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Discuss the Key elements of Psychiatric assessment and Interviewing of children.
Assessing children and adolescents is challenging. A psychiatric assessment can determine if a child is experiencing a disorder or if there are other factors that may be causing their difficulties.Establishing rapportis the first and most crucial step in any child psychiatric assessment. Children might be anxious, scared, or mistrusting, so creating a safe and welcoming environment is essential. Good rapport has a long-term agenda of providing the child with a safe, confidential, nonjudgmental place to “unburden” and discuss possible solutions to their difficulties (Sharma et al., 2019). Other techniques include using age-appropriate language, demonstrating genuine interest, and using toys or drawings to engage younger children. Play and drawing activities can help break the ice with children and can be used as standalone assessment tools, especially with preschool children who may not have the verbal repertoire to narrate distressing experiences (Sharma et al., 2019). Identify the child’s symptoms and reasons for the visit by examining the chief complaint and illness history. Understanding a child’s developmental historycan reveal important information about their behavior, including early milestones and school performance. Delays or deviations may offer clues to current issues. Family psychiatric history is critical due to the role genetics plays in mental illness. Having a medical history can aid in eliminating any medical reasons for psychiatric symptoms. A Mental Status Examination (MSE)will assess the child’s current state of mind, while a Functional Assessment evaluates the child’s abilities in areas like self-care, academic performance, and social interactions with peers and family members. A psychosocial historycovers aspects like the child’s relationships, school experiences, traumatic events, living situations, and any experiences of abuse or neglect. Information from teachers, counselors, and other adults in the child’s life can offer a more rounded perspective of the child’s behaviors and symptoms in different settings, this is considered to be collateral information.Tools like the Child Behavior Checklist (CBCL) or Conners’ Parent and Teacher Rating Scales can provide structured, quantifiable data about a child’s symptoms, and demonstrate a good approach to using standardized tools (Sharma et al., 2019). A safety assessment is essential, especially if there’s any indication of self-harm, suicidal ideation, or potential harm to others. Lastly, an understanding of the child’s cultural, religious, and socioeconomic background can influence symptom presentation and interpretation.
Discuss the role parents play in the assessment of the child.
Parents are vital in assessing a child’s mental health. Their feedback complements the child’s self-report and clinician’s observations. Parents know important details about their child’s early life, like milestones, behavior, and interventions. Parents can offer a detailed account of the primary concerns that led to seeking assessment. Parents can report on their child’s behavior in different environments. They can offer valuable information about the family’s psychiatric history and other mental health concerns. While the child might provide information from their perspective, parents can provide additional context, especially regarding school performance, relationships with peers, and other extracurricular activities. Parental involvement can be pivotal in treatment planning and intervention(Mackova et al., 2022). As primary caregivers, parents are typically the first to observe changes in the child’s behavior or mood in response to interventions, and their feedback can guide adjustments in treatment plans.
Explain the steps needed if the child discloses information about the parent(s) engaging in illicit behavior.
If a child discloses information about a parent or parents engaging in illicit behavior, it is crucial to take specific steps to ensure the child’s safety and well-being, while also adhering to professional and legal obligations. While the priority is to establish safety and report immediately ( as healthcare professionals and mandated reporters); providing emotional support, making the appropriate referrals, and providing resources are just as important (NCBI,2023). Additional general steps include documenting the disclosure, clearly and objectively (verbatim if possible), Do not lead or pressure the child. Instead allow them to share at their own pace, using open-ended questions. If you’re working within a larger organization or institution, discuss the situation with your supervisor or colleagues to gather insights and determine the next steps (NCBI,2023).
Discuss a potential DSM 5 diagnosis and treatment plan for Herode, Vanya, Telya, or Darlene.
Child neglect is one of the primary forms of child maltreatment, alongside physical abuse, sexual abuse, and emotional abuse. It refers to the failure of a caregiver to provide for a child’s basic needs, whether it be physical, emotional, medical, educational, or security needs. However, the DSM-5 does not provide specific diagnostic criteria for child neglect, as child neglect is considered to be a legal and social designation rather than a psychiatric diagnosis. The DSM-5 recognizes child neglect (and other forms of maltreatment) under the category of “Conditions for Further Study” as well as in relation to other diagnoses where maltreatment may play a role in etiology or symptom presentation (APA, 2013). Adjustment Disorder (AD) is a stress-related condition that can occur following the experience of a significant life change or stressor. According to the DSM-5 (2013), the criteria for Adjustment Disorder can include emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). There are specific subtypes of Adjustment Disorder based on the predominant symptoms. For example, with a depressed mood, and there is sadness, tearfulness, and feelings of hopelessness are predominant. Or, with disturbance of conduct. Disturbances of conduct predominate, such as truancy in children or adolescents, fighting, or defaulting on legal responsibilities ( APA, 2013). In children, AD can result from various stressors, including (but not limited to) school transitions, parental divorce or separation, the birth of a sibling, or significant losses or changes in their life. The presentation in children may include not only emotional distress but also behavioral changes such as fighting in school, withdrawing from friends or family, declining academic performance, or regressive behaviors (i.e., bedwetting after being potty trained) (APA,2013).
The treatment plan for a child diagnosed with Adjustment Disorder (AD) is individualized based on the specific symptoms, and the identified stressor(s). However, some general elements are commonly included in treatment plans for children with AD. This might include psychotherapy/counseling, CBT, play therapy, and using play to express feelings and process the stressor can be beneficial. While psychotherapy is the mainstay of treatment for AD, in some cases where symptoms are severe (e.g., significant insomnia or severe depressive symptoms), medication might be considered. Encourage expressive activities such as art, music, journaling, or other hobbies that allow the child to express feelings. A multidisciplinary approach involving therapists, pediatricians, teachers, and other professionals can be beneficial. Most importantly, early intervention can help prevent the escalation of symptoms and support the child’s return to a typical developmental trajectory.
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