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(BQ) Part 2 book “Psychiatric interview of children and adolescents” has contents: Evaluation of externalizing symptoms, comprehensive psychiatric formulation, symptom formation and comorbidity, diagnostic obstacles (resistances), countertransference,… and other contents.
CHAPTER 10 Evaluation of Externalizing Symptoms Evaluation of Hyperactive and Impulsive Behaviors Although distractibility was traditionally considered the core feature of at tention-deficit/hyperactivity disorder (ADHD), researchers, more recently, have proposed that the central deficit in ADHD is a problem of behavioral inhibition that involves a delay in the development of self-control and self regulation The behavior of children with ADHD is regulated more by imme diate circumstances (i.e., external sources) and less by executive functions and considerations of time and the future As Barkley (1997, p 313) stated, “ADHD is far more a deficit of behavioral inhibition than of attention.” DSM-5 (American Psychiatric Association 2013) distinguishes three types of ADHD: inattentive, hyperactive-impulsive, and combined The inatten tive type predominates in pediatric populations, whereas the hyperactive impulsive and combined types are more prevalent in child psychiatric pop ulations The ADHD types are associated with different clinical, comorbid, and prognostic courses According to Faraone et al (1998), children with the combined type have the highest rates of comorbid disruptive, anxiety, and depressive disorders In comparison with children who have the combined type, children with the inattentive type have similar rates of comorbid anxi ety and depressive disorders but lower rates of disruptive disorders Chil dren with the hyperactive-impulsive type, compared with children with the 239 240 Psychiatric Interview of Children and Adolescents other subtypes, have the highest rates of externalizing disorders but lower rates of associated anxiety and depression Children with the combined or inatten tive types have higher rates of academic problems than children with the hyperactive-impulsive type Compared with children with the other two types, children with the combined type have higher lifetime rates of conduct, oppo sitional, bipolar, language, and tic disorders; they also have the highest rate of counseling and multimodal treatments Few differences were found between the hyperactive-impulsive and the inattentive types, although children with the inattentive type had a higher lifetime prevalence of major depressive disorder (Faraone et al 1998) In the case of moderate to severe symptoms noted in preschoolers, the ADHD diagnosis appears stable into later childhood In chil dren diagnosed with ADHD as preschoolers, the Preschool Attention-Deficit/ Hyperactivity Disorder Treatment Study (PATS) found that at 6-year follow up, 89% of the children who were not lost to follow up and had been diagnosed with moderate to severe ADHD as preschoolers continued to have symptoms that met ADHD diagnostic criteria (Riddle et al 2013) In a 5-year prospective study by Hinshaw (2008), nearly two-thirds of fe males with ADHD showed depression at some point during the study; this rate was several times higher than that in the non-ADHD comparison group Depressive symptomatology in females with ADHD was more severe (i.e., earlier onset and longer duration, higher levels of irritability and suicidal ideation, and greater need of multiple types of treatment) than in the com parison group Major depression also predicted continuity of depression, on set of anxiety, and substance use disorders (Hinshaw 2008) Longitudinal studies of boys with or without ADHD revealed that major de pression at baseline predicted syndrome-congruent outcomes years later Boys with major depression and comorbid ADHD were at significant risk for bipolar disorder, psychosocial dysfunction, and psychiatric hospitalizations Boys with a clinical presentation meeting the criteria for major depression had prototypical symptoms of the disorder, a chronic course, and severe psycho social dysfunction (Biederman et al 2008) In contrast, females with ADHD were 5.1 times more likely to develop major depression than were control fe males Biederman et al (2008) reported that major depression in females with ADHD, compared with major depression in control females, was associated with an earlier onset and greater duration of the major depression, as well as more severe associated major depression impairment, including psychiatric hospitalization and increased suicidal ideation ADHD in females significantly increased the risk for mania, conduct disorder, and oppositional defiant dis order (ODD) independent of the major depression status Parental history of major depression and the subject’s history of mania were predictors of major depression among females with ADHD Having ADHD at baseline is a signifi cant predictor for major depression in females Evaluation of Externalizing Symptoms 241 A robust bidirectional overlap occurs between ADHD and major depres sion, and mania in childhood is a significant predictor for major depression at follow-up for females An emerging literature also documents a bidirec tional association between ADHD and bipolar disorder in pediatric subjects and adults with ADHD, as well as in pediatric and adult patients with bipolar disorder (Biederman et al 2008) Major depression is also associated with an increased risk for anxiety disorders The comorbidity of ADHD and major de pression thus indicates high morbidity and disability, as well as a poor progno sis (Biederman et al 2008) In evaluating children who have the hyperactive-impulsive type of ADHD, the examiner should inquire about the onset of the hyperactivity and impul sivity Commonly, the origin of these symptoms can be traced to early pre school age Some mothers report hyperactivity during the child’s gestational or early neonatal life Parents may complain that these children were hyper active, willful, obstinate, or disobedient from an early age, or that they got into everything without any forethought (e.g., they were frequently moving, never finishing anything they started) Many of these children have no sense of dan ger and require close and ongoing supervision A low tolerance for frustration and dysregulation of emotional states are common Some of these children have difficult temperaments and demand inordinate amounts of attention; they lack self-soothing regulatory mechanisms and are prone to intense and prolonged temper tantrums These tantrums easily escalate into dyscontrol, and when this happens, it takes the child a long time to regain self-control In severe cases, biorhythm dysregulation may be present, as evidenced by sleep difficulties Symptoms of ADHD are conspicuous in the classroom Children with ADHD are distractible and disruptive They demonstrate off-task behaviors and are unable to remain seated They commonly have difficulty completing assign ments, and they have problems taking turns and sharing with peers Some of these children are intrusive and have limited social skills, whereas others have poor problem-solving abilities Some children with ADHD develop early co morbidity Children with the hyperactive-impulsive or combined types have problems with anger control and with affective modulation; these deficits contribute further to their limited social success Cantwell (1996, p 982) recommended a comprehensive assessment for children and adolescents suspected of having ADHD This assessment in cludes the following components: A comprehensive interview with