Child assessment presentation notes HOPC Social History Grades : sudden drop may indicate emotional distress , learning diffucltiies or attention problems considetnly poor grades: learning disabilits , ADHD or congiitve delays high performing: perfectionism, anxiety Favourite Subject Having a learning disability may cause the child to favour one subject over the other Ask it before and after the presenting problem Depression or other diseases may cause the child to fabour one subject over the other, e.g. art or music may provide with means to express themselves and hating something like maths and science because they are depressed and cannot concentrate Homework Struggling to complete may indicate ADHD, learning difficulties Teachers ODD, social anxiety Does the child have any Individualized Education Plans? ADHD, intellectual disanilities , depression may mean they need more time , and extra help Have they had a psychoeducational assessment? When? By whom? Cognitive disbailities , learning disabilities and emotional functioning Report card comments. Isnighes into behaviour Especially since some diseases require the behavioural impairment to be apparent in at least two settings. Reveal comments by teachers, such as a sudden drop in grades etc. Self Ask about feelings “What are the main feelings you usually feel?” (happy, sad, angry, anxious, irritable) Feelings ? (lead to) Behaviours “What do you do when you have these feelings?” (self-harm, externalized behaviours (e.g. - acting out, truancy, disruptive), internalized behaviours (e.g. - rumination) What are your strengths? (Can ask both the parents or the child Legal History Truancy Skipping school Chronic absnces may indicate anxiety, depression, social anxiety, family issues, bullying. Social Bullying Children who experience bullying may develop anxiety, depression, social withdrawal, low self-esteem, PTSD, or suicidal thoughts. Children who engage in bullying may have underlying impulse control issues, aggression, or conduct problems . Friends Indicate insight into social skills, emotional development, possible mentla health concerns. Social media Excessive use -> anxiety, depression, cyberbullying, body image issues and sleep disturbances Relationships Self-esteem, emotional regulation and interpersonal skills Home Home Who are the family members present? Impacts emotional development Single parent’ households: stress, trauma, attachment issues Siblings Emotional distress or rivalry based resentement Parents Frequwnt conflicts – chronic stress, anxiety or behavioura ; issues Are conflicts common? Divorce, separation or custody battles -> emotional insecurity and adjustement disorder What are the family dynamics at home Neurodevelopmental history Age of parents at conception Advanced paternal age (>40) is associated with autism spectrum disorder (ASD), schizophrenia, and genetic mutations. Teen pregnancy may lead to prenatal stress, poor nutrition, and limited prenatal care, impacting fetal brain development. Illnesses in pregnancy Maternal infections (e.g., rubella, CMV, toxoplasmosis) can cause neurological damage, intellectual disability, or psychiatric disorders. Untreated maternal depression or anxiety increases the child’s risk of emotional dysregulation. Substance uses during pregnancy Alcohol use ? Fetal Alcohol Spectrum Disorder (FASD) , leading to impulse control issues, ADHD, and learning disabilities . Nicotine and drug exposure ? Premature birth, ADHD, and behavioral issues . Toxin exposure Lead exposure ? Associated with lower IQ, aggression, and ADHD. Pesticides and chemicals ? Potential links to autism and learning disabilities. Birth term Preterm birth (<37 weeks) is associated with cognitive delays, ADHD, emotional dysregulation, and social difficulties. Low birth weight increases the risk of mental health disorders like anxiety and depression. Delivery complications Lack of oxygen at birth (hypoxia) ? Increases risk for cerebral palsy, cognitive impairments, and schizophrenia. Birth trauma (e.g., forceps delivery, emergency C-section) ? Can lead to neurological impairments. Growth charts genetic, endocrine, or metabolic conditions affecting brain function Developmental Milestones Delayed speech, motor skills, or social skills may indicate autism, intellectual disabilities, or neurological conditions. What is the child/adolescent’s strengths? Medical History History of seizures, recurrent infections, easy bruising/blood clots, tumours/growth, muscle pains/arthritis, or any other diagnosed medical conditions Neurodevelopmental disorders Hearing, vision, or cardiac problems Pubertal History Age of menarche Regular/irregular menstrual cycle Family History Psychiatric (bipolar disorder, schizophrenia, completed suicide/suicide attempt) Seizures/epilepsy Birth defects Infertility Known genetic conditions Sudden Unexplained Deaths (SIDS?) Congenital Cardiac Malformations? Approaches Flexible approach Difficult