Paediatrics: Assessment

Assessment

A thorough assessment and understanding of the presenting difficulties forms the basis for any treatment interventions offered for children, young people, and their families or carers. As mental health problems rarely occur in isolation, with comorbidity the norm, it is essential that any assessment is sufficiently comprehensive to ensure that a clear and com-plete formulation of the presenting problems has been made.

An assessment will usually have 4 major components:

·Identification of problems, history, signs and symptoms.

·The information gathering stages.

·Evaluation/synthesis.

·Care/treatment planning.

The psychiatric history and examination of child and adolescent mental health problems bears many similarities to that of adults. However, there are several differences in detail and emphasis. The assessment will usually be conducted as part of a joint interview with parents and the child/young person and will often require more than one visit. The general processes include;

·Clinical interview with the parent(s)/carers.

·Clarify presenting complaints with systematic evaluation of psychopathological symptoms and description of how problems developed over time.

·Developmental history.

·Pre and post-natal factors.

·Early developmental history (e.g. milestones, language, attachment, sleep, feeding problems, early temperament).

·Medical history (esp. tics and epilepsy, and psychosis for adolescents).

·Medication (esp. anticonvulsants, antihistamines, sympathomimetics, steroids).

·Family history, functioning, problems coping styles, warmth and hostility, social networks and other resources.

·Interview with the child/young person.

·Functioning in the family, the school and the peer group.

·Emotional problems and self-esteem.

·Self report rating scales may be useful as supplement especially for emotional symptoms in those 9yrs and older.

·Behavioural observation during clinical examination can be very useful when problems are seen, but an absence of observed problems during assessment does not mean they are not there. Also look for social disinhibition and evidence of language disorder during observation.

·Systematic screening for psychiatric symptoms/disorders.

Physical examination.

Preschool or school information is invaluable–if parents’ consent. Whilst classroom observation may be helpful a narrative report of behaviour and behaviour problems seen within school setting is often adequate