all parental figures This interview should be complemented by a developmental, medical, and school his tory of the child and a social, medical, and mental health history of fam ily members 242 Psychiatric Interview of Children and Adolescents A developmentally appropriate interview with the child to assess his or her view of the signs and symptoms and to screen for comorbidity An appropriate medical evaluation to screen for health status and neu rological problems An appropriate cognitive assessment of ability and achievement The use of both broad-spectrum and more narrowly focused (i.e., ADHD specific) parent and teacher rating scales Appropriate adjunct assessments, such as speech and language assess ment and evaluation of fine and gross motor function Because children with the combined type of ADHD require frequent cor rective feedback (as a result of their impulsivity), they evolve a negative self view that contributes to the early development of dysphoric affect Frequently, children with ADHD develop a defective self-concept and a poor sense of com petence According to O’Brien (1992), self-esteem difficulties are the core psychological problems for these children The examiner needs to explore these complications to determine the extent of additional psychopathology to formulate a comprehensive treatment program The examiner should ask the child to explain the reasons for the psychiatric examination and should help the child to explain, in his or her own words, the nature and extent of the problems The examiner should consider the following questions: Does the child dis play problems with hyperactivity-impulsivity only in certain circumstances or at certain times? Are the problems evident in most of the child’s daily ac tivities? Is the child able to concentrate in the classroom? Is the child able to stay on task? Does the child finish assignments? Does the child show behav ioral disorganization? Do any activities grip the child’s attention (e.g., play ing certain games, watching television)? What television programs does the child watch? How are the child’s social and problem-solving skills? This in formation has significant clinical relevance As soon as the interviewer detects that the child is too hyperactive or im pulsive and lacks means of self-regulation, self-structure, or self-control, he or she should structure both the physical space and the activities in which the child is permitted to engage Restricting spatial boundaries and controlling the quality, quantity, and modality of stimulation are mandatory to maintain ing a safe and productive interview Such control will help the child to focus and concentrate on structured tasks (e.g., those involving building blocks, puzzles, or table games) If the child is easily distracted, the examiner should reduce the amount of stimulation by limiting the number of items available at any given time Lim iting and structuring the elements for specific tasks is important: a box full of crayons and an unlimited amount of paper are too distracting for an inatten Evaluation of Externalizing Symptoms 243 tive and disorganized child Such a child should receive one crayon or one pencil and one piece of paper at a time Similarly, the examiner should limit the number of blocks or other items that the child can use at any given time If the child is too fidgety or has difficulty remaining seated, the examiner should pull the child’s chair close to the interviewing table so that the chair and table form a physical boundary The examiner should instruct (and encour age) the child to concentrate on only one task at a time The examiner should encourage and help the child to complete the assigned task before moving on to a new one Throughout the interview, the examiner should note the child’s response to structure and limit setting; these observations have im portant diagnostic and therapeutic implications Ongoing support should be given when the child meets the examiner’s expectations and abides by the provided structure The examiner should help the child concentrate on the project at hand and should give support and reinforcement each time the child finishes a task Transitions from one activity to the next should be han dled with care, because the child may have problems with moving on to new tasks The length of the interview is an important factor; brevity is the goal Af ter 15–20 minutes of active interviewing, the child needs a break (e.g., a trip to the bathroom) In an intensely structured setting, the patient and the cli nician tire easily The amount of structure needed in subsequent sessions will indicate how well the child is responding to ongoing behavioral and psycho pharmacological interventions Observations made during structured inter viewing, as well as changes observed in ratings on specific checklists completed by the examiner, teachers, or parents, are helpful in ascertaining whether changes at school, at home, or in other settings have been made in response to treatment Additional deficits may also emerge in the course of the initial evaluation and subsequent visits Social skill difficulties are significant problems for some children with ADHD Cantwell (1996) described this comorbidity as an inability to pick up social cues, which leads to interpersonal difficulties In a child who has responded well to treatment and has demonstrated behav ioral improvements (decreases in hyperactivity and impulsivity but not at tention or academic improvements), the examiner also needs to rule out nonverbal learning disabilities Finally, rating scales should be used to support the diagnosis Galanter and Leibenluft (2008) provided a number of considerations for the examiner faced with differentiating ADHD from bipolar disorder First, ADHD is far more common than bipolar disorder Second, the venue of the assessment is important: bipolar disorder is more likely in an inpatient psy chiatric unit than in a pediatric clinic Third, the examiner should explore for an episode of mania or hypomania If such an episode is not uncovered, 244 Psychiatric Interview of Children and Adolescents the examiner should search for an episode of irritability that is greater than the child’s baseline ODD, conduct disorder, anxiety disorder, and major depressive disorder also produce irritability and are more common than bipolar disorder Fourth, the examiner should consider the DSM-5 Crite rion B symptoms for mania (symptoms that are not present in ADHD), such as grandiosity, flight of ideas or racing thoughts, decreased need for sleep, and hypersexuality Evaluation of Aggressive and Homicidal Behaviors According to Ash (2008), violence is surprisingly common among children and adolescents Longitudinal studies using youth self-reports indicate that by age 17 years, 30%–40% of boys and 16%–32% of girls have participated in a serious violent offense (i.e., aggravated assault, robbery, gang fight, or rape) Homicide is the second cause of death for youths ages 15–19 years, second to accidents and ahead of suicide; it accounts for about 2,000 deaths a year The homicide rate stands at 9.3 deaths per 100,000 youths Adolescent dating violence is also frequent: up to 9% of boys and girls reported being physi cally hit by a boyfriend or girlfriend during the previous year (Ash 2008) Ash (2008) asserted that children first learn to manage their aggression from their parents during toddlerhood and that poor parenting (abusive parent ing, neglect, coercive parenting, rearing by antisocial parents, poor limit set ting, or general family dysfunction) during toddlerhood sets the stage for the children’s later