Clinical Assessment of Children and Adolescents (eBook)

|24|Chapter 2
Process, Methods, Techniques, and Skills in Children’s and Adolescents’ Clinical Assessment

Nuria de la Osa,1 Farah Malik,2 and Miguel Á. Carrasco3

1Department of Clinical and Health Psychology, Autonomous University of Barcelona (UAB), Cerdanyola, Spain

2Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan

3Faculty of Psychology, National University of Distance Education (UNED), Madrid, Spain

Introduction

Children’s and adolescents’ development is characterised by a continuous set of achievements, with the goal of integrating them in an adaptative way into their living systems (family, school, friends, and society). Their lives remain continuously under comparison in many areas of quotidian life, as they are meant to accomplish many academic, social, physical milestones, behavioural implicit or explicit social norms, and familiar expectations, in their process of growing up to be a part of a human group. Sometimes this un|25|written sense of “normality” shared by the members of a group seems not to progress and requires professional help in the form of assessment or interventions.

Clinical assessment of children and adolescents is understood as (a) the systematic but flexible and dynamic process that enables the taking of decisions about information gathering, hypothesis generation, and testing of problems’ causes, consequences, and possible interventions; and (b) the methods and measures that clinicians use to answer a wide range of questions and also develop and evaluate our own interventions, which are, in the last instance, the main objective of the clinical assessment. These include a wide range of assessment strategies and tools, encompassing clinical histories, interviews, psychopathological explorations, screening tools, specific tests, and observational records. In addition, it is of great interest to include in all of the phases of the assessment process, new diagnostic theoretical approaches such as network theory (Borsboom, 2017) and transdiagnostic assessment (Achenbach, 2015), as well as technological advances such as ecological momentary assessment (EMA; Russell & Gajos, 2020). This comprehensive framework allows clinicians to understand children and adolescents with or without mental disorders, and their living systems.

Methodologically, this perspective includes the increasing interest in integrating the best of both categorical and dimensional approaches to diagnosis, given the limitation of diagnostic systems (Kotov et al., 2017), or the consideration of subthreshold disorders (Lewinsohn et al., 2004). Clinical assessors must develop their approaches in a society that needs to reduce costs and increase efficiency, and therefore special attention to brief interventions and emphasis on intervention evaluation must characterise their practice.

The proposed way of understanding and proceeding in the clinical assessment process of children and adolescents is rooted, and integrated within, different theoretical frameworks: (a) behavioural assessment principles (Haynes, 1978), focusing assessment on emotions, thoughts, behaviours, and personality, and their relation, giving a great relevance of present and past context, which includes wider family and social systems; (b) developmental psychopathology (Cicchetti, 1984) that claims for the need of having wide knowledge about developmental trajectories of problems and what is developmentally normative. This approach means that what drives assessment decisions is a deep knowledge of the clinical manifestations that better fit with the developmental moment. For instance, a conduct problem with late onset should indicate to clinicians the need to assess friends or peers, rather than focusing efforts on cognitive deficits, temper vulnerability, or comorbid attention-deficit/hyperactivity disorder (ADHD) conditions. Likewise, our knowledge of normative aggression in boys and girls should indicate the use of instruments that are developmentally sensitive. And, finally (c) evidence-based assessment (EBA; Hunsley & Mash, 2007; Mash & Hunsley, 2005) is based on the assumption that basic knowledge is the starting point of the assessment process, and also requires the utility of the information gathered for taking decisions to design the interventions. Social utility and the measurement of the value of any assessment process are the main objectives of EBA. EBA principles also imply to consider psychometric issues and scientific guaranties which means that techniques used during the process should present reliability and validity. The techniques should be adapted to different populations, and cultural diversity, and be representative and useful for a certain objective (Hunsley, 2015; Kazdin, 2005).

Under this paradigm, the maximum value of any assessment process depends on the degree of usefulness that it might contribute for children, adolescents, and their families. |26|In this context, there is a need to highlight the relevance of assessing adaptive behaviour, and individual and family functioning beyond symptoms and disorders. The assessment process should be an idiographic approach soundly based on EBA principles, and knowledge of normal and abnormal development of children, adolescents, and families, with similar problems that allow the integration of a nomothetic approach. Great attention should also be given to the assessment (and prevention, where appropriate) of high-risk populations, intrafamilial violence, poverty, social exclusion, and cultural and personal diversity (Mash & Barkley, 2007).

Specific Procedural Competences and Skills

The practice of clinical assessment with children and adolescents is particularly challenging and complex for clinicians and requires special competencies (Finch et al., 2012). The practical implications of assuming the aforementioned perspective, together with the numerous specific characteristics of children’s and adolescents’ clinical assessment as described in Chapter 1, suggest that clinicians must know (a) which are the relevant data and how to get them to be able to identify the reasons that lead the family to seek a consultation. This can be a tangible ability to elaborate clinical histories and interviewing skills, hypothesis formulation, and the accomplishment of formal diagnosis; (b) the procedures for and interpretation of different developmental areas and different problems; (c) identification and delimiting of the main problems in order to plan the main lines of the intervention process and its evaluation; and (d) integration of all of the information and return of the results to the demandant.

The psychological clinical assessment in this context is a sort of “three-for-one,” as families and teachers are also included in the “package.” Children and adolescents live immersed in different settings at home or in school, so the gathering and integration of information from more than one source is always indispensable and necessary (Makol et al., 2020). Clinical and academic difficulties are often conjugated, which means that psychopathology knowledge is not enough. The cognitive, heterogeneous, and ongoing changes that are characteristic of this population put an extra demand on clinicians’ knowledge about developmental milestones and psychopathology....