Citation

Harrington R. Medicine (Abingdon) 2004; 32(7): 11-13.

Copyright

(Copyright © 2004, Medicine Publishing)

DOI

10.1383/medc.32.7.11.36669

PMID

unavailable

Abstract

Because most child and adolescent psychiatric disorders do not include pathognomonic features, the first issue in assessment is whether a psychiatric disorder is present. Considerations include duration of symptoms, social impairment (particularly changes in functioning) and degree of suffering. If the assessment shows that a disorder is present, the next question is about its form - which formal psychiatric diagnosis is present (e.g. depressive disorder, schizophrenia), and what other problems are present? This question is important because most psychiatric disorders are associated with other problems (e.g. specific or general learning problems). These different domains (e.g. depression, general learning problems) are coded on different axes of a multi-axial framework. Hypotheses about the likely causes of the young person's problems are then developed. These causes are usefully divided into predisposing, precipitating and maintaining factors, though in clinical practice it is often difficult to distinguish them. The clinical assessment is often designed to answer these initial questions. It usually involves direct observations of the family, an interview with the child or adolescent alone, a parental interview, and reports from other sources, particularly the school. It should be remembered that these questions may not be uppermost in the minds of those making the referral (e.g. the parents, the school). Their main concerns may be more about the child's school placement, or about whether the child is going to develop a major mental illness that runs in the family (e.g. schizophrenia). It is important that the initial assessment clarifies the context of the referral.