problems with aggression or violence ODD is a frequent pre cursor of more serious aggression; about 30% of individuals with early ODD progress to conduct disorder, and 40% of those with conduct disorder prog ress to antisocial personality disorder The most potent risk factors for pre adolescent violence are general nonviolent criminal offenses and preadoles cent substance abuse, whereas peer effects are the most influential factors for adolescent-onset violence For both preadolescent-onset and adolescent onset violence types, a developmental progression of offenses is common, be ginning with minor crimes such as vandalism and shoplifting, then progress ing to aggravated assault, followed by robbery, and then rape That robbery precedes rape in 70% of cases is the strongest evidence that rape is a criminal violent offense and not a crime of sex (Ash 2008) Dating violence should be explored According to Wolitzky-Taylor et al (2008), older age, female sex, and exposure to previous and recent stressors were associated with greater risk for experiencing dating violence Experience of severe dating violence (i.e., physical assault causing harm, threat with a weapon, rape or forced sexual activity) was estimated, conservatively, to be 2.6% for girls and 0.6% for boys, representing 335,000 girls and 78,000 boys Evaluation of Externalizing Symptoms 245 in the United States (Verbal threats, hitting or slapping without injury, and verbal aggressiveness were not considered in the study.) Sexual assault was the highest act of violence, followed by physical assault and drug- or alcohol facilitated rape Dating violence is associated fourfold with posttraumatic stress disorder and major depressive episodes Also, an association exists between dating violence and having experienced a prior traumatic event (Wolitzky-Taylor et al 2008) The examiner should explore aggressive behavior at school Results from a 1995 survey of students ages 12–18 years indicated that 2.5 million stu dents were victims of some crime at school Serious crimes (i.e., rape, aggra vated assault, sexual assault, and robbery) accounted for 186,000 victims in schools; 47 of the crimes resulted in 47 school-associated deaths, including 38 homicides (Malmquist 2008) As Tardiff (2008, p 4) noted, “The evaluation of violence potential is anal ogous to that of suicidal potential Even if the patient does not express thoughts of violence, the clinician should routinely ask the subtle question, ‘Have you ever lost your temper?’ in much the same way as one would check for suicide potential with the question, ‘Have you ever felt that life was not worth living?’ If the answer is yes in either case, the evaluator should pro ceed with the evaluation in terms of how, when, and so on with reference to violence as well as suicidal potential.” Tardiff added, “When making decisions about violence potential, the clinician also should interview family mem bers, police, and other persons with information about the patient and about violence incidents to ensure that the patient is not minimizing his or her dan gerousness” (p 4) Ash (2008) advised, “Whenever risk of predatory violence by an adolescent is a serious consideration, if at all possible some friend should be talked to [because] the evaluee’s friends are most likely—more so than parents—to have heard the youth express threats, even if the friends did not take the threats seriously” (p 371) The examiner should keep in mind, when evaluating violence, that the standard unstructured assessment interviews have limited diagnostic validity and no predictive validity: “Research has not been kind to unstructured vio lence risk assessment” (Monahan 2008, p 19) For predictions of violence, “ac tuarial” methods are recommended (see Note at the end of this chapter) An important consideration in assessing an adolescent’s risk for violence is where he or she is on the violence pathway or trajectory: fantasies about killing, initiation of planning, increased interest in weapons and how to use them, interest in how others have committed mass murders, use of the In ternet for this purpose, and detailed preparation (obtaining weapons, scouting out sites, and stalking potential victims) The farther along this path the ado lescent is, the higher the risk he or she poses A person does not have to make a threat to be a threat The examiner should also explore the motivation, in 246 Psychiatric Interview of Children and Adolescents cluding why people are included on the “hit list” (Ash 2008) Ash (2008) stated the importance of reducing the availability of weapons, but many parents not comply with the recommendation to dispose of weapons For the evaluation of short-term violence risk in adults, Tardiff (2008) rec ommended the importance of the following factors: 1) appearance, 2) pres ence of violent ideation and degree of formulation and/or planning, 3) intent to be violent, 4) available means to harm and access to the potential victims, 5) past history of violence and other impulsive behaviors, 6) history of alcohol or drug abuse, 7) presence of psychosis, 8) presence of personality disorder, 9) history of noncompliance with treatments, and 10) demographic and so cioeconomic characteristics These factors have a parallel importance in the assessment of violence in children and adolescents In an article on assessing violence risk in children and adolescents, Weis brot (2008) discussed infamous school shootings Warning signs are evident, and the interviewer needs to confront the child’s denial or minimization of these issues “Leakage” relates to clues signaling a potential violent act, in cluding feelings, thoughts, fantasies, attitudes, and intentions expressed via direct threats, boasts, doodles, Internet sites, songs, tattoos, stories, and year book comments with themes of death, dismembering, blood, or end-of-the world philosophies School shooters indicated their plans before the shoot ings occurred via direct threats or by implication in drawings, diaries, or school essays Prior to school shootings, other students usually know about the impending attacks (in 75% of cases, at least one person knew; in about 66% of cases, more than one person knew), but this information was not com municated to adults Weisbrot (2008) advised that threat assessment requires a thorough psy chiatric diagnostic evaluation, including fundamental assessments of suicid ality, homicidality, thought processes, reality testing, mood, and behavior A detailed developmental history should be gathered, with a specific focus on abuse, past trauma, school suspensions and expulsions, school performance, and peer leadership A red flag for potential violence is the history of trauma or violence, either as a victim or as a perpetrator Attackers feel teased, per secuted, bullied, threatened, or injured by others before the attacks Impor tant issues to cover in the assessment include verification of the threat, as well as exploration of the ongoing intent, the focus on the threat, the intensity of the threat preoccupation, the access to weapons, and the concern expressed in the child’s environment Parents may demonstrate pathological levels of denial, indicating a chaotic home environment, a highly conflicted parent child relationship, and inadequate limit setting Contemporary models of antisocial behavior recognize both social and biological factors, reflecting the assumption that both types of factors inter Evaluation of Externalizing Symptoms 247 play in a complex fashion to influence the development and persistence of antisocial behaviors Genetic influences are suggested