INTERNATIONAL MENTAL HEALTH NETWORK, LTD.
P.O. Box 578
Poway, CA 92074-0578
Phone: (858) 486-9745
Fax: (858) 486-9760
E-mail: nac01@juno.com
Booklets and answer sheets available from Pro-Ed: (800) 211-8378
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S A M P L E P R O F I L E
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INTERNALIZING SYMPTOMS SCALE FOR CHILDREN (ISSC)
Children's Interpretive Profile
INTERNATIONAL MENTAL HEALTH NETWORK, LTD.
2150 East Tahquitz Canyon, Suite 10
Palm Springs, CA 92262
Phone: (760) 320-9553
Fax: (760) 320-0079
E-mail: nac01@juno.com
TC: 1518
FACILITY ID: 123
SOCIAL SECURITY NUMBER: 111-11-1111
LAST NAME: Doe
FIRST NAME: John
GENDER: Male
AGE: 13
RACE: White
HIGHEST GRADE COMPLETED: 7
DATE OF TESTING: 08/01/1999
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This profile is confidential and is developed for use by professional staff
only. Its intended purpose, combined with other instruments, is to delineate
directions for further assessment of this client. Recommendations made in
this profile do not imply that other approaches should be replaced or
modified. Statements in this profile should be interpreted as hypotheses for
further consideration in combination with other assessment factors utilized
in the individualized and comprehensive screening and selection process.
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Reviewing Professional Title Date
Copyright (C) 1999 IMH-Network, Ltd. ISBN 1-58028-088-9
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
NOTE TO A PROFESSIONAL
Clinical experience, as well as numerous studies of children with a
potential for development of a spectrum of internalizing behaviors, indicate
that this population is characterized by a complex array of psychological,
personality, and behavioral issues that distinguish them from those children
who do not have such potential. Research further provides evidence that these
types of issues, early in a child's life, may often continue into adolescence
and adult life, developing into full syndromal disorders. Among the
constellation of clinical manifestations, and their continuance into later
stages of life, are higher levels of psychiatric and physiologic comorbidity,
suicidality, violence, impulsivity, cognitive, emotional and psychological
dysfunctionality, relapse, recurrence, and numerous other issues which
require careful clinical attention.
A vast variety of influences, such as social, familial, genetic, and
contextual factors play a significant role in the process of deterioration of
what otherwise should be a normal course of a child's psychosocial
development. The internalizing domain of child psychopathology includes
over-controlled and inner-directed behaviors. Internalizing disorders tend to
be considered emotional, rather than behavioral disorders. The major
syndromes of this spectrum include depression, anxiety, social withdrawal,
and somatic problems. The externalizing domain includes undercontrolled and
outer-directed behaviors, often classified as behavioral disorders. The major
problem areas within this domain include conduct disorder, antisocial and
aggressive behavior, and attention-deficit/hyperactivity disorder (ADHD).
The intent of this interpretive profile is to address both internal and
external domains of child psychopathology and to provide a comprehensive
clinical profile which can be utilized as one of the guidelines in
optimization of therapeutic interventions and effectiveness.
The Assessment Summary presents both raw and clinical T-scores for all
components from which this profile is comprised. The score levels, which are
intended to be used as clinical base rates, are interpreted as:
LEVEL 1: no involvement, or low degree of dysfunctionality or
impairment
LEVEL 2: mild degree of involvement, dysfunctionality or
impairment
LEVEL 3: moderate degree of involvement, dysfunctionality or
impairment
LEVEL 4: significant degree of involvement, dysfunctionality or
impairment
LEVEL 5: severe degree of involvement, dysfunctionality or
impairment
No known test saturation effects exist with this inventory, and it can be
administrated repeatedly during an entire therapeutic continuum. Multiple data
sets for each patient would provide valuable information for detailed
monitoring and evaluation of both short- and long-term treatment impact and
effectiveness.
