The assessment of neuropsychiatric disorders during adolescence – the role of school psychologist Maria Taanila School Psy...
The content of the presentation <ul><li>What are the  neuropsychiatric disorders? </li></ul><ul><li>University Hospital of...
Neuropsychiatric disorders <ul><li>Medical disorders with internationally accepted diagnostic criteria (DSM-IV, ICD-10) </...
Neuropsychiatry and adolescents <ul><li>Neuropsychiatric disorders are developmental: problems begin in childhood </li></u...
Neuropsychiatry in Finland <ul><li>Neuropsychiatric disorders have received a lot of attention in Finland during the last ...
Referrals to the neuropsychiatric examination <ul><li>Age range 13-19 years, mean 15 years </li></ul><ul><li>60 % males, 4...
Problems and symptoms in referred adolescents <ul><li>School problems: poor performance, conduct problems </li></ul><ul><l...
Examination protocol <ul><li>Structured interviews of parents (3Di for autism spectrum disorders, ICD-10 diagnostic criter...
Psychological assessment <ul><li>Was made when necessary in a needed extent </li></ul><ul><ul><li>Cognitive level (WISC II...
<ul><li>WISC-III = Wechsler’s Intelligence Scale for Children –Third Edition </li></ul><ul><li>WAIS-R = Wechsler Adult Int...
When ADHD/ADD was suspected <ul><li>Attention deficit disorder was found only in about 20% of cases </li></ul><ul><li>Othe...
When autism/Asperger’s syndrome was suspected <ul><li>An autism spectrum disorder was found in about 60% of cases  </li></...
Extreme examples <ul><li>Bizarre behaviour and withdrawal from peers: Autism spectrum disorder?  </li></ul><ul><ul><li>Can...
Some explanations for declining school performance and conduct problems <ul><ul><li>Learning can just become too demanding...
Some explanations for withdrawal from peers <ul><ul><li>Bullying is common, can be chronic, invisible and only seemingly h...
Difficulties from school psychologist’s perspective <ul><li>It isn’t always easy to differentiate harmless  and temporary ...
School psychologist’s unique perspective: seeing different sides <ul><li>What parents seem to think? </li></ul><ul><ul><li...
Finally <ul><li>Differential diagnostics of neuropsychiatric disorders during adolescence is complicated and difficult </l...
<ul><li>THANK YOU! </li></ul>© Maria Taanila
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© Maria Taanila The assessment of neuropsychiatric disorders ...

  1. 1. The assessment of neuropsychiatric disorders during adolescence – the role of school psychologist Maria Taanila School Psychologist The Municipality of Kangasala, Finland 27th July 2007, ISPA Congress © Maria Taanila
  2. 2. The content of the presentation <ul><li>What are the neuropsychiatric disorders? </li></ul><ul><li>University Hospital of Tampere, Department of Adolescent Psychiatry – neuropsychiatric team for adolescents </li></ul><ul><ul><li>What kind of issues did we work with </li></ul></ul><ul><ul><li>What we learned </li></ul></ul><ul><li>Neuropsychiatric disorder or not? </li></ul><ul><ul><li>School psychologist’s view </li></ul></ul><ul><li>Discussion, questions </li></ul>© Maria Taanila
  3. 3. Neuropsychiatric disorders <ul><li>Medical disorders with internationally accepted diagnostic criteria (DSM-IV, ICD-10) </li></ul><ul><li>Broadest definition: disorders that include both neurological deficits and psychiatric symptoms (eg TBI, Parkinson, depression, schizophrenia) </li></ul><ul><li>Narrower definition: developmental language, learning and motoric disorders, attention deficit disorders (ADHD, ADD), autism spectrum disorders (eg Asperger’s syndrome), Tourette’s syndrome </li></ul>© Maria Taanila
