PSYCHIATRY FROM MALAYSIA

1. CHILD PSYCHIATRY ASSESSMENT
Presentor: DR SITI NADIAH BT JAMALUDIN
Supervisor : DR NOORFAIZAH BT IBRAHIM
3 MARCH 2022

2. CONTENTS
• Introduction
• Clinical interview process
• Special issues in the assessment of children
• Techniques of assessment
• Tool used in assessment
• Laboratory measure
• Recommendation of treatment

3. INTRODUCTION
• Most common psychiatric disturbances in
children are related to developmental delay in
one or more domains.
• Developmental status influence the clinical
presentation of various syndromes
• Distressing emotions/impairing behaviors may
occur as a part of normal transition

5. CLINICAL ASSESSMENT OF CHILD
• Possible referral sources include:
– Parent
– Legal guardians
– Schools
– Court
• Evaluation /assessment settings:
– Clinicical visits
– Schools
– Pediatric wards
– Resident treatment centers
– Detention centers
– Emergency Department

6. SPECIAL CONSIDERATION
• The referral is typically
requested by someone
other than the patient
• Assessment may
misinterpret as a kind of
punishment for being bad
• Assessment need to be non-
judgemental and
collaborative
• Given children as much as
control as is appropriate
and safe.
• Methods/tools of
assessment are specific to
the age of the children
• Primary goal is to
understand child’s inner
world and perspective
• Techniques range from
observing an infant, parents
or using play.
• to understand the preschool
and young elementary
school child to talking
directly about symptoms to
an adolescent
• Alter approaches according
to the child developmental
needs.
• Children are not be
considered as little adults

7. SPECIAL CONSIDERATION
• Specific diagnosis is more difficult in children
– Varying presentation of symptoms at different
ages
– The evolution of disorders
– The lack of diagnostic and etiological specificity of
many symptoms.
• Diagnosis vary with time

9. SPECIFIC METHODS
• PLAY TECHNIQUES
• PROJECTILE TECHNIQUES
• DIRECT QUESTIONING

10. SPECIFIC METHODS
• Imaginative play with puppets/small figures
• Play materials are given based on the child’s concern,
perceptions and characteristic modes of regulating
affects and impulses
USES
- For diagnostic/Trust building
- Form of play as an important information to MSE
PLAY TECHNIQUE

11. SPECIFIC METHODS
PROJECTIVE TECHNIQUE (DAP)
• Invite the child to draw a picture
• As the child what animal he/she would most or least like?
• Whom he/she would take along to a desert island/holiday?
• What he/she would wish for if given 3 magic wishes?
• (Winkey, 1982)
• Describe a dream, book, movie, TV show which she recalls?
• Future ambitions?

12. SPECIFIC METHODS
DIRECT QUESTIONING
• Inquire about the presenting
problems or other aspects of the
child’s life timing.
• Attention to the child’s cognitive and
linguistic level of development
• Respect for the child’s self-esteem.

13. DOMAINS OF EVALUATION
• Developmental process
• Cognitive and academic
development
• Family relationships
• Peer relationships
• Development conscious
and values
• Interest, Hobbies and
Talents
• Unusual Circumstances
• Prior psychiatric treatment
• Family history of medical or
psychiatry illness

14. DOMAINS OF EVALUATION
• Developmental process
• Cognitive and academic
development
• Family relationships
• Peer relationships
• Development conscious
and values
• Interest, Hobbies and
Talents
• Unusual Circumstances
• Prior psychiatric treatment
• Family history of medical or
psychiatry illness

15. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence

16. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
The motor component present in a given child’s functioning and the
diurnal proportion of active and inactive periods
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence

17. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
The predictability or unpredictability in time of any function, it can
be analyzed in relation to the sleep-wake cycle, hunger, feeding
pattern or elimination schedule
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence

18. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
The nature of the initial response to a new stimulus, be it a new
food, a new toys, or a new person
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence

19. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
Response to a new or altered situations.
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence

20. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
The intensity level of stimulation needed to evoke a noticeable
response, irrespective of the specific form of the response or the
sensory modality affected.
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence

21. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
The energy level of response, irrespective of its quality or direction
• Quality of mood
• Distractibility
• Attention span and persistence

22. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
The amount of pleasant, joyful, and friendly behavior or the other
ways.
• Distractibility
• Attention span and persistence

23. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
The effectiveness of extraneous environmental stimuli in interfering
with or altering the direction of the ongoing behavior
• Attention span and persistence

24. TEMPERAMENT CATEGORIES
Need to observe and assess in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence
Concerns the length of time a particular activity is pursued by child.
Persistence refers to the continuation of activity in the face of
obstacles to the maintenance of activity direction.