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
ASSESSMENT SUMMARY
Clinical
Raw Score T-Score Range
AREAS OF EVALUATION:
DIMENTION TOTALS
FACTOR 1: NEGATIVE AFFECT/GENERAL DISTRESS 155 115 Level 4 <<
FACTOR 2: ABSENCE OF POSITIVE AFFECT 150 210 Level 3
FACTOR 1:
DE - DEPRESSION 71 Level 4 <<
AX - ANXIETY 31 Level 4 <<
SC - SOMATIC COMPLAINTS 16 Level 4 <<
SW - SOCIAL WITHDRAWAL 37 Level 4 <<
FACTOR 2:
CB - CONDUCT DISORDER 34 Level 3
AS - ANTISOCIAL BEHAVIOR 48 Level 3
AG - AGRESSIVE BEHAVIOR 30 Level 3
AD - ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 38 Level 4 <<
DESCRIPTION OF LEVELS
LEVEL 1: Subclinical, low degree of dysfunctionality, or impairment
LEVEL 2: Mild degree of pathology, dysfunctionality, or impairment
LEVEL 3: Moderate degree of pathology, dysfunctionality, or impairment
LEVEL 4: Significant degree of pathology, dysfunctionality, or impairment
LEVEL 5: Severe degree of pathology, dysfunctionality, or impairment
<< : Area requiring immediate clinical attention and intervention
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
DEPRESSION
Raw Score = 71
CLINICAL IMPRESSIONS: John Doe is a 13 years old boy who has indicated on
this inventory that he is currently experiencing CLINICALLY VERY SIGNIFICANT
and a syndromal level of depression.
In view of the level of John's scores in this category, it is appropriate
to point out that the majority of the clinical features of depressive disorder
as diagnosed in the adult patients, have also been observed in children and
adolescents, such as dysthymia, cyclothymia, major depression, and mania.
Clinical experience has shown that child and adolescent major depressive
disorder and dysthymic disorder are often common, chronic, familial, and
recurrent conditions that usually persist into adulthood. Epidemiologic
studies indicate that the prevalence of Major Depressive Disorder is
estimated to be approximately 2% in children and 4% to 8% in adolescents,
with a male-female ratio of 1:1 during childhood and 1:2 during adolescence.
Thus, John's score level indicates that further assessment and diagnostic
clarification is necessary in order to properly intervene therapeutically.
Additionally, some researchers indicate that there may be a different
clustering of symptoms in children and adolescents than adults. There is a
more pronounced manifestation of psychomotor agitation in children, while
adolescents manifest delusions more frequently than adults. With the
psychotic type of depression, children more frequently manifest
hallucinations, while adolescents, again, will manifest delusions more
frequently. Secondary conduct disorders are frequent in both age cohorts. In
view of this, the limitations of this instrument to provide accurate
diagnosis of John's current emotional state should be taken into
consideration, and a more comprehensive battery of tests should be
implemented.
DIAGNOSTIC CONSIDERATIONS: Every child, like John, can experience occasional
mood changes, sadness, anxiety, other emotions, and exhibit a range of
unusual and sometimes undesirable behaviors. However, John's responses to
test items in this inventory indicate that an early and an accurate diagnosis
of his current emotional state is important. This is further highlighted by
the results of clinical studies which report that major depression persists
beyond two years in 6% to 10% of young patients, and that 70% have a
recurrence of depression within five years of treatment.
Depression also represents a spectrum of symptomatology which, in John's
case may be associated with other psychological and physical illnesses. It
could be either a primary disorder, or component of a manic-depressive
syndrome. Physical symptoms often accompany depression and may be related to
an underlying physical disorder. Feelings of being tired or finding it
difficult to move quickly are common. Other physiologic changes which John may
be experiencing at present, but are beyond the limits of this instrument to
detect, include: psychomotor retardation, loss or increase of appetite, loss
of energy, feelings of physical weakness, and changes in sleeping patterns.
Depressed children and teenagers often have a slumping posture and furrowed
brow.
