Psychiatric assessment for children is quite different from that of adults. This is because it is necessary to include parents or guardians in the decision-making process regarding treatment when dealing with children or adolescents. In adults, however, it is the individuals who make the decisions. It then means that psychiatric assessment of children needs to be integrated and comprehensive. By definition, a comprehensive assessment consists of collecting data, patient history, mental status examination, neurology, and testing of developmental and educational state (Srinath et al., 2019). To successfully achieve all the tests indicated herein, it is essential to have an integrated approach where different individuals, including parents, primary caregivers, and teachers, are involved in understanding the patient’s history. The focus of the psychiatric assessment in children or adolescents is to help diagnose any emotional, developmental, or behavioral disorders then approach the treatment based on an evidence-based approach (Srinath et al., 2019). An example where a PMHNP psychiatrically assesses a child is in YMH Boston Vignette 5 video. A comprehensive psychiatric assessment is achievable through an integrated approach.
YMH Boston Vignette 5 Video Response
Q1. The practitioner did well in various areas of conducting the psychiatric assessment. An example is when the practitioner is cautious of confidentiality. The nurse tells the child that the discussions and assessment will be confidential. Indeed, confidentiality is an essential ethical principle that guides psychiatric and overall healthcare delivery (Srinath et al., 2019). It is imperative that even in an integrated approach, the information shared with one party does not move to other individuals in the assessment. The practitioner also did well by asking open-ended questions during the assessment process. Open-ended interviews or assessment is considered one of the best ways to gather information from the respondents (Furnes et al., 2018). In the case of the young client, this approach helped gather all the possible information that the practitioner might not have thought of when formulating the questions. The practitioner also understood how to gain information where the client has interacted with others. For example, the practitioner asked the school how the client was doing academically. Additionally, the practitioner inquired from the client why the mother sent him for psychiatric evaluation. Thus, this initial stage of the assessment covered the main points where more and essential information could be gathered.
Nonetheless, there are areas the practitioner can improve. The first is that the practitioner would have introduced himself to the client. It is imperative to have an introduction when meeting the client for the first time (Furnes et al., 2018). This helps in building trust between the patient and the practitioner. The practitioner would have also asked questions related to the client’s family to assess if the occurrence witnessed in him is inherited from the family (Furnes et al., 2018). Other questions the practitioner ought to have asked were alcohol use and drug abuse cases and if the client smokes. These would help in singling out a single condition distinct from other conditions.
Q2. The main concern is the readiness of the client to start anger management therapy. The therapy intends to help the client overcome the emotional challenges. Another concern is the patient’s clinical history since it helps in assessing the presenting behavior and emotional challenges the client must have experienced (Srinath et al., 2019). Thus, the practitioner must consider the parents and guardians in the diagnosis to determine the client’s readiness to start the therapy.
Q3. The next question would be, “What is the diagnosis, and how did you consider it over other similar conditions?” After every assessment, the practitioner must clarify the diagnosis based on the evidence-based practice associated with the assessment. This helps in achieving a correct approach to treatment.
Other Questions
Q1. A thorough psychiatric assessment of a child or adolescent is highly important. One importance is that it helps diagnose various emotional, developmental, and behavioral disorders present in a patient (Srinath et al., 2019). In addition, a thorough assessment helps in reviewing the behaviors in association with the genetic, physical, environmental, cognitive, cultural, social, educational, and emotional components that might mutually interact with the behavior.
Q2. The possible two symptom rating scales that can be used during psychiatric assessment of a child or adolescent are the Children’s Depression Rating Scale (CDRS-R) for depression assessment and ADHD Rating Scale-IV (ADHD RS-IV) for Attention-Deficit/Hyperactivity Disorder (ADHD) in children. CDRS-R has 17 items on clinical rating, which is scored on a scale between 17 and 113 (Stallwood et al., 2021). The assessment items are used to characterize various symptoms of depression. The criteria for the ratings are dependent on semi-structured interviews with both the child and an informant adult who understands the child. This rating scale has 14 items for symptoms that include crying, sadness, or sleep and is rated on a 7-point scale and three items of observation such as appearance and rated on a five-point scale. The sum of all these item scores yields a summary score. A moderate depression level severity should have a score of greater than 40, while remission is a summary score of at most 28 (Stallwood et al., 2021). On the other hand, ADHD RS-IV can be used for both parent and teacher reports on the ADHD condition of the patient (Alexandre et al., 2018). A clinician can also completes this scale based on the interview had with the parent or the child. Every version of the scale comprises 18 items rated between 0 and 3, rarely indicating, sometimes, often, and often and correspond with 18 ADHD symptoms in DSM-V. It is based on the results of the scale that treatment gets formulated.
Q3. Two possible treatment options for adolescents or children that may not be used while treating adults is cognitive behavior therapy (CBT) and child behavior therapy. CBT is mainly used when treating mild depression in children. It should mainly be used with other medical interventions (Kreuze et al., 2018). It has been shown that CBT based on anxiety effectively minimizes or controls anxiety in adolescents and children (Kreuze et al., 2018).