for lifelong, persistent antisocial behaviors rather than for adolescence-limited behaviors (Popma and Vermeiren 2008) (see Note at the end of this chapter) Research in creasingly shows that multiple genes are simultaneously involved to create the susceptibility for antisocial behavior Otnow Lewis’s (1991) advice to clinicians working with children with con duct disorder is particularly applicable to those dealing with aggressive and vi olent behaviors: “Clinicians are obliged to attempt to overcome the negative feelings toward the child that may be aroused by the child’s frightening and obnoxious behaviors One must embark on the evaluation of a behaviorally disturbed child with curiosity and an open mind” (p 571) Negative responses toward the patient (i.e., countertransference) may interfere with the clinician’s ability to thoroughly and systematically assess these children If the clinician knows in advance that the child is likely to be aggressive or self-abusive, he or she should make preparations beforehand to meet the child’s special needs No matter how syntonic a child’s aggression seems to be, the clinician should assume that the child is anxious about, if not afraid of, the possibility of losing control If the child appears to have this anxiety, the exam iner should reassure the child that every effort will be made to help him to stay under control or to regain control, if needed The examiner may need to con sider psychopharmacological interventions, hospitalization, or other options The diagnostic interview should be stopped if the examiner becomes con cerned with his or her personal safety If this happens, the examiner should take the steps needed to prevent the patient from injuring anyone During the evaluation of a volatile, labile, or aggressive adolescent, the ex aminer should avoid provoking the patient any further The examiner should also be attentive to signs that the patient is about to lose control Regard less of the etiology of the aggressive behavior, all communications and inter ventions need to take into account that the patient is struggling to maintain self-control and is experiencing an ongoing disturbance with his or her sense of self—a narcissistic disturbance that needs to be identified, abreacted, un derstood, and if possible repaired Something has injured the patient’s self esteem and the patient’s narcissism to the point that he needs to resort to ag gressive behavior to restore his self-worth (i.e., to repair the perceived injury) If the examiner knows the nature of the injury, he should offer empathic com ments regarding the perceived injury, evaluate the patient’s response to such comments, and explore alternatives to deal with the identified injury The examiner will be more successful if he assesses aggression in this broader context and prudently assumes that the patient may lose control at perceived provocations 248 Psychiatric Interview of Children and Adolescents Depending on the individual case, the patient may appear defensive, sus picious, fearful, or ashamed If the patient feels humiliated or has been hu miliated, he or she may anticipate further humiliation or even retaliation for aggressive, hateful, and vengeful feelings Some adolescents who are strug gling with aggressive feelings may experience shame or guilt secondary to intense anger and the fear of losing control The examiner should explore para noia and other psychotic features exhaustively The examiner’s emphasis in dealing with aggressive adolescents is to de termine their propensity for violence and to establish whether such adoles cents are at imminent risk of losing control If the examiner determines that the patient is on the verge of losing control, the examiner needs to be extra cautious in his or her approach and demeanor and should be particularly ju dicious with his or her words Regardless of the nature of the aggression, the examiner’s priority is to help the patient regain a sense of self-control Lion (1987) expressed this princi ple in the following manner: “The evaluator’s goal [when meeting belligerent and violent patients], whenever possible, is to convert physical agitation and belligerence into verbal catharsis This principle holds true irrespective of the etiology of the patient’s violence” (p 3) Because a history of violence is the best predictor of future violence, the ex aminer should make a comprehensive inquiry into this area The following questions may be pertinent: Has the child ever lost control? What has been the nature of the child’s dyscontrol? Has the child ever hurt someone? Does the child intend to harm someone? Has the child developed a plan to kill someone? The examiner should remember his duty to protect potential victims Many adolescents exhibit a facade of bravado or a bullish attitude The examiner should take these surface behaviors seriously An attempt to chal lenge these defenses carries a serious risk and is not recommended; the child might act out to prove to the examiner that she can what she says By stress ing the dangerousness of threatened behaviors and highlighting the poten tial risks of what the adolescent is contemplating or the repercussions of the intended behaviors, the examiner may help the adolescent to take another look at his intentions and may also help the adolescent to better understand his potential for acting out Being honest, direct, and compassionate are indispensable qualities in building trust with aggressive children When adolescents have grown up in deceptive and manipulative environments, they expect that everyone else (the examiner included) will try to put something over on them or to “con” them If being honest and direct are indispensable qualities, they are of particular importance when dealing with hostile and assaultive adolescents Issues need to be discussed plainly and directly Index Genetics additive genetic influence, 410n6 environment in behavioral genetics, 410n6 epigenetic regulation, 408n2, 409n5 hereditary factors of attention deficit/hyperactivity disorder, 367n8 non-additive genetic influence, 410n6 quantitative genetic theory, 410 schizophrenia and, 371n14 susceptibility for antisocial behavior, 270n2 X chromosome in intellectual development disabilities, 335 Glutamatergic agents, 372n18 Goal directedness case examples, 180, 181–182 Grandiosity, 257, 262 Graphesthesia, 365n4 Guilt, 202 case examples, 202–203 Guns See Firearms Hallucinations, 185, 189–190n1, 352–353 auditory, 290 autoscopic, 186 case example of preschooler with, 153–154 command auditory, 288 Halstead-Reitan Neuropsychological Battery advantages and disadvantages, 316 Harassment, online, 275 Hare PCL: Youth Version, 270n1 HCR-20, 269–270n1 Health Insurance Portability and Accountability Act of 1996 (HIPAA), 122n3 Highly structured interviews, 51n1 examples of, 51n1 HIPAA (Health Insurance Portability and Accountability Act of 1996), 122n3 489 Holding, during diagnostic assessment, 55–57 Homicidal behavior, 244–253 Hopelessness, 203–204 Hospitalization sample formats/ documentation, 449 Human behavior comprehensive psychiatric formulation and, 398n1 Huntington’s disease, 362 Hypersexuality, 362, 262 Hypochondria, 186 Hysteria, epidemic, 292 ICD-10, psychiatric formulation development in, 373 Ideas of reference, 186 Ideo-affective dissociation, 184 Ideokinetic praxis, 307–308 Ideomotor praxis, 307–308 ID/IDD See Intellectual disability (intellectual developmental disorder) Illness children with serious acute or chronic medical illness, 123–124 in the family, 101–102 case example, 101–102 Illusion, 185 Immigrants, children of undocumented, 140–141 