronic stressors
    • Poor relational supports
    • Chronic disease
    • Poverty
    • Poor cultural adjustment
    • Marital discord
    • Job loss
    • Life transition
  • 35. Assessing for suicidality
    • Ideation : thoughts of taking one’s own life, or preoccupation with leaving a situation
    • Intent : Making a decision to take one’s life
    • Plan : having a specific idea of method of suicide
    • Means : having the materials and opportunity to carry out the plan
  • 36. Juvenile delinquency
  • 37. Effectiveness Safety and security Love and belonging Self-actualization Basic Needs: Food, clothing, shelter Maslow’s Hierarchy of Needs
  • 38.
    • Low intelligence
    • Poor academic achievement
    • Small vocabulary
    • Poor verbal reasoning
    • Poor executive functioning
    Predictors of chronic delinquency
  • 39.
    • Traditional measurement instruments have a focus on pathology
    • Increasing attention is being paid to evaluating children’s programs from a strengths perspective
    • Newer, strengths-based instruments have been more commonly used
    Evaluation of delinquency
  • 40. Specific areas of evaluation
    • Family
    • Evaluation of the family is important in determining the cause of delinquent behavior.
    • Aggressive children tend to come from families with high levels of hostility and aggression.
    • An assessment needs to address the types of emotional supports available.
  • 41. Families of aggressive children frequently have the following characteristics:
    • High levels of hostility and aggression
    • A history of maltreatment
    • Physical fighting
    • Cycles of coercive behavior
    • High parental rejection
    • Physical punishment
    • Parental ineffectiveness
    • Family disorganization
    • Absence of father
    • Conflict between parents
  • 42.
    • Chronic adult offenders commonly begin their careers as chronic juvenile offenders.
    • This suggests that intervention strategies which are initiated early have the best chance of changing juveniles’ behavior, before the criminal behavior is ingrained into the child’s skill repertoire.
    • Possibilities for intervention include family- and school-based programs
  • 43.
    • In the early part of the 20th century the emphasis of treatment for children was on the individual and focused on assisting the child to successfully adapt to the presenting environment.
    • The climate of treatment for children has since shifted to include the family and community in intervention efforts
  • 44. Family Support Model
    • Families are viewed from a health-promotion framework rather than a pathology-based model
    • Uses collaboration between family and professionals for goal determination and intervention strategy
    • Builds upon inherent strengths
  • 45. Goals of the Family Support Model
    • Strengthening the family unit
    • Enhancing growth of individual family members
    • Empowering the family to gain more adaptive skills
    • Enabling the family to require fewer professional interventions in the long run
  • 46. Use of family support model
    • Involves assessing the child as an integral part of a larger family system
    • Considers it counterproductive to attempt to provide services to the child alone
    • The family’s unique set of resources is utilized
    • Resources may include the strength of the marital relationship; individual coping skills of the parents; extended family and/or community support; and the problem-solving abilities of the family as a whole
  • 47.
    • Personal issues
  • 48. Managing personal issues
    • The bottom line:
    • If you do not have a good understanding of your “personal baggage,” and develop adaptive coping skills for addressing it, you will have a difficult time in clinical practice.
    • It is NOT appropriate to enter this field as a way to understand and/or deal with personal issues. These should be resolved – or healthfully addressed - prior to beginning practice.
  • 49. Resources thought helpful by dr. mallett
  • 50. Talking to Children about Sex
    • Age 6 to 9:
    • Harris, R. (2004). It’s so amazing!. Cambridge, Mass: Candlewick Press
    • Age 10 and up:
    • Harris, R. (2004). It’s perfectly normal. Cambridge, Mass: Candlewick Press.
  • 51. “ Body Safety”
    • Koke, S. (1995). My body is mine, my feelings are mine. Plainview, NY: Childsplay LLC.
    (or, teaching children to be safe from sexual abuse)
  • 52. Sexual Abuse Resources
    • Kahn, Timothy J. (1999). Pathways: a guided workbook for youth beginning treatment. Brandon, VT: The Safer Society Press.
    • Steen, Charlene. (1998). The Conduct Management Workbook. Brandon, VT: The Safer Society Press.
  • 53. Oppositional Child Resources
    • Barkley, R. (1997). Defiant children: A clinician’s manual for assessment and parent training. New York: Guliford Press.
    • Berg, B. (1992). The Conduct Management Workbook. Dayton, OH: Cognitive Therapeutics.
  • 54. Foster/Adoptive Families
    • Delaney, Richard. (1997). The healing power of the family. (1997). Oklahoma City, OK: Wood ‘n Barnes Publishing.
    • An array of materials from Boys Town Press:
    • www.girlsandboystown.org/btpress
  • 55. References
    • Marsh. E.J. & Barkley, R.A. (1998). Treatment of Childhood Disorders. New York: Gulliford Press.
  • 56. Play Therapy

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