Nonetheless, the results from CBT in children might be different from those in adults; hence may not be applied in the case of adults. On its side, child behavior therapy is mainly used to control ADHD in children (Weiss et al., 2018). The importance of child behavior therapy is that it is used to teach a child and the families how to strengthen the child’s position and reduce or eliminate problematic or unwanted behavior. This may not be applied in the case of an adult because it might be challenging for the family members to help contain the behavior of an adult during the therapy process as it would be with a child.
Q4. Parents or guardians play a significant role in the psychiatric assessment of a child or adolescent. Specifically, their role would be to help answer some interview questions by the practitioner (Fortnum et al., 2021). Furthermore, it is the practitioner’s role to actively involve the parent or guardian in the treatment process of the child. Thus, parents and guardians are important in the assessment since they help with both the required information and decide on the most appropriate treatment after the assessment.
Why the Supporting Sources are Considered Scholarly
The supporting sources in this paper are all scholarly. This is based on the journals from where they are extracted and the methods used in collecting and presenting the sources. For example, Srinath et al.’s (2019) citations are from the Indian Journal of Psychiatry – a peer-reviewed medical journal by the Indian Psychiatry society. Another article by Furnes et al. (2018) is published in BMC Nursing, a peer-reviewed nursing journal. Furnes et al. (2018) also use experimental design, an example of a scholarly article. Stallwood et al.’s (2021) resource is derived from the American Academy of Child and Adolescent Psychiatry; a peer-reviewed medical journal focused on pediatric psychiatry. The authors also used various databases to indicate the different properties of a child’s depression rating scales. The article Alexandre et al. (2018) is published in Research in Developmental Disabilities, a bimonthly peer-reviewed medical journal focused on developmental disabilities in children. The sample used in the research was composed of pre-school children, kindergarten teachers, and parents who completed ADHD RS-IV. Other sources also come from peer-reviewed journals, including Kreuze et al. (2018) (from Journal of Anxiety Disorders), Weiss et al. (2018) (from Journal of Child Psychology and Psychiatry), and Fortnum et al. (2021) (from Qualitative Research in Sport, Exercise and Health). The fact that all the sources came from peer-reviewed journals mean that they are scholarly.
Conclusion
It can be concluded that comprehensive psychiatric assessment of children or adolescents is best achieved through an integrated approach. Children are quite different from adults since their parents or guardians have to be included in the assessment process, which brings the element of integration. In the vignette video presented, the nurse was aware of ethical principles by stating that the information from the discussions would be confidential. The possible rating scales for children and adolescents and CDRS-R and ADHD RS-IV, while the treatment approaches that might not be used for adults are CBT and child behavior therapy. It is also discussed that parents and guardians are highly important in the assessment process of the child patient since they help in getting more information and decisions of the treatment method.
References
Alexandre, J. L., Lange, A.-M., Bilenberg, N., Gorrissen, A. M., Søbye, N., & Lambek, R. (2018). The ADHD rating scale-IV preschool version: Factor structure, reliability, validity, and standardisation in a Danish community sample. Research in Developmental Disabilities, 78, 125–135. https://doi.org/10.1016/j.ridd.2018.05.006
Fortnum, K., Reid, S., Elliott, C., Furzer, B., Wong, J., & Jackson, B. (2021). Physical activity participation among children diagnosed with mental health disorders: A qualitative analysis of children’s and their guardian’s perspectives. Qualitative Research in Sport, Exercise, and Health, 1–20. https://doi.org/10.1080/2159676X.2021.1961848
Furnes, M., Kvaal, K. S., & Høye, S. (2018). Communication in mental health nursing – Bachelor Students’ appraisal of a blended learning training program – an exploratory study. BMC Nursing, 17(1), 20. https://doi.org/10.1186/s12912-018-0288-9
Kreuze, L. J., Pijnenborg, G. H. M., de Jonge, Y. B., & Nauta, M. H. (2018). Cognitive-behavior therapy for children and adolescents with anxiety disorders: A meta-analysis of secondary outcomes. Journal of Anxiety Disorders, 60, 43–57. https://doi.org/10.1016/j.janxdis.2018.10.005
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for the assessment of children and adolescents. Indian Journal of Psychiatry, 61(8), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18
Stallwood, E., Monsour, A., Rodrigues, C., Monga, S., Terwee, C., Offringa, M., & Butcher, N. J. (2021). Systematic Review: The Measurement Properties of the Children’s Depression Rating Scale−Revised in Adolescents With Major Depressive Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 60(1), 119–133. https://doi.org/10.1016/j.jaac.2020.10.009
Weiss, J. A., Thomson, K., Burnham Riosa, P., Albaum, C., Chan, V., Maughan, A., Tablon, P., & Black, K. (2018). A randomized waitlist‐controlled trial of cognitive behavior therapy improves emotion regulation in children with autism. Journal of Child Psychology and Psychiatry, 59(11), 1180–1191. https://doi.org/10.1111/jcpp.12915
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