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Assessing Serious Emotional and Behavior Difficulties in Children and Adolescents

New York (Apr 29, 2010)

Troubled Boy

Has your child's behavior suddenly changed?

Where once your eight-year-old daughter was easy-going and well behaved, is she now anxious or exhibiting disruptive behavior in school? Or, does your teenage son seek isolation from his family and friends and are his once-high grades now dramatically slipping? Perhaps your teenager's school has also noticed this unexplained behavioral change that is causing him to have many obvious difficulties with learning and socializing.

"These types of sudden changes in behavior are the warning signs we encourage families and schools to look out for," says Erica M. Chin, PhD, Director of Assessment in the Child and Adolescent Psychiatry Division at NewYork-Presbyterian Morgan Stanley Children's Hospital. "They can indicate that a child or adolescent may have a psychiatric illness that needs to be immediately addressed."

Before emotional and behavioral difficulties can be addressed, they must first be assessed. In the Division's Assessment Clinic, a multidisciplinary team of child and adolescent psychiatrists, psychologists, social workers, and a psychometrician (a professional skilled in the administration and interpretation of objective psychological tests) provides comprehensive psychiatric diagnostic evaluations for children and adolescents. To guide these professionals in making an accurate diagnosis on what is causing the children—ages 4 to 19 years—to exhibit behavior that is of concern to their families and their schools, the evaluation process includes:

  • an initial telephone screening interview with one of the patient's parents or caregivers
  • a battery of tests ranging from psycho/educational to neuropsychological screenings
  • in-depth and in-person separate interviews with the patient and the parents or caregivers
  • compilation of relevant information from the patient's family, pediatrician—and if the parents or caretakers consent—from the school and sometimes unrelated adults, such as an after-school music teacher, who may be able to provide additional insights

The assessment process requires between three and four visits to the clinic. "Our focus," Dr. Chin says, "is to obtain a sense of the whole child. And that's why our evaluation process is so comprehensive."

Once the evaluation is completed, the team presents its diagnosis and recommends a course of treatment that often includes psychotherapy and/or psychopharmacology (the use of medications to treat mental or psychological disorders). The team may refer the young patient to one of the Child and Adolescent Psychiatry Division's subspecialty clinics—such as the Children's Anxiety and Depression Clinic or the Disruptive Behaviors Disorder Clinic—or to school-based programs, community-based programs, or back to the pediatrician who manages the child's medications.

Other recommendations may include a consultation with the school, further psychological testing, and/or case management to coordinate all necessary treatment and support services.

Because the family plays such a key role in the child's progress, the assessment team sometimes suggests family therapy along with psychological education and ongoing support for the parents and caregivers to help them understand the diagnosis and treatment and how they can best help their child.

Parenting and advocacy groups are also available through the Child and Adolescent Psychiatry Division, which offer additional support such as steering the family to community-based resources and providing guidance on how to navigate the school system when the child has learning disorders or special needs.

"Ultimately," says Dr. Chin, "we want to help educate and empower families that come into our program so that they're best able to support the needs of their children. And we want the children and adolescents who come here to feel comfortable and understood."

To request an evaluation at the Assessment Clinic, please contact the intake coordinator at (212) 305-0924.

Faculty Contributing to this Article:

Erica M. Chin, PhD, Director of Assessment, Division of Child and Adolescent Psychiatry, NewYork-Presbyterian Morgan Stanley Children's Hospital

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