Chapter 10: Psychiatric Disorders in Children

PSYCHIATRIC EXAMINATION OF A CHILD

Sources of Information

Gather and integrate collateral information from multiple sources to obtain as accurate a clinical picture as possible: primary caregivers, teachers, pediatricians, and the child welfare system (if relevant).

Methods of Gathering Information

Determine the child's developmental stage and tailor the interview appropriately.

• Play therapy: Utilizes the child's symbolic play, storytelling, or drawing as a forum for expression of emotions and experiences.

• Classroom observation: A window into the child's functioning in school.

• Formal neuropsychological testing: Quantitatively assesses a child's strengths and weaknesses by examination of their cognitive profile: intelligence quotient (IQ); language and visual-motor skills; memory, attention, and organizational abilities.

• Kaufman Assessment Battery for Children (K-ABC): Intelligence test comparing intellectual capacity with acquired knowledge of patients between 2 and 12 years old.

• Wechsler Intelligence Scale for Children-Revised (WISC-R): Assesses verbal, performance, and full-scale IQ of patients between 6 and 16 years old.

Safety Assessment

• Always screen for safety issues including self-injurious behavior, suicidal ideation, homicidal ideation, and command auditory hallucinations in a developmentally appropriate manner.

• In the United States, suicide rates have increased significantly and are currently the second leading cause of death in individuals 10–34 years old. In the United States, 2½ times as many suicides occurred as homicides. Collectively, deaths due to suicide and homicide have remained a major cause of premature death for victims between 10 and 24 years old.

INTELLECTUAL DISABILITY

Intellectual disability (ID), or intellectual developmental disorder, is characterized by impaired cognitive and adaptive/social functioning. Severity level is currently based on adaptive functioning, indicating the degree of support required. A single IQ score does not adequately capture this and is no longer used solely to determine ID severity.

Diagnosis and DSM-5 Criteria

• Deficits in intellectual functioning include learning, reasoning, judgment, planning, abstract thinking, and problem solving.

• Deficits in adaptive functioning include communication, social participation, and independent living.

• Deficits affect multiple domains including conceptual, practical, and social.

• Onset occurs during the developmental period.

• Intellectual deficits are confirmed by clinical assessment and standardized intelligence testing (scores at least two standard deviations below the population mean).

• Adaptive functioning deficits require ongoing support for activities of daily life.

• Severity levels: Mild, moderate, severe, and profound.

Epidemiology

• Overall: 1% of ...