DIFFERENTIAL DIAGNOSIS CONSIDERATIONS: Major Depressive Disorder; Depressive
Disorder NOS; Bipolar I Disorder; Bipolar Disorder NOS; Dysthymic Disorder;
Adjustment Disorder with Depressed Mood; Cyclothymic Disorder; Schizoaffective
Disorder-Depressive Type; Bereavement;
NOTE: Some of the DSM-IV diagnostic categories listed here are specific to the
adult patients only. However, their inclusion in the context of this profile
is based on numerous clinical studies indicating that there is strong evidence
of continuance between child and adolescent emotional and behavioral
disturbances and adult psychiatric disorders.
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
TREATMENT RECOMMENDATIONS: Both psychotherapy and pharmacotherapy have been
found to be beneficial for the acute treatment of youth who, like John,
exhibit this level of depressive symptomatology. Opinions vary regarding which
of these treatments should be offered first and whether they should be offered
in combination. In general, the choice of initial therapy for John would
depend on his clinical and psychosocial factors and therapist's expertise.
Psychotherapy may be the first treatment for most depressed youth like John.
However, antidepressants must be considered for those patients with psychosis,
bipolar depression, severe depressions, and those who do not respond to an
adequate trial of psychotherapy.
When formulating a treatment plan for John, some of the following steps
should be included:
- inquire about child's family and/or significant others availability
and willingness to participate in the treatment process;
- develop schedule of attendance for family members to meet with the
clinical staff both separately, and together with the child;
- explain to child importance of family involvement in his/her treatment;
- ensure that child is in agreement with the plan to involve family
members;
- initially, allow child to select family members with whom he/she is
most comfortable for participation in treatment;
- explain to family why psychiatric treatment is being recommended and how
it will be implemented;
- describe other treatment alternatives and how they compare;
- during therapy with the child alone, explore any possible causes of
discomfort with the family members not selected by the child for
participation in his/her treatment;
- begin psychosocial treatment with the education of the child and
family regarding the nature of the illness, the relapse risk factors,
and treatment options;
- educate both the child and the family members about pharmacological
treatment options;
- explain to the child and the family the known facts about the
medication's helpfulness with other individuals with similar
condition(s);
- explain how long it would take before improvement in child's condition
can be observed;
- explain and educate both the child and the family member(s) about
possible side effects of the prescribed medication, as well as
ameliorating means and procedures which will be implemented if
necessary;
- caution both the child and the family about the child's possible use
of alcohol and/or other drugs, both prescribed and illicit while on
psychopharmacological regimen;
- inquire whether the family has a private physician and whether they
would object that he/she be advised about the psychopharmacotherapy of
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
the child;
- advise and educate both the child and the family about possible
withdrawal symptoms from the prescribed medication regimen, and about
methods of amelioration and/or prevention;
- based on a careful differential diagnosis, advise and educate both the
child and the family if certain disorders/symptoms were misdiagnosed
in the past due to their high degree of coincidence with depression
such as schizophrenia, anxiety disorders, conduct disorders,
attention-deficit hyperactivity disorder, eating disorders, etc;
- monitor family's compliance and degree of involvement in child's
treatment;
- observe and monitor temporal variations/increase/ decrease in child's
comfort/discomfort with family's participation in his/her treatment;
- jointly with the child and his/her family, discuss and evaluate at
regular intervals treatment progress;
- assess if any changes in the family's dynamics and/or constellation have
taken place as a result of their involvement and participation in the
child's treatment;
- assess family's means of maintaining child's treatment regimen;
- assess degree of family's willingness to continue participating in the
child's aftercare;
- explore with appropriate professionals and agencies other resources of
support and cohabitation if return to the family is not an option;
- provide for other individuals who are willing to participate in
child's recovery an opportunity to meet with the clinical staff and
discuss treatment and aftercare options;
ADDITIONAL ASSESSMENT: In view of John's score level, an additional
component of his profile must be addressed. Mood disorders, as one of the
most prominent domains of internalization, is the diagnostic category most
often represented among persons of all ages who contemplate, attempt, and
commit suicides. Presence of a mood disorder in suicidal persons ranges from
45%, to as high as 77%. In addition to depressive disorders, anxiety, and
particularly panic attacks, are another major short-term risk factor in teen
suicide.