to follow a set routine with children However, still important to record information systematically Method of interviewing parents is similar to that of adults Interviewing family members Information from school Interviewing and observing the child May not be willing to express their ideas and feelings in words Observations of their behaviour and interactions during the interview are especially important With very young children this could include toys, drawing etc. Starting the interview Begin by establishing a friendly atmposphere by winning the child’s confiendence Ask what they like to be called Begin with a discussion of neutral topics such as pets, favourite games, birthdays or current school information Techniques of intervweing Friendly relationship approach Ask about their likes, dislikes, their problems and the future It is informative to ask about what ehy would request of they were given three wishes or for older children what their goals are after contacting the mental health service Behaviour and mental state Developmental assessment At the end of the interview Assessment should have made of the child’s developmental state relative to other children of the same age Avoid comparisons with other siblings Interviewing the family Who is the best person to tell me why we are there? Note: Who is the spokesperson for the family Who seems the most worried about the problem? What are the alliances within the family? What is the hierarchy in the family/who is most dominant How well do the family members communicate with one another? How do they seem to deal with conflict? Psychological assessment Most intelligence and educational achievements are often valuable If mental health development and achievements are inconsistent with chronological or mental age or with expectations of parents and teachers This may indicate a generalised or specific disorder of development or may indicate other sources of stress in disorders of other kinds Case formulation Usually begins with the diagnosis and a differential diagnosis Aetiology Developmental stages of child should be noted Assessment of problems and the strengths of the family are recorded Psychometric tests INTELLIGENCE CHILDREN Designed to measure cognitive ability rather than fixed intelligence Use age appropriate tasks such as picture recognition , block design and verbal reasoning Intelligence test WISC-V Verbal, comprehension, reasoning and working memory and processing speech , identifies learning strengths and weaknesses SB-V Assesses general intelligence and cognitive abilities ADULTS Focuses on crystallised (knowledge based) and fluid intelligence More abstract reasoning and language heavy tasks KABC-II Focuses on problem solving and information processing ACHIEVEMENT TESTS Assessing skills in reaching, maths etc. CHILDREN Assesses academic progress and identifies learning disabilities. Compares performance with developmental milestones. Examples: WIAT-4 : Helps diagnose specific learning disorders Woodcock-Johnson IV : Assesses academic skills like math, reading, and writing ADULTS Used for college/workplace assessments or accommodations for learning disabilities. May evaluate functional literacy and numeracy. Examples: Wonderlic Test (for employment), Test of Adult Basic Education (TABE) DELEOPMENTAL AND SCHOOL READINESS TESTS indications: Delayed speech, motor skills, or social interaction Concerns about school readiness Identifying early developmental delays Assessing pre-kindergarten cognitive skills CHILDREN Screens for early developmental delays in motor skills, language, and cognition. Helps determine school readiness. Examples: Denver-II -> Screens for developmental delays Brigance Screens -> preschool evaluations ADULTS Not commonly used, as adults have passed key developmental stages. Instead, neuropsychological tests assess cognitive decline (e.g., dementia screening). 4. Emotional and Behavioural Assessments Indications: Frequent emotional outbursts, anxiety, depression Behavioural E issues (aggression, defiance, social withdrawal) Suspected ADHD, anxiety, depression, or conduct disorders Parental or teacher concerns about social skills or emotions Examples & Uses: Child Behaviour Checklist (CBCL) ? Identifies emotional and behavioural problems BASC-3 ? Comprehensive tool for behavior evaluation Conners Rating Scale (Conners-4) ? Specifically for ADHD and impulsivity For Children: Focus on emotional regulation, impulse control, social skills, and conduct issues . Parent and teacher observations are often included. Examples: CBCL, BASC-3, Conners Rating Scales For Adults: Examines mental health, personality traits, and psychiatric disorders like anxiety, depression, or personality disorders. Self-report questionnaires are more common. Examples: Minnesota Multiphasic Personality Inventory (MMPI-2), Beck Depression Inventory (BDI-II) 5. Autism and Social Communication Assessments Indications: Poor eye