post response Mari:
Assessing children and adolescents is challenging. Generally, the child/adolescent in question would not have initiated the consultation or may not be in agreement with the need for a consultation. The consultation may or may not even be sought for the most impairing problem at hand. While children may be able to report the nature of symptoms, they may not be very good at reporting the timing and duration of their problems. They may not report problems if they are embarrassing or show them in a bad light. Clinical assessments with children and adolescents are, therefore, elaborate and require the clinician to be astute and conscientious in obtaining information from multiple sources and settings, i.e., the child, parents, teachers, and other caregivers. (Srinath S et al., 2019). To adequately comprehend the origins, maintenance, and factors affecting remission from the disorder, it is essential to place the child within a psychosocial background, relate the presentation to his/her unique context, and to gather details about what has happened to the illness so far, including what has been the treatment and response history.
The clinical setting for the assessment of children and adolescents should engage the child for the requisite duration of time. The waiting period and meeting a doctor can intimidate children, making them irritable, and uncooperative during the assessment. Most child clinics pay special attention to the appearance of the place, and the availability of toys, books, and play spaces. Simple things such as walls painted in bright colors, with cartoon characters, and fables keep the children engaged and wanting to come back to the place, should repeat consultations be required.
Child and adolescent mental health shares close links with other medical specialties such as neurology and pediatrics while being rooted in the child’s psychosocial environment and experience. Assessment of children and adolescents must evolve from a biopsychosocial perspective, taking into account these inextricably interlinked aspects. Clinical history taking and interviewing are one of the most powerful tools available to the child and adolescent mental health professional to make a diagnosis and plan management. Other measures such as rating scales, diagnostic interviews, and laboratory investigations must be used in conjunction with the information obtained during history taking and interviewing.
The clinician must be sensitive to the child’s lived experience and culture as well as their developmental and cognitive capabilities. Clinical judgment and expertise is required to assimilate the information obtained from the child and other key informants. In child and adolescent mental health, multidisciplinary inputs are required for almost every child and family and efforts must be made to link the different arms of evaluation and treatment such that there is convergence. Confidentiality and the limits thereof must be discussed with the child and family. Documentation is a very important aspect of assessment and must be strictly maintained. A comprehensive clinical assessment goes a long way in ensuring interventions in the best interest of the child and family. (Srinath S et al., 2019)
Given that children must be evaluated and managed in the context of their caregiving environment, parents and the extended family are important informants and an integral part of the treatment plan. (Srinath S et al., 2019).
Providing information: parents have valuable knowledge about their child’s developmental history, including early milestones, behavioral patterns, and any significant life events or trauma. This information helps psychiatrists understand the child’s background and potential factors contributing to their current mental health concerns.
Sharing observations: parents spend a significant amount of time with their child and can provide valuable observations about their behavior, emotions, and any changes they have noticed. These firsthand accounts help in assessing the child’s symptoms, identifying patterns, and gaining a deeper understanding of their mental health needs.
Collaborating in assessments: parents are often involved in the assessment process, participating in interviews, questionnaires, and discussions with healthcare professionals.
Communicating family context: parents provide insights into the child’s family dynamics, relationships, and the overall environment in which they live. This includes information about family history, relationships with family members, as well as any stressors or challenges within the family. Understanding these factors is crucial for assessing how the family context may influence the child’s mental health.
Supporting the assessment process: parents provide support to their child throughout the assessment process. This includes providing emotional support, reassurance, and helping the child feel comfortable and secure during appointments.
Herode is one of the children in the documentary Children of Shadows, he shows symptoms of Post-traumatic stress disorder (PTSD). He has the obligation to take care of all the housework, in which his “aunt” takes care of him, but forces him to fetch water, wash the dishes, cook, go to the market and bathe the child at home. At first, he values the possibility of escaping from there because he feels exploited and with a lack of affection because he is not really a true relative. He puts it off because he feels that he has no other alternative, he has no way to return or to be in a place where he is valued, or where it might even be even worse for him. When the documentary begins, he dreams of being a mechanic and after two years we see a teenager in a state of resignation who finds himself in the same situation, with even more responsibility, because his “aunt’s” husband died and he has to continue taking care of all the hard work at home, and even gives up the idea of escaping from the place due to the lack of alternatives in such a harsh reality at his fragile age. PTSD is defined by four symptom clusters: avoidance, negative alterations in cognition and mood, intrusion, and hyperarousal per DSM-5. The consequences of PTSD are often deleterious, with adverse outcomes in physical and mental health besides impaired social and occupational functioning. (Malejko K et al., 2020). Post-traumatic stress disorder is a debilitating disorder. It can cause life-long impairment and dysfunction. In the pediatric setting, it can be even more deleterious, as it can go undiagnosed and thus untreated for an extended period of time. (Fariba et al., 2020).
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