Suicidal ideation and attempts among young people frequently coincides
with factors such as:
a. a dissolution of a familial bond, love affair, close friendship, etc.
b. altruistic gestures for the benefit of others where young person may
perceive suicide as a way of redemption, or an attempt to relieve
someone of the burden of caring for him/her;
c. when the youth feels that he/she has failed an integration into a
family, close circle of peers, or a society in a more general sense
and thus is experiencing a profound lack of a sense of belonging, or
d. ritualistic practices endorsed by small, closed, and fanatic groups
and organizations where the self-destructive act is often promoted
as an ultimate proof of loyalty to the group and its beliefs and
ideology.
e. role of psychological factors such as impulsivity, dependence,
unrealistic expectations;
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
f. role of family history, such as susceptibility to mood disorders,
suicide, alcoholism, or bipolar illness.
Assessment of John's risk factors should include:
a. assessment and accurate diagnosis of possible comorbid psychiatric
disorder(s),
b. his medical status with a particular emphasis on factors such
as pain, recent injury, illness, malignancies, physical handicaps or
disfigurement (especially facial), etc.,
c. assessment of any previous suicide ideation and/or attempts;
d. acute factors in John's life such as dissolution of a family or
love relationship or other realistic and perceived significant
losses, substance abuse, and
e. his clinical features such as panic attacks, severe anxiety,
anhedonia, etc.
If additional assessment indicates that John is at the high risk level for
self-destructiveness, the following steps may be clinically appropriate:
a. establishing rapport with John;
b. developing an understanding of his suicidal ideation and
possible attempts, the background, events preceding them, and the
circumstances in which they occurred;
c. understanding and appreciation of John's current perception of
his problems and difficulties;
d. thorough understanding of John's personal and family dynamics and
relationships;
e. full assessment of his mental state, with particular emphasis
on the recognition of his depression, alcohol or drug abuse
(if any), and
f. an interview with his parent(s), close relative, significant
other, or a friend who knows John well.
g. assessment of family structure and dynamics, and factors which
possibly may have, or still are contributing to John's current
mental and emotional state;
Additionally, the following issues should also be addressed:
a. is he depressed, and for how long?
b. is there any evidence that he is psychotic, and for how long?
c. is he using/abusing illicit substances, and for how long?
d. has he suffered a recent family/love/friendship loss?
e. does John have any realistic plans for his own future?
f. what is his current medical status?
g. has he previously attempted suicide?
h. are John's demographic characteristics indicative of a high
risk for suicide?
i. has he recently began, or discontinued psychopharmacotherapy?
j. has he shown recently signs of self-neglect and given away
personal belongings?
k. is he able to remain oriented to the interview?
l. does he have suicidal ideas or wishes?
m. to what degree does he intend to carry out suicidal ideas?
n. does John have a detailed suicidal plan?
o. is it feasible for him to carry out the plan?
p. has he chosen a potentially lethal method?
q. has he allowed for the possibility of being saved?
r. does John have panic attacks and for how long?
s. does John feel hopeless, and for how long, and,
t. does he report a pervasive loss of interest and pleasure?
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
Affirmative answers to any of the above issues should be taken very
seriously and appropriate preventive and therapeutic interventions
implemented in a timely manner.