  4. 4. Neuropsychiatry and adolescents <ul><li>Neuropsychiatric disorders are developmental: problems begin in childhood </li></ul><ul><li>Sometimes certain problems may become more obvious during adolescence when academic and social challenges increase </li></ul><ul><li>Growing publicity and awareness: nowadays problems tend to be more easily explained by a neuropsychiatric disorder </li></ul><ul><li>Prevalence of neuropsychiatric disorders is under debate…common or rare? </li></ul>© Maria Taanila
  5. 5. Neuropsychiatry in Finland <ul><li>Neuropsychiatric disorders have received a lot of attention in Finland during the last ten years </li></ul><ul><li>In the biggest hospitals there are teams specialized in neuropsychiatric disorders in children, some units can diagnose adults </li></ul><ul><li>First neuropsychiatric team specialized in adolescents began its work in University Hospital of Tampere in the Department of Adolescent Psychiatry in the autumn 2005 </li></ul>© Maria Taanila
  6. 6. Referrals to the neuropsychiatric examination <ul><li>Age range 13-19 years, mean 15 years </li></ul><ul><li>60 % males, 40 % females </li></ul><ul><li>Most often the suspected disorder was either ADHD or Asperger’s syndrome </li></ul><ul><li>The initiative to the referral was usually taken by parents or teachers </li></ul>© Maria Taanila
  7. 7. Problems and symptoms in referred adolescents <ul><li>School problems: poor performance, conduct problems </li></ul><ul><li>Emotional problems: depression, sudden changes of mood, irritability, anxiety </li></ul><ul><li>Affect control problems: aggression, violence, tantrums </li></ul><ul><li>Self-injurious behaviour, suicidal thoughts </li></ul><ul><li>Substance abuse </li></ul><ul><li>Lack of contemporary friends, loneliness </li></ul><ul><li>Bizarre behavior </li></ul>© Maria Taanila
  8. 8. Examination protocol <ul><li>Structured interviews of parents (3Di for autism spectrum disorders, ICD-10 diagnostic criteria for attention deficit disorders) </li></ul><ul><li>Structured observation (ADOS* for autism spectrum disorders) </li></ul><ul><li>Psychological assessment </li></ul><ul><li>Psychiatric assessment </li></ul><ul><li>Collection of case history from earlier assessments and interventions </li></ul><ul><li>*Autism Diagnostic Observation Schedule </li></ul>© Maria Taanila
  9. 9. Psychological assessment <ul><li>Was made when necessary in a needed extent </li></ul><ul><ul><li>Cognitive level (WISC III, WAIS-R or WAIS-III) </li></ul></ul><ul><ul><li>Assessment of neuropsychological deficits (eg NEPSY, WMS-R, CPT-II, WCST, TMT) </li></ul></ul><ul><ul><li>Academic skills (Finnish reading, writing and calculation tests) </li></ul></ul><ul><ul><li>Personality assessment (usually interview, Ro-CS, MMPI, sometimes also questionnaires and projective tests) </li></ul></ul>© Maria Taanila
  10. 10. <ul><li>WISC-III = Wechsler’s Intelligence Scale for Children –Third Edition </li></ul><ul><li>WAIS-R = Wechsler Adult Intelligence Scale – revised </li></ul><ul><li>WAIS-III = Wechsler Adult Intelligence Scale –Third Edition </li></ul><ul><li>NEPSY = An abbreviation of a neuropsychological instrument for children (made in Finland, also available in English) </li></ul><ul><li>WMS-R = Wechsler’s Memory Scale – revised </li></ul><ul><li>CPT-II = Conner’s Continuous Performance Test </li></ul><ul><li>WCST = Wisconsin Card Sorting Test </li></ul><ul><li>TMT = Trail Making Test (A and B) </li></ul><ul><li>Ro-CS = The Rorschach Comprehensive System (J. Exner) </li></ul><ul><li>MMPI = Minnesota Multiphasic Personality Inventory </li></ul>© Maria Taanila
  11. 11. When ADHD/ADD was suspected <ul><li>Attention deficit disorder was found only in about 20% of cases </li></ul><ul><li>Other explanations for difficulties: </li></ul><ul><ul><li>Moderate/Severe developmental difficulties: maturation delay, distortions in identity development (eg psychopathic traits, narcissistic features) (about 50%) </li></ul></ul><ul><ul><li>Cognitive deficits such as learning disabilities, even mental retardation (about 15%) </li></ul></ul><ul><ul><li>Behavioral problems without significant attention deficits, such as conduct disorder, impulse control disorder (about 10%) </li></ul></ul>© Maria Taanila