Impulse-control difficulties, 342 Inattention, 149 Infant-Toddler Social and Emotional Assessment (ITSEA), 160, 164n8 Informants multiple, 143–144 Inhibition, 211 Inner language, 314 Innocent lying, 292 Insight during psychiatric examination, 180, 189 Institutional rearing, 149 490 Psychiatric Interview of Children and Adolescents Insulin, 402 Intellectual disability (intellectual developmental disorder; ID/IDD), 126–128 differential diagnosis of, 149 in DSM-5, 126 Intelligence, 167, 179 Intergenerational boundaries, 95–96 Internalizing symptoms, evaluation of, 191–238 anxious symptoms, 209–214 case example, 209–211 elective mutism, 213 fears, 212 features within the family, 213 case example, 214 mood disorders, 214 physical and sexual abuse, 213 separation anxiety, 212 social phobia, 212–213 somatization, 213 worrying, 212 cognitive testing, 238n7 depressive symptoms, 200–209 academic problems, 205 anhedonia, 203 cardinal features, 200 comorbidities, 205 constitutional factors, 201 differential diagnosis, 207–209 case example, 208–209 emotional withdrawal, 203 family factors, 206 feeling tired, 204 feeling unloved, 201 guilt, 202 case examples, 202–203 hopelessness, 203–204 illegal drug use, 205 irritability, 201–202 maternal depression, 206 mood disorders in father, 206–207 negative cognitions, 205 overview, 200 psychomotor activity, 205 psychotic features, 205–206 sleep problems, 204 weight changes, 204 eating disorders, 220–222 neurological screening, 237n6, 237n7 obsessive-compulsive behaviors, 214–220 case examples, 216, 219–220 common symptoms in children and adolescents, 219 obsessive-compulsive disorder spectrum, 217–218 occupational therapy assessment, 237n6 overview, 191 physical examination, 237n6, 237n7 projective testing, 237n6, 238n7 psychological testing, 237n6, 238n7 psychotic symptoms case example, 226–233 developmental events and precursors of very-early onset and early-onset schizophrenia, 224 differential diagnosis between pediatric mania and very early-onset schizophrenia, 225 instruments used in diagnosis of schizophrenic disorders in childhood and adolescence, 229 schizoid symptoms, 233–234 case example, 233–234 suicidal behaviors, 191–200 areas of inquiry in examining children who have attempted suicide, 199 factors that affect bereavement risk after parental death, 197 frequency of suicidal thoughts, 193–194 Index nature of, 192–193 plans the child has conceived, 193 THIS PATH IS DEATH mnemonic for suicidal assessment, 195 time and place plan, 193 Internalizing symptoms, evaluation of psychotic symptoms, 222–233 Interpersonal skills difficulties with, 350–351 Interpersonal theory, 385–386 Interviewer bias, 285 Interview for Childhood Disorders and Schizophrenia, 229 Interviews of children from minority populations, 135–136 of children in out-of-home placement, 136–138 of children living in poverty, 135 of children with burn trauma, 124–125 of children with cerebral palsy, 128–129 of children with intellectual disability, 126–128 of children with neurodevelopmen tal disorders, 126 of children with neurogenetic disorders, 129–135 Angelman syndrome, 131–132 Chromosome 22q11.2 deletion syndrome/velocardiofacial syndrome, 133 Down syndrome, 130–131 Fragile X syndrome, 129–130 overview, 129 Prader-Willi syndrome, 131 Rett syndrome, 133–135 Smith Magenis syndrome, 132 Turner syndrome, 132 Williams syndrome/WilliamsBeuren syndrome, 132–133 491 of children with posttraumatic stress disorder related to terrorism, 139–140 of children with serious acute or chronic medical illness, 123–124 comprehensive psychiatric formulation, 373–400 countertransference, 429–440 diagnostic and therapeutic engagement, 1–13 in interviewing families, 426–427 diagnostic obstacles (resistances), 411–427 case examples of severe interview ing obstacles, 422–426 classification, 414–426 in interviewing families, 426–427 case example of, 426–427 pseudo resistances, 414–415 true resistances, 415–416 of displaced and refugee children, 138–139 documenting the examination, 165–190 emotional interference with, 431 evaluation of internalizing symptoms, 191–238 family assessment, 93–112 general principles of interviewing, 15–52 of migrant children, 138 neuropsychiatric interview and examination, 297–372 process of, 1–2 psychiatric evaluation of preschoolers and very young children, 143–164 sample formats/documentation, 439–451 special interviewing techniques, 53–92 confrontation as engagement technique, 57–59 case example, 57–58 492 Psychiatric Interview of Children and Adolescents Interviews (continued) special interviewing techniques (continued) double chair technique, 64–67 case examples, 64–67 drawing techniques, 69–84 case examples, 70–84, 73–77, 79–84 sequence of requested diagnostic drawings, 71 gathering collateral information, 53 interviewing in displacement, 60–61 case examples, 60–61 limit setting during psychiatric examination, 54–55 case example, 54–55 nonverbal techniques when interviewing children and adolescents, 67–69 case example, 68–69 overview, 53 physical holding during diagnostic assessment, 55–57 case example, 56–57 play techniques, 84–90 case examples, 85–90 elements of child’s subjective world, 85 prospective interviewing, 90–92, 91–92 psychiatrist’s role enactment during psychiatric examination, 63–64 case example, 63–64 use of role reversal during a child or adolescent interview, 62–63 case example, 62–63 of undocumented immigrants, 140–141 Interview Schedule for Children (ISC), 51n1 Involuntary movements, 173 abnormal posture and, 303–304 IQ, 127, 311–312, 323 See also Fragile X syndrome; Intellectual disability (intellectual developmental disorder) low, 155 Irritability, 156 as depressive symptom, 201–202 ISC (Interview Schedule for Children), 51n1 ITSEA (Infant-Toddler Social and Emotional Assessment), 160, 164n8 I WATCH DEATH mnemonic, 325 Judgment impairment, 262 during psychiatric examination, 180, 188 Ketamine, 372n18 KIDDIE–Positive and Negative Syndrome Scale (PANSS) Interviewer Parent/Child, 229 Klüver-Bucy syndrome, 362 K-SADS (Schedule for Affective Disorders and Schizophrenia for School Aged Children), 51n1, 229 Kyphosis, 134 Lamotrigine, 372n18 Language See also Nonverbal interviewing techniques communication, 308 development, 162n3 developmentally appropriate terms and phrases for communicating with children, 37 disorders, 234, 335–337 disturbances, s149, 353 inner, 314 receptive and expressive function, 308–309 receptive difficulties, 175 Index unidentified disorders, 171–172 use of developmentally attuned language with preadolescents, 36–37 Laterality, 306 “Leakage,” 246 Learning disabilities difficulties with, 335 interviewing children with, 314, 315, 318–321 case example, 318–320 Legislation Affordable Care Act, 100 Health Insurance Portability and Accountability Act of 1996 (HIPAA), 122n3 Limit setting, 54–55 Lithium, 402 Logic, during psychiatric examination, 180, 180 Love, feeling unloved, 201 Luria-Nebraska Neuropsychological Battery advantages and disadvantages, 316 Lying, 292 Magnetic resonance imaging (MRI), 311, 364–365n3, 365n5 Major depressive disorder, 408–409n3 Mania, 172 case example, 255–256, 256n1 diagnosis of, 270n3 differential diagnosis between pediatric mania and very-early onset schizophrenia, 225 DSM-5 criteria for symptoms, 244 symptoms in children, 254 MAOA (monoamine oxidase A), 270n2 Marriage, as subsystem of family, 95 See also Parents Meaningfulness, 49 Melancholia, 346–347 Memantine, 372n18 Memory, 177–178 disturbances, 290 493 episodic, 337 immediate, 310 impairments (amnesias), 337–340 case example, 338–340, 368–370n11 long-term, 310 procedural, 337 