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I worry about things - Sometimes
- I feel cheerful - Almost Never
- I have bad dreams - Sometimes
- I feel important - Never
- Things are hard for me - Often
- I feel lonely - Often
- I have lots of energy - Never
- I have trouble sleeping - Sometimes
- I feel upset - Sometimes
- I believe I am good at lots of things - Almost Never
- I feel like I have made too many mistakes - Often
- Other kids like me - Sometimes
- I feel like crying - Sometimes
- When there is a problem, it is my fault - Often
- I do things as well as other kids - Often
- I worry that something bad will happen - Sometimes
- I like the way I look - Often
- I feel sad - Sometimes
- I feel sorry for myself - Sometimes
- I feel like being alone - Almost Never
- It is hard for me to think - Never
- I laugh and smile as much as other kids - Sometimes
- My feelings get hurt easily - Almost Never
- Nothing is fun for me - Often
- I have a hard time making up my mind - Often
- I think about hurting myself - Almost Never
- I do well in school - Sometimes
- It seems that no one cares about me - Often
- I feel happy - Never
- I feel very tired - Almost Never
- I do not feel like doing anything - Sometimes
- I like myself - Often
- I worry that people will not like the way I do things - Almost Never
- I hate it when I am the center of attention - Sometimes
- Bad things happen to me - Often
- I think about dying - Sometimes
- I feel like playing with my friends - Sometimes
- I can't do anything right - Often
ANXIETY
Raw Score = 31
CLINICAL IMPRESSIONS: John's score in this category reveals a VERY
SIGNIFICANT, syndromal level of anxiety. His vital signs should be taken and
the chief complaint identified. Symptoms such as sudden sharp pain,
appearance of sudden confusion or fugue states, dizziness, chest pains, etc.
should be regarded as indicators of possible physiological pathology.
It is important to emphasize that anxiety disorders in both children and
adults do not appear in isolation, but as part of a broad array of other
symptoms and maladaptive traits including, but not limited to, depression,
timidity, social withdrawal, lack of self-confidence, dysphoria, and
hypersensitivity.
This comorbidity of symptoms may reflect either shared etiological factors
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
(genetic, experiential, or intrapsychic) or the debilitating impact of anxiety
on John's development. Unrealistic worry about future events is a key
criterion in almost all children and adolescents with anxiety disorders.
Physiologic changes which may affect John can include: pupillary
dilatation, increased heart rate, palpitations and extrasystoles, shakiness,
paresthesias, choking or smothering sensations, sweating, temperature
sensitivity and hypersensitivity to light, noise and sound.
Character traits and behavioral patterns may include: low self esteem,
depression, obsessional thinking, ritualistic behavior and resentment.
Feelings of unreality, suddenly being scared or generalized fear of new
situations and difficulty in eating in restaurants, or, at times, even eating
alone, are other patterns. Alcoholism, substance abuse and sexual acting out
may be the adolescent and adult sequelae of childhood depression.
Developmental differences also exist in the presentation of the anxiety
disorders, and this should be taken into consideration when formulating the
final clinical picture of John. Panic disorders tend to begin in late
adolescence and peak at around 25 years of age. Manifestations of
obsessive-compulsive disorder (OCD) can occur in childhood but usually
develops fully in adulthood. The risk for generalized anxiety disorder spans a
lifetime although it appears to be the most common form of anxiety at older
ages. Studies report that depression in adolescence was a strong predictor of
generalized anxiety disorder (GAD) in adulthood.
DIAGNOSTIC CONSIDERATIONS: At least one third of children with the anxiety
levels similar to John's meet criteria for two or more anxiety disorders. Such
children, as it may be the case with John, commonly have comorbid major
depression, with comorbidity rates ranging from 28% to 47%. Clinical research
also indicates that in the case of those children there may be a strong
association between attention-deficit hyperactivity disorder (ADHD) and their
anxiety disorders.
Psychiatric diagnostic considerations for children like John who score in
this scale range usually include: anxiety state, generalized anxiety disorder,
conversion disorders, phobias, panic disorder and panic associated with the
onset of major psychoses.
DIFFERENTIAL DIAGNOSIS CONSIDERATIONS: Anxiety Disorder NOS; Separation
Anxiety Disorder; Adjustment Disorder with Anxiety; Generalized Anxiety
Disorder; Social Phobia; Substance-Induced Anxiety Disorder; Acute Stress
Disorder; Posttraumatic Stress Disorder; Agoraphobia without history of Panic
Disorder; Hyperthyroidism; Organic Brain Disorder;
NOTE: Some of the DSM-IV diagnostic categories listed here are specific to the
adult patients only. However, their inclusion in the context of this profile
is based on numerous clinical studies indicating that there is strong evidence
of continuance between child and adolescent emotional and behavioral
disturbances and adult psychiatric disorders.