25. TEMPERAMENT CATEGORIES
Need to observe and assess
in term of:
• Activity level
• Rhythmicity (regularity)
• Approachable/withdrawal
• Adaptability
• Threshold of responsiveness
• Intensity of reaction
• Quality of mood
• Distractibility
• Attention span and persistence
OUTCOME
EASY
 biological regularity
 approach tendencies to the new
 Quick adaptability to change
 Predominantly positive mood of mild or moderate
intensity
DIFFICULT (opposite of EASY)
 Biological irregularity
 Withdrawal tendencies to the new
 Slow adaptability to change
 Frequent negative emotional expressions of high
intensity
SLOW-TO-WARM UP
 Withdrawal tendencies to the new
 Slow adaptability to change
 Frequent negative emotional reactions of low intensity
 Such individuals are often labeled SHY

26. MENTAL STATE
EXAMINATION IN
CHILD PSYCHIATRY
MSE components may be
gather through direct
questioning, play activities
or observations during the
session.
 Appearance and
behaviour
 Ability to cooperate and
engage
 Speech and language
 Motor function
 Mood and affect
 Thought process and
content
 Insight
 Perception
 Anxiety feature
 Conduct symptoms
 Cognitive function
 Risk assessment

27. BIOPSYCHOSOCIAL FORMULATION
• BIOLOGICAL VULNERABILITIES
- Prenatal, birth history
- Early temperament
- Child development
- Genetic predisposition/family history,
medical and neurological disorders
• PSYCHOLOGICAL FACTORS
- Personality
- Psychological issues and attribution
- Defense mechanism
- Developmental stage tasks
• SOCIAL / ENVIRONMENTAL
CONTRIBUTORS
- Family/interpersonal
- Socio-environmental
- Trauma
- Cultural factors
KEY POINTS
1) An understanding of what brings
the child or adolescent to this point
of life.
2) With this understanding, the most
focused and affective treatment
recommendations can be
formulated

28. METHOD OF FORMULATION

29. TOOLS IN ASSESSMENT
• Ranging from systematized
questionnaires to specific areas
difficulty
• Rating scales are adjunctive to
clinical diagnosis
• Rating scales are completed along
with parents/guardians or
teachers
• RATING SCALES
1) Achenbach Child Behaviour
Checklist
2) Conner’s Questionnaires
(ADHD)
3) SADS-C = Schizophrenia and
affective discorder scale
children V)
4) K-SADS = Kiddie Schedule for
affectove disroder and
Schizophrenia
5) Pictorial DOMINIC-R =For
anxiety symptoms in young
children
6) ChiPS =the Children’s Interview
for psychiatry Syndromes
7) DISC = Diagnositc Interview for
Children

30. LABORATORY INVESTIGATION
• MENTAL RETARDATION AND PERVASIVE DEVELOPMENTAL
DISORDERS
- Wood Lamp examination (Tuberous sclerosis)
- EEG
- Chromosome analysis
- Serum iron (Pica)
• MOOD DISORDER
- Routine thyroid function
- Infectious disease
- Toxicology testing
• PSYCHOTIC DISORDER
- CSF Analysis: Cognitive decline, Altered level of consciousness,
headache, abnormal neuro examination, alter vital signs,
leukocytosis or new - onset of seizure

31. LABORATORY INVESTIGATION
• ADHD
- Thyroid profile if indicated
• TIC, OCD
- Throat culture and serological studies for Group A Beta
hemolytic strep infection (GABHS)
- ASOT
• SUBSTANCE USE DISORDER
- Toxicology screening for ALL adolescents who are:
 Psychiatric symptoms or who have exhibited acute
behavioural changes.
 High risk (delinquents and runaways)
 Recurrent accidents or unexplained somatic symptoms.
• SEXUALLY TRANSMITTED DISEASE
- History of sexual activity or sexual abuse who are being
evaluated for depression / change in cognitive function.
- HIV, Syphilis, VDRL

32. RECOMMENDATION FOR TREATMENT
• Child is at imminent risk and
required acute hospitalization
• Care is provided in a safe, non
threatening, home-like
environment
• Child requires treatment services
like,
- Invidual therapy: CBT, IPT, DBT,
etc
- Psychotropic medication
- Group therapy
- Family therapy
(Counselling and Clinical
Psychologist)
• Adjunctive childcare services
includes:
- School services for emotional,
attention, learning related
problems
- School-based counseling
- Remedial education services
- Speech therapy
- State protective services
- Mentoring programs for the
siblings as well as the parents
- Legal guardian