semantic, 337 short-term, 310 working, 337 Mental status examination of child with neuropsychiatric disorder, 302–303 completing during diagnostic interviewing, 30–31 sample formats/documentation, 443 Metaphorical thinking during psychiatric examination, 180, 180 Metapsychological profile, 376 Metformin, 402 N-methyl-D-aspartate antagonists, 372n18 Methylphenidate, 122n4 Migrants, 138 Minorities acculturation, 136 children from minority populations, 135–136 Miscommunication, 292 Misinterpretation, 292 Monoamine oxidase A (MAOA), 270n2 Mood disorders, 156–157, 335, 403 coherence, 180, 180 description of, 176 dysregulation, 343–438, 262 evaluation of internalizing symptoms, 214 in father, 206–207 logic, 180, 180 metaphorical thinking, 180, 180 Mother assessment, 150–152 maternal depression, 100, 206, 236n3, 406 494 Psychiatric Interview of Children and Adolescents Mother (continued) maternal pathology and attachment subtypes, 148, 150 psychological stability of, 151 unmarried, 151–152 Motor skills disturbances, 353 fine, 305 gross, 304–305 MRI See Magnetic resonance imaging Multiaxial assessment, 144–145 Multicultural perspective, 144 Mutism, elective, 213 Negative evidence, 121n1 Neurocutaneous disorders, 303 Neurodevelopmental disorders, 126 elements of evaluation, 303–311 voice melody and, 176 Neurofibromatosis, 303 Neurogenetic disorders, 129–135 Angelman syndrome, 131–132 Chromosome 22q11.2 deletion syndrome/velocardiofacial syndrome, 133 Down syndrome, 130–131 Fragile X syndrome, 129–130 overview, 129 Prader-Willi syndrome, 131 Rett syndrome, 133–135 Smith Magenis syndrome, 132 Turner syndrome, 132 Williams syndrome/Williams- Beuren syndrome, 132–133 Neuroimaging studies, for obsessive compulsive disorder, 371–372N15 Neuroleptics, 172 Neuropsychiatric interview and examination, 297–372 advantages and disadvantages of commonly used neuropsycho logical batteries and individual ized approaches, 316–317 conditions indicating need for neu ropsychiatric investigation, 301 elements of neurodevelopmental evaluation, 303–311, 304 abnormal posture and involuntary movements, 303–404 abstraction ability, 310 calculating ability, 310 cerebellar function, 307 dysmorphic features, 303 executive functions, 311 information, 309 laterality and dominance, 306 midline behaviors, 306 motor skills fine, 305 gross, 304–305 orientation to time and place, 309–310 praxis, 307–308 receptive and expressive language function, 308–309 sensory functioning, 305 writing and reading, 310 elements of neuropsychiatric history, 299–301, 300 immediate, short-term, and long term memory, 310 indications for consultation and testing, 311–313 indications for neuropsychological testing, 313–314, 315 interviewing children with learning disabilities and other neuropsychiatric deficits, 314, 315, 318–321 case example, 318–320 mental status examination of child with neuropsychiatric disorder, 302–303 neuropsychiatry and psychosocial factors, 302 overview, 297–299 specific neuropsychiatric symptoms, 322–362 aggressive behavior, 349–350 Index antisocial behavior, 340–342 anxiety, 348–349 attention and concentration deficits, 322–324 autistic behavior, 355–357 chronic traumatic encephalopathy, 334 cognitive impairments, 334–335 delirium, 324–326 differential diagnosis of delirium/ psychosis, 327–328 impulse-control difficulties, 342 language disorders, 335–337 learning difficulties, 335 memory impairments (amnesias), 337–340 case example, 338–340, 368–370n11 mood and affect dysregulation, 343–348 bipolar disorder, 344–346 depression, 346–348 obsessive-compulsive disorder, 357–362 case example, 359–360 paraphilia and hypersexuality, 362 psychosis, 351–355 structural brain abnormali ties in very-early-onset and early-onset schizo phrenia, 354 regressive behavior, 330 case example, 330 seizure disorders, 329–330 case example, 329–330 social and interpersonal difficulties, 350–351 soft neurological signs, 326, 368n9 traumatic brain injury, 331–334 case example, 332–334 sequelae of, 332 Neuropsychiatric symptoms, 322–362 495 Neuropsychiatry psychosocial factors and, 302 Neuropsychological testing misconceptions, 365–366n6 Nightmare disorder DSM-5 criteria, 158 NIMH Diagnostic Interview Schedule for Children–IV, 229 Non-additive genetic influence, 410n6 Non–rapid eye movement sleep (NREM), 163n6 Nonverbal interviewing techniques, 67–69, 315 See also Language case example, 68–69 nonverbal props, 286 NREM (non–rapid eye movement) sleep, 163n6 Obesity, in children, 159 Object relations theory, 383 Obsessive-compulsive and related disorder (OCRD), 236–237n5 oxytocin and, 372n15 Obsessive-compulsive behaviors, 214–220 case examples, 216, 219–220 obsessive-compulsive disorder spectrum, 217–218 Obsessive-compulsive disorder (OCD), 100, 357–362 case example, 359–360 neuroimaging studies, 371–372n15 symptoms, 371–372n16 Obsessive-compulsive personality disorder (OCPD), 362 Occupational therapy in evaluation of internalizing symptoms, 237n6 OCD See Obsessive-compulsive disorder OCPD (obsessive-compulsive personality disorder), 362 OCRD See Obsessive-compulsive and related disorder ODD See Oppositional defiant disorder 496 Psychiatric Interview of Children and Adolescents Olweus, Dan, 295n2 Online harassment, 275 Oppositional defiant disorder (ODD), 155–156, 261–266 case examples, 263, 265–266 DSM-5 category, 340 productive and counterproductive approaches in dealing with children with, 264–265 Organigram family, 96, 98, 97, 99 Orientation, 177 Out-of-home placement, children in, 136–138 Oxytocin, 372n15 late-onset obsessive-compulsive disorder and, 372n15 Pain response, 134 PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), 358, 372n17 PANESS (Physical and Neurological Examination for Soft Signs), 326, 368n9 PANS (pediatric acute-onset neuropsychiatric syndromes), 359 PANSS (KIDDIE–Positive and Negative Syndrome Scale), 229 Paranoia, case example, Paraphilia, 362 Parents, 236n4 behavior, 252 chronic illness of, 100 concept of bad parent, 203 countertransference and, 430 death of, 197 delusions of, 292 differing philosophies of, 151 dynamics of, 387 examination of mental health of, 150 with high-risk offspring, 271n4 history of domestic violence, 162–163n5 indoctrination, 292 legal/custody concerns, 113–114 marital subsystem, 95 maternal depression, 100, 206, 236n3, 406 maternal pathology and attachment subtypes, 148, 150 misinterpretations and suggestions from, 291–292 mood disorders in father, 206–207 overstimulation of children, 292 psychopathology in, 387 quality of parenting, 162–163n5 response to child’s problems, 302 role in diagnostic interviewing, 16 self-dysregulation, 162–163n5 Parkinson’s disease, 362 Pathological lying, 292 Patient education sample formats/ documentation, 449 neuropsychiatric history, 98, 300 PATS (Preschool Attention-Deficit/ Hyperactivity Disorder Treatment), 240 Pediatric acute-onset neuropsychiatric syndromes (PANS), 359 Pediatric Advisory Committee, 122n4 Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), 358, 372n17 Pediatric mania differential diagnosis between pediatric mania and very-early onset schizophrenia, 225 Peers contamination (co-witness contamination), 286 development of relations, 386 supportive relationships with, 288 Perceptions disturbance of perception of body image, 186 Index during psychiatric examination, 185–186 Performance IQ, 312 Personal Experience Inventory, 271n6 Personality dimensions of, 398–399n2 traits and affective dysregulation, 404 Personal Screening Experience Questionnaire, 271n6 Pertinence description of, Pervasive refusal, 290 Physical abuse, 213 developmental consequences of, 287–288 