TREATMENT RECOMMENDATIONS: The recommended treatment of anxiety disorders in
children like John usually involves a multimodal approach. John's
comprehensive treatment should include education of his parents about the
anxiety disorders; consultation with his school personnel and primary care
physicians; behavioral interventions; psychodynamic psychotherapy; family
therapy; and pharmacotherapy.
Psychotherapeutic interventions should be oriented toward resolving the
presence of John's chronic anxiety states. Psychosocial side effects of such
anxiety are often shown in poor planning skills, high stress levels, and
difficulty in relaxing. Reducing John's stress and increasing his overall
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
coping skills may also be beneficial in helping John. Individual therapy is
usually the recommended treatment modality. A clear distinction should be made
at the onset of the comprehensive evaluation of John to differentiate
generalized anxiety disorder from social phobia so that the proper treatment
modality for him can be chosen and implemented effectively.
When formulating a treatment plan for John, some of the following steps
should be included:
- Provide recreational and diversionary activities such as
swimming, jogging, walking, running errands, simple tasks
and repetitive activities;
- Promote sleep with comfort measures (warm bath, music,
back rub and quiet presence of a significant person);
- If child is a victim of rape, assault, abuse, or
molestation, refer to appropriate professional person
if you are unable to help child deal with the anxiety;
- Treat physical complaints matter-of-factly;
- Give positive feedback when child is symptom-free;
- Provide nutritious, regular meals;
- Maintain appropriate eye contact even when child avoids it;
- Identify the source and meaning of perceived threat;
- Sit quietly with child who cries;
- Increase child's feelings of security and control;
- Provide feedback on behavior that indicates anxiety;
- Identify behaviors that indicate that anxiety is mounting
such as restlessness, pacing, tenseness, or irritability;
- Allow specified "worry time" (e.g.. 15 minutes each day at 10 am);
- Refrain from false reassurance;
- Help child make connections between feelings of anxiety and subsequent
behavior;
- Speak slowly and calmly;
- Use simple, short sentences;
- Give brief, concise directions;
- Refrain from making demands on or requiring decisions from child;
- Enforce rules consistently;
- Respond to requests promptly;
- Discuss what relieves child's anxiety;
- Initiate problem solving when anxiety is lessened;
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
- Set limits on demands by stating clearly and simply what is expected;
- Give positive reinforcement for not exceeding limits;
- Help child participate in decisions;
- Help child learn to control behavior by setting limits
and rewarding positive behavioral changes;
- Remove child from excessive stimulation;
- Explore secondary gains child may be receiving from
others through own anxious behavior;
- Help child understand that mild anxiety levels are
sometimes inevitable and can be tolerated and managed
through strategies which can be learned/acquired;
- Explore with child range of behaviors which can
reduce anxiety level, and encourage child's
engagement of such behaviors when appropriate;
ADDITIONAL ASSESSMENT: Important areas to assess when evaluating a child
like John include history of the onset and development of the anxiety
symptoms, associated stressors, medical history, school history, family
psychiatric history, and mental status examination. A comprehensive
evaluation of John and his family structure and dynamics may include
structured or semistructured psychiatric interviews to establish or confirm
the anxiety diagnoses and comorbid psychiatric disorders. Working with John's
family may be the key way to decrease his anxiety symptoms. The aim of
therapy should be to disrupt the dysfunctional family interactional patterns
that promote his family's insecurity and to support areas of family
competence.
Because anxiety accompanies so many medical conditions, some serious, at
these score levels it is important to assess John for any medical problems or
medications that might underlie or be masked by an anxiety attack. A
comprehensive physical examination of John, and a thorough investigation of
his medical and personal history would be essential.
In addition, clinician rating scales, self-report scales, and
parent-report instruments may be used to determine types and severity of
anxiety symptomatology. It would be advantageous to include instruments from
a variety of perspectives, including those from John Doe's..
