Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Chapter 4
Assessment, Diagnosis, and Treatment
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
The Decision Making Process
 Typically begins with a clinical assessment, which is
directed at differentiating, defining, and measuring
the child’s behaviors, cognitions, and emotions of
concern, as well as contributing environmental
circumstances
 Assessments are meaningful to the extent that they
result in practical and effective interventions
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
The Decision Making Process (cont.)
 Idiographic vs. Nomothetic Case Formulation
 idiographic case formulation involves a detailed
understanding of the child and family as a unique
entity
 nomothetic case formulation emphasizes more
general inferences that apply to broad groups
individuals
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Developmental Considerations
 Age, gender, and culture must be considered when
making judgments about abnormality and when
selecting assessment and treatment methods
 Normative information must be considered
 knowledge about normal development needed to
make decisions about abnormality
 isolated symptoms not typically related to
children’s overall adjustment
 age inappropriateness and patterns of symptoms
typically define childhood disorders
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Purposes of Assessment
 Description and Diagnosis
 clinical description summarizes the child’s unique
behaviors, thoughts, and feelings that together
make up the features of a given psychological
disorder
 diagnosis involves analyzing information and
drawing conclusions about the nature or cause of
the problem, and in some cases, assigning a
formal diagnosis
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Purposes of Assessment (cont.)
 Prognosis and Treatment Planning
 prognosis involves generating predictions
regarding future behavior under specified
conditions
 treatment planning involves making use of
assessment information to generate a treatment
plan and evaluating its effectiveness
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Clinical Interviews




The most universally used assessment procedure
Often includes a developmental and family history
May incorporate a mental status exam
Differ in degree of structure (e.g., unstructured, semistructured)
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Behavioral Assessment
 Emphasis on observing child’s behavior directly
 “ABCs of assessment” - involves observing the
antecedents, the behaviors, and the consequences of
the behaviors
 Functional analysis of behavior - a more general
approach, the goal of which is to identify as many
potentially contributing factors as possible, and to
develop hypotheses about which are most important
and/or most easily changed
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Behavioral Assessment (cont.)
Figure 4.1 Functional analysis: antecedents, behaviors, consequences.
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Behavioral Assessment (cont.)
 Checklists and Rating Scales
 often allow for a child’s behavior to be compared
to a normative sample
 usually economical to administer and score
 lack of agreement between informants is relatively
common, which in itself is often informative
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Behavioral Assessment (cont.)
 Behavioral Observations and Recording
 provide ongoing information about behaviors of
interest in real-life settings
 recordings may be done by parents or others,
although it may be difficult to ensure accuracy
 children often know they are being watched and
may react differently as a result
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Psychological Testing
 Tests are tasks given under standard conditions with
the purpose of assessing some aspect of the child’s
knowledge, skill, or personality
 Test scores should always be interpreted in the
context of other assessment information
 Developmental tests are used for the purpose of
screening, diagnosis, and evaluation of early
development
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Psychological Testing (cont.)
 Intelligence and Educational Testing
 is a central component in clinical assessments for
a wide range of childhood disorders
 most popular intelligence scale is the Wechsler
Intelligence Scale for Children (WISC-IV), which is
well-standardized, reliable, valid, and provides
measures of verbal comprehension, perceptual
reasoning, working memory, and processing
speed
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Psychological Testing (cont.)
 Projective Testing
 involves presenting the child with ambiguous
stimuli and asking the child what he or she sees
 it is believed that the child projects his or her own
personality, including unconscious fears, needs,
and inner conflicts, on the ambiguous stimuli
 projective techniques, including figure drawings
and play, may be used to help children relax and
to make it easier for them to talk about difficult
events
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Psychological Testing (cont.)
 Personality Testing
 may assess a child in terms of the “Big 5” Factors:
 timid-bold
 agreeable-disagreeable
 dependable-undependable
 tense-relaxed
 reflective-unreflective
 may use interviews, projective techniques,
behavioral measures, or objective inventories
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Psychological Testing (cont.)