contact, repetitive behaviors , or difficulty with social cues Delayed speech or difficulty in peer interactions Suspected Autism Spectrum Disorder (ASD) Parent or teacher concerns about communication skills Examples & Uses: ADOS-2 ? Gold standard for diagnosing autism SRS-2 ? Measures social difficulties in autism For Children: Evaluates early signs of autism , focusing on language development, play, and social interaction . Often involves direct observation and parent interviews . Examples: ADOS-2, SRS-2 For Adults: Focuses on adaptive functioning and self-reported challenges in social interaction . More emphasis on how autism impacts daily life and work . Examples: Autism Spectrum Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale (RAADS-R) 6. Attention and Executive Function Tests Indications: Difficulty in sustaining attention, following instructions, or completing tasks Impulsivity, hyperactivity, or poor concentration Concerns about working memory, planning, and organization Screening for ADHD or executive function deficits Examples & Uses: CPT-3 (Continuous Performance Test) ? Screens for ADHD D-KEFS (Delis-Kaplan Executive Function System) ? Evaluates problem-solving and impulse control For Children: Measures attention span, impulsivity, and executive functioning (skills like problem-solving and self-regulation). Often used for ADHD diagnosis . Examples: CPT-3, D-KEFS For Adults: Focuses on workplace functioning and cognitive decline (e.g., post-injury, aging). Used in neuropsychological evaluations for brain injuries or dementia. Examples: Wisconsin Card Sorting Test (WCST), Stroop Test Physical exam 1. Motor Function Assessment Children Gross Motor Skills (e.g., running, jumping, balance) ? Delays may indicate developmental coordination disorder (DCD), cerebral palsy, or neurodevelopmental disorders . Fine Motor Skills (e.g., grasping objects, drawing) ? Poor performance may suggest dyspraxia (developmental coordination disorder) or ADHD . Muscle Tone : Hypotonia (low tone) ? Seen in autism spectrum disorder (ASD), Down syndrome, cerebral palsy . Hypertonia (high tone) ? Seen in cerebral palsy, neurodegenerative disorders . Involuntary Movements : Tics (sudden, repetitive movements/sounds) ? Tourette syndrome, OCD, or stimulant-induced tics . Choreoathetoid movements (writhing, jerky movements) ? May indicate Huntington’s disease, cerebral palsy, or Wilson’s disease . Adults Fine & Gross Motor Function : Impairment may be due to stroke, Parkinson’s disease, multiple sclerosis, or medication side effects . Tremors : Resting tremor ? Associated with Parkinson’s disease . Intention tremor ? Seen in cerebellar dysfunction, multiple sclerosis . Bradykinesia (slow movement) ? Can indicate Parkinsonism, catatonia, or major depression . Chorea (involuntary jerky movements) ? Seen in Huntington’s disease, tardive dyskinesia (antipsychotic-induced). Areas Assessed: Muscle Tone: Assessing the level of resistance in muscles at rest. Body Posture: Evaluating how the body is positioned and held. Equilibrium: Assessing the ability to maintain balance. Grip Strength: Measuring the force with which a person can hold an object. Fine Motor Control: Evaluating the ability to perform precise, small movements. Gross Motor Skills: Assessing large movements like walking, running, and jumping. Many tools exist Some are specific Gross motor skills, assessment of motor and process skills, quick motor function tests Reasons Neurological reflexes and coordination Children Primitive Reflexes (Infants & Toddlers) : Persistent reflexes beyond normal age may indicate cerebral palsy, developmental delay, or neurological disorders . Examples: Moro reflex (startle) should disappear by 6 months . Palmar grasp reflex should disappear by 6 months . Balance & Coordination Tests : Finger-to-nose, heel-to-shin tests ? Assesses cerebellar function . Gait assessment ? Abnormalities may indicate muscular dystrophy, cerebral palsy, or neurodevelopmental disorders . Adults Reflex Testing : Hyperreflexia or hyporeflexia may indicate upper or lower motor neuron lesions . Gait Abnormalities : Shuffling gait ? Seen in Parkinson’s disease . Ataxic (wide-based) gait ? Suggests cerebellar dysfunction . Cranial Nerve Examination : Important for identifying neurological causes of psychiatric symptoms (e.g., visual hallucinations in temporal lobe epilepsy ). 3. Extrapyramidal Symptoms (EPS) These are movement disorders caused by antipsychotic medications or neurological conditions. Children Drug-induced dystonia (sudden muscle spasms) ? More common in children on antipsychotics (e.g., risperidone, aripiprazole) . Restlessness (Akathisia) ? Can occur with ADHD medications or antipsychotics. Adults Tardive Dyskinesia (involuntary repetitive movements, often of face/lips) ? Seen in long-term antipsychotic use . Parkinsonism (rigidity, bradykinesia, resting tremor) ? Can be caused by antipsychotics (e.g., haloperidol) .