Individual

Clinical Assessment
Mr. and Mrs. Lawson brought their 4-year-old adopted daughter, Clara, to see Dr. Mason, a psychiatrist. Clara was polite in greeting Dr. Mason, but did not smile and kept her gaze down as she took a seat. Mr. and Mrs. Lawson sat next to Clara and began explaining their concerns. They described Clara as a quiet child who has recently begun throwing temper tantrums, during which she is inconsolable. Her sleep and eating patterns have changed, and she no longer wants to go to preschool.



Create a brief response to each of the following questions:



· What other information would you like to learn during the interview with the family? What questions would you ask?

· In addition to the clinical interview, what other clinical assessment tools should you consider? Why?

· Although you need more information to begin treatment, what factors might you take into consideration in designing an effective intervention for this family?

· If you were preparing to diagnose Clara, you would refer to the DSM-IV classification system to evaluate her condition on five separate axes. What type of information would go into each axis? You are not asked to enter a diagnosis, only describe the kind of information that would be entered in each axis.

· Do you think that diagnosing Clara would be beneficial or harmful? Explain why.

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See later post for a partial response.

1. During the interview with the family, it would be helpful to gather more information about Clara's background and history, including her time before adoption. Some questions you could ask include:

- What do you know about Clara's early life before adoption?
- Have there been any recent major life changes or stressors for Clara?
- How does Clara interact with other children and adults?
- Has Clara exhibited any other concerning behaviors besides the temper tantrums?

2. In addition to the clinical interview, other clinical assessment tools that may be considered include:
- Observational assessments: This could involve observing Clara in different settings, such as at home and at preschool, to assess her behavior and interactions.
- Psychological testing: Selecting appropriate psychological tests could help explore Clara's cognitive abilities, emotional functioning, and potential developmental delays.
- Rating scales or questionnaires: These tools could be used to gather information from parents, caregivers, teachers, or other individuals involved in Clara's life, and can provide valuable insights into her functioning and behaviors from different perspectives.

The use of additional assessment tools can help gather more comprehensive information and provide a more well-rounded understanding of Clara's difficulties.

3. In designing an effective intervention for this family, factors that should be considered include:
- Understanding the underlying cause of Clara's temper tantrums and behavioral changes through further assessment.
- Taking into account any potential trauma or emotional difficulties Clara may have experienced prior to adoption.
- Collaboration between the psychiatrist, Clara's parents, and any other relevant professionals to create a holistic treatment plan.
- Addressing any environmental factors that may be contributing to Clara's difficulties, such as changes at home or school.

4. The DSM-IV classification system includes five different axes:
- Axis I: This axis includes clinical disorders and other mental health conditions that Clara may be experiencing, such as anxiety, depression, or adjustment disorder.
- Axis II: This axis focuses on personality disorders or developmental disorders that may be present in Clara.
- Axis III: This axis considers any general medical conditions or physical health factors that may be impacting Clara's mental health or contributing to her symptoms.
- Axis IV: This axis includes psychosocial and environmental stressors or factors that may be playing a role in Clara's difficulties, such as adoption-related stressors or changes at home or school.
- Axis V: This axis assesses the individual's overall level of functioning and provides a Global Assessment of Functioning (GAF) score, which indicates the individual's psychological, social, and occupational functioning.

It is important to note that the DSM-IV classification system has been updated to DSM-5, which is the current edition used for diagnosing mental health conditions.

5. The potential benefits of diagnosing Clara include:
- Providing a framework for understanding and communicating Clara's symptoms and difficulties.
- Guiding treatment planning and interventions by identifying appropriate evidence-based approaches.
- Facilitating access to appropriate support and services.
- Enhancing communication and collaboration between professionals involved in Clara's care.

However, it is also important to consider the potential harms of diagnosing:
- Possibility of stigmatization or labeling, which may negatively impact Clara's self-esteem and perception of herself.
- Overemphasis on diagnosis, potentially overlooking individual strengths and unique factors contributing to Clara's difficulties.
- The potential for misdiagnosis or diagnostic errors, which can lead to inappropriate treatment or interventions.

Ultimately, the decision to diagnose should be made carefully, weighing the potential benefits and harms, and considering the specific needs and circumstances of the individual.