 Neuropsychological Testing
 attempts to link brain functioning with objective
measures of behavior that are known to depend
on an intact central nervous system
 often involves using a comprehensive battery that
assesses a full range of psychological functions,
including verbal and nonverbal cognitive functions,
perceptual functions, motor functions, and
emotional/executive control functions
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Classification and Diagnosis
 Categorical vs. Dimensional Classification
 “classical/pure” categorical approach assumes
that every diagnosis has a clear underlying cause
and that each disorder is fundamentally different
 dimensional classification systems assume that a
number of independent dimensions or traits of
behavior exist and that all children possess these
to varying degrees
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Classification and Diagnosis (cont.)
 The Diagnostic and Statistical Manual (DSM)
 a multiaxial system consisting of five axes:
 clinical disorders
 personality disorders and mental retardation
 general medical conditions
 psychosocial and environmental problems
 global assessment of functioning
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Classification and Diagnosis (cont.)
 DSM (cont.)
 criticisms of the DSM-IV:
 fails to capture the complex adaptations, transactions,
and setting influences crucial to understanding and
treating child psychopathology
 gives less attention to disorders of infancy/childhood
 fails to emphasize situational and contextual factors
 fails to capture the comorbidity known to exist among
many childhood disorders
 sometimes improperly used, such as when a specific
diagnosis is needed in order for a child to qualify for
special services
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Classification and Diagnosis (cont.)
 Pros and Cons of Diagnostic Labels
 pros:
 help clinicians summarize and order
observations
 facilitate communication among professionals
 aid parents by providing recognition and
understanding of their child’s problem
 facilitate research on causes, epidemiology,
and treatments of specific disorders
 cons:
 may lead to negative perceptions and reactions
by child and others
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment of Childhood Disorders
 Interventions are problem-solving strategies that
involve treatment of current problems, maintenance
of treatment effects, and prevention of future
problems
 Must take into account the cultural context of the
child and family
 Treatment goals include outcomes related to the child
and family, as well as those of societal importance
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment of Childhood Disorders (cont.)
 Models of Delivery
 conventional care model: the child is seen
individually by a therapist for a limited number of
treatment sessions
 continuing care model: an alternative to the
conventional care model; two examples are the
chronic care model and the dental care model
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment of Childhood Disorders (cont.)
 Ethical and Legal Considerations
 clinicians who work with children are required to
think not only about the impact that their actions
will have on the children that they see, but also on
the responsibilities, rights, and relationships that
connect children and parents
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment of Childhood Disorders (cont.)
 General Approaches to Treatment
 more than 70% of clinicians take an eclectic
approach
 psychodynamic treatment approaches focus on
developing awareness of underlying unconscious
and conscious conflicts
 behavioral approaches emphasizes re-education
using behavioral principles
 cognitive approaches focus on changing faulty
cognitions
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment of Childhood Disorders (cont.)
 General Approaches to Treatment (cont.)
 cognitive-behavioral approaches focus on
changing maladaptive cognitions, teaching the
child to use cognitive and behavioral coping
strategies, and helping the child learn selfregulation
 client-centered approaches attempt to create a
therapeutic setting that provides a corrective
experience for the child through unconditional
positive regard
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment of Childhood Disorders (cont.)
 General Approaches to Treatment (cont.)
 family models focus on the family issues
underlying problematic behavior
 biological/medical models rely primarily on
pharmacological and other biological approaches
to treatment
 combined treatments make use of two or more
interventions
Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe
Chapter 4: Assessment, Diagnosis, and Treatment
Treatment Effectiveness
 Positive Findings
 therapy leads to significant and meaningful improvements
 treatments are equally effective for internalizing and
externalizing disorders
 treatment effects tend to be long-lasting
 specific problems are more amenable to treatment than
nonspecific problems
 the more outpatient therapy children receive, the more
symptoms improve
 Negative Finding
 community-based clinic therapy far less effective than
structured research therapy