Academic journal article Indian Journal of Psychiatry

Clinical Practice Guidelines for Assessment of Children and Adolescents

Academic journal article Indian Journal of Psychiatry

Clinical Practice Guidelines for Assessment of Children and Adolescents

Article excerpt

Byline: Shoba. Srinath, Preeti. Jacob, Eesha. Sharma, Anita. Gautam

Need for Clinical Practice Guidelines

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. There are bound to be discrepancies in the report; nevertheless, multi-source information is a requirement during diagnosis and management. Assessment and treatment are generally multidisciplinary. Information may also be gathered in a staged manner to not overwhelm the child and family. Gathered information has to be shared across professionals involved in the care of the child and family.

These guidelines cover general principles in the assessment of children and adolescents who present to a clinic [Box 1]. These principles are not restricted to particular psychiatric presentations or contexts of evaluation. Assessments for forensic and legal purposes are beyond the scope of these guidelines. These guidelines must be used with an understanding and grasp of child development and childhood mental health disorders.[INLINE:1]

Operational terms used in the guidelines

The term 'child'/'children' will appear in most references to children and adolescents. At some places, distinguishing age groups becomes relevant. The term 'child' will be used for all children between 0 and 12 years of age and the term 'adolescent' for those between 13 and 18 years of age. To further delineate the early developmental period, where needed, the term 'infant' will be used for children 0-12 months of age and 'toddler' for children between 12 and 36 months of age. Given that children have to 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. The term 'parents' will be used for the biological or adoptive parents of the child, and the term 'family' will be used for all other individuals who live in the same household (siblings, grandparents, other members in a joint family, etc.). For any other individual involved in primary caretaking responsibilities of the child, the term 'caregiver(s)' will be used.

Objectives of Clinical Assessment

The central goal of a clinical assessment is to come to a case formulation that would guide management decisions.[1] Delineating signs and symptoms through detailed clinical history and examination help ascertain key areas of concern and presence (or absence) of a mental health disorder. 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. On the face of it, these components appear factual. However, it is often challenging to get consistent, continuous, corroborative information from the child and family. A therapeutic alliance plays a vital role. If the child and the family perceive a mutually beneficial relationship, the elucidation of facts becomes more meaningful and useful leading to shared intervention goals. The case formulation is, therefore, a culmination of these individual components, helps adopt a holistic view of the child's problems, and helps in treatment planning, including assigning roles and responsibilities to the multidisciplinary team [Figure 1]. …

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