NRNP – 6665: Child and Adolescent Assessment
All diagnoses, from infancy to adulthood, begin with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine the severity of their bipolar disorder. Instead, the field of psychiatry must use psychiatric assessments, such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.
Diagnostic assessment of the child and adolescent is a specialized area of expertise. The PMHNP will often see children who have already been seen by a primary care provider. Many PCPs are comfortable handling attention-deficit/hyperactivity disorder (ADHD) and other straightforward childhood disorders. That means that the PMHNP will often treat the more complicated patients. This week, you explore psychiatric assessment techniques and tools for children and adolescents. You also examine the role of the parent/guardian in the assessment process for this patient population.
NRNP – 6665: Child and Adolescent Assessment Learning Objectives
- Evaluate comprehensive integrated psychiatric assessment techniques for children and adolescents
- Recommend assessment questions for child and adolescent patients
- Explain the importance of thorough psychiatric assessment for children and adolescents
- Identify rating scales that are appropriate for child/adolescent psychiatric assessment
- Identify psychiatric treatments appropriate for children and adolescents
- Explain the role of the parent/guardian in child/adolescent psychiatric assessment
Optional Discussion Forum: PMHNP Study Support Lounge
The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.
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You are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like this is a statistically significant predictor of success.
To Participate in this Optional Discussion:
PMHNP Study Support Lounge
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Discussion: Comprehensive Integrated Psychiatric Assessment
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Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.
Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.
In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.
- Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.
- Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.
By Day 3 of Week 1
Based on the YMH Boston Vignette 5 video, post answers to the following questions:
- What did the practitioner do well? In what areas can the practitioner improve?
- At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
- What would be your next question, and why?
Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.
- Explain why a thorough psychiatric assessment of a child/adolescent is important.
- Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
- Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
- Explain the role parents/guardians play in assessment.
Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
NRNP – 6665: Child and Adolescent Assessment – Comprehensive Integrated Psychiatric Assessment Example
The extensive integrated psychiatric assessment of a child/adolescent is vital to establishing the diagnosis and subsequent management of the patient. This process, however, is exceedingly challenging and requires the Psychiatric mental health nurse practitioner to deploy skills and expertise to be able to gather useful information.
Similarly, the process should be multidisciplinary based to extract information from multiple sources to comprehensively understand and manage the underlying psychiatric conditions in children and adolescents (Srinath et al., 2019). This writing focuses on answering discussion questions that correlate to a video provided. In addition, the paper shall shed light on the psychiatric assessment of the child/adolescent, primarily focusing on its importance, symptom rating scales, treatment options, and the role of parents.
The YMH Boston Vignette video describes an adolescent client (Tony), who has been referred to a social worker by his medical provider after he reported symptoms of anxiety and depression during his physical exam. Nevertheless, it is apparent from the video that the client did not fancy this scheduled appointment.
What did the practitioner do well?
The practitioner commences the discussion by inquiring if the client understood the basis of the consultation, which evaluates the insight of the client. The practitioner further does not use medical jargon as she keeps the conversation simple and comprehensible. Additionally, she comprehensively evaluates critical symptoms related to depression, including feeling hopeless, lack of energy and interest, suicidal ideas, feeling sad and angry, crying a lot, substance abuse, and academic performance (Boston, 2013). Finally, she explores the duration of symptoms and determines the etiological basis of depression that Tony was suffering from, which in this case was a breakup with his girlfriend.
In what areas can the practitioner improve?
First and foremost, the practitioner should create a therapeutic alliance with the client. This process should have begun with a clear introduction of who she is and a detailed explanation of her profession and the rationale of the consultation. The therapeutic relationship would have enabled the practitioner to gather much information (Sadock et al., 2015). Furthermore, the practitioner can also maintain eye contact and scribble the critical points during the conversation. Finally, the practitioner should strive to gather information from multiple sources, including the parents, teachers, and the client’s medical provider, to evaluate the client for depression exhaustively.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
It was concerning that the practitioner failed to put ethical considerations of informed consent, privacy, and confidentiality into practice. Being an adolescent, as well as the initial visit, the guardian should sign a consent form. Similarly, the practitioner should have clarified and explained in details issues of privacy and confidentiality to the client. Lastly, it is concerning that the practitioner failed to create a rapport to encourage information sharing.
What would be your next question, and why?
My next question would focus on the relationship between the client and his family. I would ask if he has tried sharing his problems with his parents or, rather, how he feels communicating with them. Depression consequentially diminishes family ties. I would also enquire if he has been accompanied by a guardian to sign the consent form. The client talked about breaking up with his girlfriend and suicidal ideas, it will be thus imperative to extensively inquire about these outstanding issues in the face of depression.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
A meticulous psychiatric assessment of a child or an adolescent is critical for a variety of reasons. First and foremost, it enables the psychiatric mental health nurse practitioner (PMHNP) to diagnose emotional, behavioral, and developmental disorders affecting the child/adolescent (Srinath et al., 2019). However, diagnosis of emotional, behavioral, and developmental disorders in a child can be quite challenging, with the exception of uncomplicated disorders such as attention deficit hyperactivity disorder.