  12. 12. When autism/Asperger’s syndrome was suspected <ul><li>An autism spectrum disorder was found in about 60% of cases </li></ul><ul><li>Other explanations: </li></ul><ul><ul><li>Moderate/Severe developmental difficulties: maturation delay, distortions in identity development (eg narcissistic features), high psychosis risk/psychosis in adolescence </li></ul></ul><ul><ul><li>Long-term bullying with its consequences </li></ul></ul><ul><ul><li>Dysphasia affecting on social relations </li></ul></ul>© Maria Taanila
  13. 13. Extreme examples <ul><li>Bizarre behaviour and withdrawal from peers: Autism spectrum disorder? </li></ul><ul><ul><li>Can result from poor social skills and lack of insight into social codes and rules: future professor? </li></ul></ul><ul><ul><li>Can be a serious sign of mental illness: future psychiatric patient? </li></ul></ul><ul><li>Poor performance at school and conduct problems: ADHD? </li></ul><ul><ul><li>Can result from excessive need for stimulation and difficulty to tolerate monotonous situations: future risk-taking executive manager? </li></ul></ul><ul><ul><li>Can be a serious sign of broader asocial development: future criminal? </li></ul></ul>© Maria Taanila
  14. 14. Some explanations for declining school performance and conduct problems <ul><ul><li>Learning can just become too demanding, resistance and lack of motivation can be adjustment to fear of failure </li></ul></ul><ul><ul><li>Depression is a common psychiatric condition and may among adolescents manifestate as conduct problems and affect control problems </li></ul></ul><ul><ul><li>Parental and other family related problems affect children and can be more serious than anyone might expect from school’s point of view </li></ul></ul>© Maria Taanila
  15. 15. Some explanations for withdrawal from peers <ul><ul><li>Bullying is common, can be chronic, invisible and only seemingly harmless, even serious bullying can be denied by the victim </li></ul></ul><ul><ul><li>Depression and anxiety are common during adolescence and affect both capability and willingness to social interaction </li></ul></ul><ul><ul><li>Social interaction becomes more complicated and challenging during adolescence, shyness and low self-esteem can lead to being left outside </li></ul></ul>© Maria Taanila
  16. 16. Difficulties from school psychologist’s perspective <ul><li>It isn’t always easy to differentiate harmless and temporary adolescent behavior from serious developmental problems </li></ul><ul><li>One hasn’t got resources and expertise to evaluate every deviantly behaving adolescent thoroughly </li></ul><ul><li>One can’t refer all the problematic cases into psychiatric evaluation </li></ul><ul><li>Even getting a diagnosis does not solve all the problems at school </li></ul>© Maria Taanila
  17. 17. School psychologist’s unique perspective: seeing different sides <ul><li>What parents seem to think? </li></ul><ul><ul><li>There’s nothing wrong with him, just like me in her age, somebody please do something, couldn’t care less? </li></ul></ul><ul><li>What peers seem to think? </li></ul><ul><ul><li>One of us, one of them or an outcast? </li></ul></ul><ul><ul><li>Admired, frightening, ridiculed, despised, bullied, disturbed? </li></ul></ul><ul><li>What teachers seem to think? </li></ul><ul><ul><li>The misunderstood, just one of many, the usual suspect, just like his brother, the root of all evil? </li></ul></ul>© Maria Taanila
  18. 18. Finally <ul><li>Differential diagnostics of neuropsychiatric disorders during adolescence is complicated and difficult </li></ul><ul><li>Luckily, at least in Finland, diagnosis is made by a physician! </li></ul>© Maria Taanila
  19. 19. <ul><li>THANK YOU! </li></ul>© Maria Taanila

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