developmental disruptions fostered by, 288 interviewing physically abused children, 282–286 in preschoolers, 157 Physical and Neurological Examination for Soft Signs (PANESS), 326, 368n9 Pioglitazone, 402 PLASTIC, 352–353 PLASTRD, 325 Playfulness, 169–170 Play techniques, 84–90 See also Toys, required for diagnostic examination case examples, 85–90 elements of child’s subjective world, 85 pretend, 149 Positive evidence, 121n1 Positron emission tomography, 364n2 studies, 335 Posttraumatic stress disorder (PTSD) of children with burn trauma, 124–125 differential diagnosis of, 149 related to terrorism, 139–140 Posture, 168–169 abnormal, and involuntary movements, 303–304 497 Poverty, children living in, 135 Prader-Willi syndrome, 131–132, 303 Praxis, 307–308 Preadolescents See also Adolescents; Children strategies for evaluation, 32–34 toys required for diagnostic examination, 33, 34 use of developmentally attuned language with, 36–37 Preschool Age Psychiatric Assessment, 160 Preschool Attention-Deficit/ Hyperactivity Disorder Treatment Study (PATS), 240 Preschoolers depression in, 157 identified child as, 109–111 case example, 110–111 physical abuse in, 157 psychiatric evaluation, 143–164 case example, 110–111 sexual abuse in, 157 Problem Oriented Screening Instrument for Teenagers, 271n6 Process interviewing, 38–39 case example, 38–39 Pseudologic phantastica, 292 case example, 293–294 versus confabulation, 293 Psychiatric assessment documentation, 11 eye contact during, 11 limit setting during, 54–55 preparation for psychiatric examination, 16–17 of preschoolers and very young children, 143–164 assessment domains, 146–147 assessment of mother or caretaker, 150–152 attachment and bonding, 145–148 common psychopathology in, 153–160 498 Psychiatric Interview of Children and Adolescents Psychiatric assessment (continued) of preschoolers and very young children (continued) case example, 153–154 conduct disorder, 155–156 mood disorders, 156–157 oppositional defiant disorder, 155–156 psychosis, 159–160 sleeping disorders, 157–159 developmental scales, 160–161 differential diagnosis of attachment disorders and other psychiatric conditions, 149 maternal pathology and attachment subtypes, 148, 150 multiaxial assessment, 144–145 multicultural perspective, 144 multiple experts, 144 multiple informants, 143–144 multiple modes of assessment, 144 multiple sessions, 143 observations of child, 152–153 sample formats/documentation, 440–449 Psychiatric examination appearance, 166–169, 167 gait and posture, 168–169 physical, 167–168 behavior, 167, 169–176 behavioral evidence of emotion, 173–174 behavioral organization, 171 cooperative, 171–172 disturbances of attention, 174 exploratory, 169 eye contact, 170–171 involuntary movements, 173 playfulness, 169–170 psychomotor activity, 172 relatedness, 170 repetitive activities, 174 countertransference and, 429–440 diagnosis sample formats/ documentation, 448 documentation of, 165–190 mood and affect, 176–189 intelligence, 167, 179 sensorium, 177–179 calculating ability, 178 concentration, 178 memory, 177–178 orientation, 177 thought, 179–189 abstracting ability, 180, 188–189 associations, 184–185, 180 coherence, 180, 180 content, 188, 180 delusions, 180, 186–188 goal directedness, 181–182, 180 insight, 189, 180 judgment, 188, 180 logic, 180, 180 metaphorical thinking, 180, 180 perceptions, 185–186 reality testing, 180, 182–184 speech, 167, 174–176 disturbances of speech melody, 175–176 using AMSIT, 165–166 elements of appearance, behav ior, and speech for children and adolescents, 167 elements of thought section for children and adolescents, 180 Psychiatric sessions, 143 Psychiatrist failure to diagnose, 403 interface with school and other systems, 118 role enactment during psychiatric examination, 63–64 case example, 63–64 role in engagement, skills, 411–412 Index Psychomotor activity, 172, 263 as symptom of depression, 205 Psychosis description of, 179 differential diagnosis of, 327–328 psychiatric assessment, 159–160 structural brain abnormalities in very-early-onset and early onset schizophrenia, 354 symptomatology for bipolar disorder, 263 in violent youths, 252 Psychotic features developmental events and precur sors of very-early-onset and early-onset schizophrenia, 224 differential diagnosis between pediatric mania and very-early onset schizophrenia, 225 evaluation of internalizing symptoms, 222–223 instruments used in diagnosis of schizophrenic disorders in childhood and adolescence, 229 as symptoms of depression, 205–206 Psychotic spectrum syndrome, 222 Psychotropic medications, 119–120 risks, 120 PTSD See Posttraumatic stress disorder Quantitative genetic theory, 410n6 Questioning in assessing external factors, 389 behavioral incidents, 24 CRAFFT, 267 denial of specific questions, 24 gentle assumptions, 24 open and leading, 34–35 repeated specific questions, 285 repeated suggestive interviews, 285 representing issues to be resolved in validation of sexual abuse, 281–282 499 in sexual abuse, 283 stereotyped induction (vilification), 285 systemic case examples, 185–186 “yes” or “no” questions, 285 Rape, case example, 47 Rapid eye movement sleep (REM), 163–164n6 Rapport with children and adolescents, description of, Reactive attachment disorder, differential diagnosis of, 149 Reading, 310 Reality testing, 180, 182–184 Reasoning, diagnostic, 122n1 Refugees, 138–139 Relatedness, 170 Relevance, description of, Religion, 95 REM (rapid eye movement) sleep, 163–164n6 Repetitive activities, 174 Restlessness, 149 Retrograde amnesia, 177 Rett syndrome, 133–135 Reverse engagement, 12–13 conduct disorder, 12 disinhibited social engagement disorder, 12 Riluzole, 372n18 Role reversal use during child or adolescent interview, 62–63 case example, 62–63 Rorschach Inkblot Test, 312 SAD (social anxiety disorder), 408n1 Safety, 116–117 Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS), 51n1, 229 Schizoid disorders, 234 500 Psychiatric Interview of Children and Adolescents Schizophrenia case examples, 229–232, 237–238n7 cognitive impairments in, 371n14 developmental events and precursors of very-early-onset and early-onset schizophrenia, 224 differential diagnosis between pediatric mania and very-early onset schizophrenia, 225 instruments used in diagnosis of schizophrenic disorders in childhood and adolescence, 229 structural brain abnormalities in very-early-onset and early onset schizophrenia, 354 symptoms case example, 233–234 very-early-onset, 222 School academic problems, 364n2 academic problems as symptom of depression, 205 bullying in, 273–274, 388 case examples, 276–280 grades, 278 “phobia,” 278 positive adaptation to, 288 Scoliosis, 134 SED (socioeconomic disadvantage), 363–364n1 Seizure disorders, 329–330 case example, 329–330 Selective serotonin reuptake inhibitor (SSRI) antidepressants, 172 Self-esteem, 288 Self psychology, 384 Self-regulation, 322 Semistructured interviews, 51n1 examples of, 51n1 Sensory functioning, 305 Sensory loss, 365n4 Sensory phenomena, 359 Sentence Completion Test, 312 Separation anxiety, 212 Separation Anxiety Test, 162n3 Separation-individuation theory, 384 Sexual abuse, 121n2–3, 213, 480–490 See also Child abuse case example, 208–209 children’s false reports, 286 developmental disruptions fostered by, 288 example of interviews with, 285–286 first interview with, 286 interviewing sexually abused children, 282–286 moral and legal implications of patient's disclosures, 284 in preschoolers, 157 psychiatric disturbances observed in, 289 questions representing issues to be resolved in validation of, 281–282 reliability of child, 284–285 Sexual