For instance, consultations in this category of patients may be far from the most impairing trouble at hand. Additionally, the duration and timing of symptoms may remain unelicited. Despite these drawbacks, a scrupulous psychiatric assessment will help in case formulation and subsequently guide therapeutic interventions.
According to Srinath et al. (2019), a thorough psychiatric evaluation of a child significantly enables PMHNP to exclude concurrent medical illnesses that may be the foundation of the underlying patient’s distress. This is particularly important as most organic illnesses manifest with mental symptoms. Additionally, an elaborate psychiatric evaluation guides the child’s family towards the development of a vivid comprehension of their hitches and accords them with an opportunity to chew over the information they share, which subsequently improves family relationships, although a therapeutic alliance is a crucial prerequisite.
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
Rating scales are key components of the psychiatric assessment of a child/adolescent. They aid in triaging, decision-making as well as monitoring of interventions. As a result, multiple rating scales have been formulated that are utilized for diagnosis, symptom assessment, functioning assessment, and observational measures. Symptom rating scales include a Pediatric symptom checklist (PSC) and Child symptom inventories (CSI). The CSI is based on DSM-5 criteria and covers multiple disorders.
This inventory is completed by multiple informants and considerably varies across age groups and informants. It consists of 77 to 120 items. The majority of the items are rated on a four-point scale with responses as never, sometimes, often, and very often, while the rest are rated on a 2-point scale as yes or no (Hilt & Nussbaum, 2015).
The symptom severity scores are generated by summing items scores per subscale to obtain representational scores of disorders in the DSM-5. On the other hand, the pediatric symptom checklist is a brief parent, self or teacher-reported questionnaire consisting of 35 items that are rated on a three-point scale as never, sometimes, and often. It is principally for the assessment of emotional and behavioral problems.
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Psychiatric treatment for children and adolescents strives to assist them to have a proper comprehension of their problem, resolve the problem, modify their behaviors, and making positive transformations in their lives (Bhide & Chakraborty, 2020). A couple of treatment options are available, including play therapy, acceptance and commitment therapy, and parent-child interaction therapy, among others. Play therapy encompasses the use of toys, dolls, drawings, puppets, blocks, and gameplays to aid the child to realize, identify and verbalize feelings (Bhide & Chakraborty, 2020).
The psychotherapist can deduce themes and patterns that contribute towards the overall understanding of the child’s condition by heedfully observing as the child plays. These plays are integrated with talk therapy to enable the children to manage and understand their feelings, conflicts, and behaviors. On the other hand, parent interaction therapy involves the parents interacting with their children in a positive direction by the therapist (Young et al., 2019). These real-life coaching sessions remarkably help children and parents struggling with behavioral problems.
Explain the role parents/guardians play in assessment.
The parents are exceedingly crucial in the psychiatric assessment of children and adolescents. To begin with, the parents usually initiate the consultation, which helps in the early diagnosis and management of child psychiatric disorders. Secondly, the parents considerably contribute to case formulation and diagnosis by providing extensive information on the symptomatology of their children, especially the nature, timing and duration of symptoms (Srinath et al., 2019). They further provide valuable information by completing a variety of symptom rating scales.
Similarly, the parents facilitate the acquisition of corroborative information through active participation in the formation of a therapeutic alliance (Srinath et al., 2019). Parents further offer the caregiving environment necessary for evaluating and managing their children (Bhide & Chakraborty, 2020). Finally, parents actively participate in shared decision-making and provide the informed consent necessary for initiating and continuing therapy.
Evaluation and psychiatric assessment of children and adolescents pose a great difficulty and require a multidisciplinary approach involving parents, guardians, teachers, and health care providers. Therapeutic rapport is a critical step to obtaining corroborative information for an evidence-based treatment plan. Psychotherapeutic options for children must be tailored toward the child’s individual needs. The sources used for referencing are scholarly since they have been published within the last five years, they are peer-reviewed journal articles and they are from the recommended sources.
Bhide, A., & Chakraborty, K. (2020). General principles for psychotherapeutic interventions in children and adolescents. Indian Journal of Psychiatry, 62(Suppl 2), S299–S318. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_811_19
Boston, Y. M. H. (2013, May 22). Vignette 5 – assessing for depression in a mental health appointment. Youtube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU
Hilt, R. J., & Nussbaum, A. M. (2015). DSM-5 (R) pocket guide for child and adolescent mental health. American Psychiatric Association Publishing. http://www.aacp.com/articles/view_pdf/dsm-5-pocket-guide-for-child-and-adolescent-mental-health
Sadock, B., Sadock, V. A., & Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry: Behavioral science/clinical psychiatry (11th ed.). Lippincott Williams and Wilkins.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for the assessment of children and adolescents. Indian Journal of Psychiatry, 61(Suppl 2), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18
Young, J., Ramachandran, S., Freeman, A. J., Bentley, J. P., & Banahan, B. F. (2019). Patterns of treatment for psychiatric disorders among children and adolescents in Mississippi Medicaid. PloS One, 14(8), e0221251. https://doi.org/10.1371/journal.pone.0221251