behavior, 30 Sexual identity, case example, 47–48 Single photon computed tomography, 364n2 Sleep See also Nightmare disorder central nervous system and, 163n6 disruption, 159 impaired, 134 NREM, 163n6 REM, 163–164n6 slow-wave, 163n6 as symptom of depression, 204 Sleeping disorders, 157–159 in DSM-5, 158 Sleepwalking, 159 Slow-wave sleep, 163n6 Smith Magenis syndrome, 132 SNS (soft neurological signs), 326, 368n9 Social anxiety disorder (SAD), 408n1 Social (pragmatic) communication disorder DSM-5 criteria, 350–351 Index Social phobia, 212–213 Social skills difficulties with, 350–351 reciprocity, 356 strategies for teaching, 295n4 Socioeconomic disadvantage (SED), 363–364n1 Soft neurological signs (SNS), 326, 368n9 Somatization, 213 Specificity, 49 Speech, 167 disorders, 308 disturbances of speech melody, 175–176, 353 during psychiatric examination, 174–176 SSRI (selective serotonin reuptake inhibitor), 172 Stimulants, 122n4 Strange Situation, 145, 161–162n1 Stressors attachment and, 162–163n5 definition of, 402 in displaced and refugee children, 138–139 financial, 102 vulnerability to, 403 Structured Assessment of Violence Risk for Youth, 270n1 Structured interviews, 31–32, 511–2 Sturge-Weber-Dimitri syndrome, 303 Subaffective temperament, 201 Substance abuse, 118, 267–268 examiner’s inquiry of, 29 Substance Abuse Subtle Screening Inventory, 271n6 Substance use disorders (SUDs), 267–268 SUDs (substance use disorders), 267–268 Suffocation, 191 Suicide areas of inquiry in examining children who have attempted suicide, 199 501 case examples, 38–39 of family during interview involving adolescent threatening suicide, 107–109 of observations of family with suicidal adolescent, 105–107 death, 295n1 involving bullying, 295n1 multiple attempts of, 194 risk assessment sample formats/ documentation, 445 statistics, 235n symptoms of suicidal behaviors, 191–200 frequency of suicidal thoughts, 193–194 THIS PATH IS DEATH mnemonic for suicidal assessment, 195 Sullivan, Herbert (“Harry”) Stack interpersonal theory, 385–386 Supernatural influences, 95 Symptom formation and comorbidity, 401–410 avoidant personality disorder, 408n1 bipolar disorders, 402 case example, 405–406 failure to diagnose, 403 maternal depression, 406 personality traits and affective dysregulation, 404 psychodynamic constellations, 401 response to loss, 401 social anxiety disorder, 408n1 stress, 402 type diabetes mellitus, 402 T2DM (type diabetes mellitus), 402 Tangentiality, 181 Tarasoff vs Regents of the University of California, 24, 117 Target detection, 323 Target selection, 323 502 Psychiatric Interview of Children and Adolescents Teen Addiction Severity Index, 271n6 Temperament, 404 definition of, 398–399n2 dysregulation, 201 Terrorism, children with posttraumatic stress disorder related to, 139–140 Thematic Apperception Test, 312 Therapeutic monitors, 295n3 THIS PATH IS DEATH mnemonic, 195 Thought, 179–189 abstracting ability, 180, 188–189 associations, 180, 184–185 content, 180, 188 delusions, 180, 186–188 goal directedness, 180, 181–182 insight, 180, 189 judgment, 180, 188 perceptions, 185–186 sample formats/documentation, 444 Thought disorder, description of, 179 Threats, 295n1 Time and place orientation, 309–310 Tired, as symptom of depression, 204 Topiramate, 372n18 Tourette’s disorder/Tourette’s syndrome (TS), 335, 361, 362 Toys, required for diagnostic examination, 33, 34 See also Play techniques TRACK CHAOS mnemonic, 325–326 TRacking Adolescents’ Individual Lives Survey (TRAILS), 275 TRAILS (TRacking Adolescents’ Individual Lives Survey), 275 Traumatic brain injury, 331–334 case example, 332–334 sequelae of, 332 Truthfulness assessment in abused children, 291–294 case examples, 291, 293–294 description of, TS (Tourette’s disorder/Tourette’s syndrome), 335, 361, 362 Tuberous sclerosis, 303 Turner syndrome, 132 Type diabetes mellitus (T2DM), 402 bipolar disorders and, 402 Unstructured interviews, 31, 51n1 Velocardiofacial syndrome, 133 VEOS See Very-early-onset schizophrenia Verbalization, 314 Versatility, 49–50 Very-early-onset schizophrenia (VEOS), 237n6 case examples, 226–233 developmental events and precursors of, 224 structural brain abnormalities in, 354 symptoms, 222 Vigilance, 323 Violence dating, 244–245 evaluation of potential, 245 “leakage,” 246 short-term, 246 Violence Risk Appraisal Guide, 269–270n1 Wechsler Intelligence Scale for Children—4th Edition (WISC-IV), 311–312 Weight, changes, as symptom of depression, 204 Williams-Beuren syndrome, 132–133 Williams syndrome, 132–133 differential diagnosis of, 149 WISC-4 (Wechsler Intelligence Scale for Children—4th Edition), 311–312 Word salad, 184 Worrying, 212 Writing, 310 “Many worry that in modern psychiatry the compassionate and in-depth interview of the child and family with mental health issues will become a lost art Dr Cepeda’s excellent book will en sure that this does not happen Using engaging case histories, Dr Cepeda illustrates complex interview techniques in a way that makes them easy to implement in the clinic Those new to child and adolescent psychiatry can learn all the basics of interviewing here, while the experienced clinician will find new ways to hone their skills The book provides a clear roadmap for both a complete mental status examination and formulation The book is a great resource for seminars on diagnostic interviewing.” Steven R Pliszka, M.D., Dielmann Distinguished Pro fessor and Chair, Department of Psychiatry, The University of Texas Health Science Center at San Antonio Eliciting useful information from young patients and their fam ilies is both a skill and an art, and Psychiatric Interview of Children and Adolescents, an exceptionally practical and comprehensive guide, enables mental health clinicians and trainees to first improve their interviewing skills and then organize and integrate the information derived from the interview to construct an effective treatment program This book, building on the success of its predecessor, Clinical Manual for the Psychi atric Interview of Children and Adolescents, offers updated and revised material, as well as expanded coverage that includes new findings and ad dresses emerging issues in the field For example, a new chapter focusing on the psychiatric evaluation of preschoolers and very young children has been added, and the section on bullying in the chapter on abuse has been expanded to include cyberbullying Clinical vignettes illustrate important concepts and techniques, providing a real-world component that readers will find both fascinating and instructive, and the key points at the end of each chapter and numerous quick-reference tables facilitate consolidation of learning Easy to read, yet rigorous in its clinical focus, Psychiatric Interview of Children and Adolescents provides a solid foundation and expert guidance for clinicians evaluating and treating this critically important population Cover design: Tammy J Cordova Cover images: © igorstevanovic and Yuri Getanov Used under license from Shutterstock ... strive to determine the history and epigenesis of ag gressive behaviors Aggressive children frequently have a history of problem 25 2 Psychiatric Interview of Children and Adolescents atic temperament,... diagnosis of disruptive mood dysreg ulation disorder to include clinical presentations of children and adolescents 25 4 Psychiatric Interview of Children and Adolescents with history of chronic... motivation, in 24 6 Psychiatric Interview of Children and Adolescents cluding why people are included on the “hit list” (Ash 20 08) Ash (20 08) stated the importance of reducing the availability of weapons,