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I worry about things - Sometimes
- I have bad dreams - Sometimes
- I worry that I will hurt someone - Often
- I have lots of energy - Never
- I have trouble sleeping - Sometimes
- I feel dizzy - Sometimes
- I feel upset - Sometimes
- It is hard for me to breathe - Sometimes
- I worry that something bad will happen - Sometimes
- I get scared for no reason - Never
- My stomach hurts - Sometimes
- My head hurts - Often
- It is hard for me to sit still - Sometimes
- It is hard for me to think - Never
- I worry that people will not like the way I do things - Almost Never
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
- My hands and feet feel sweaty - Often
SOMATIC COMPLAINTS
Raw Score = 16
CLINICAL IMPRESSIONS: John has endorsed a large quantity of test items
indicating a SEVERE level of somatization. At these score levels, an
etiological basis should be considered first and a comprehensive physical
examination including a drug history should be a clinical priority.
DIAGNOSTIC CONSIDERATIONS: Among those who report high degree of somatic
complaints may be children and teenagers receiving medication (with
distressing side effects), those suffering from chronic illnesses, or those
who come from families in which there is a tendency to focus upon physical
illness. Physical complaints may involve all organ systems. Among the more
common symptoms are: headaches, neck tension, dizziness, chest pain, lower
back pain, nausea, muscle soreness, breathing difficulty, hot spells, cold
spells, numbness, tingling, bodily weakness and extremity heaviness.
In evaluating the severity of John's symptoms, it should be taken into
consideration that his score may reflect underlying physiological comorbidity,
his lack of ability to tolerate possible pain, a tendency to complain and
magnify symptoms, or the possible role of secondary gains.
Although recurrent, medically unexplained physical symptoms are not
uncommon in the children in this age group, are often associated with the
internalizing domain of psychiatric symptoms, and may represent a common
presentation of various psychiatric disturbances including poor school
performance, chronic health problems, substance use and suicidal behavior.
At times, physical complaints and depression may be present before a
diagnosis of physiological disturbance can be established. Somatization may be
associated with psychosis, significant degree of depression, or obsessive
compulsive disorders. If it is suspected that the psychological basis may
exist for the high level of John's somatization, psychiatric diagnostic
considerations at this score levels may possibly include: hypochondriasis,
somatization disorder, conversion disorder, psychogenic pain disorder,
atypical somatoform disorder, obsessional illness, depression, anxiety
disorders, histrionic personality disorder, antisocial personality disorder,
and schizophrenia.
Since physical complaints may involve all organ systems, the limitations
of this instrument to detect a wider scope of John's somatic complaints
should be taken into consideration. At this score level, some of the more
common symptoms may include: headaches, neck tension, dizziness, chest pain,
lower back pain, nausea, muscle soreness, breathing difficulty, hot spells,
cold spells, numbness, tingling, bodily weakness and extremity heaviness.
It is significant to emphasize again that with all patients who report
such high level of somatic disturbances as John did, it is advisable that his
medical and drug history be comprehensively assessed, and that he be given a
thorough medical examination in order to rule out possibility of concomitant
medical condition(s).
DIFFERENTIAL DIAGNOSIS CONSIDERATIONS: The symptom picture encountered in
Somatization Disorder is frequently nonspecific and can overlap with a
multitude of general medical conditions. Three features that suggest a
diagnosis of Somatization Disorder rather than a general medical condition
include 1) involvement of multiple organ systems, 2) early onset and chronic
course without development of physical signs or structural abnormalities, and
3) absence of laboratory abnormalities that are characteristic of the
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
suggested general medical condition. It is still necessary to rule out
general medical conditions that are characterized by vague, multiple, and
confusing somatic symptoms (e.g., hyperparathyroidism, acute intermittent
porphyria, multiple sclerosis, systemic lupus erythematosus). Moreover,
Somatization Disorder does not protect individuals from having other
independent general medical conditions. Objective findings should be
evaluated without undue reliance on subjective complaints.
NOTE: Some of the DSM-IV diagnostic categories listed here are specific to the
adult patients only. However, their inclusion in the context of this profile
is based on numerous clinical studies indicating that there is strong evidence
of continuance between child and adolescent emotional and behavioral
disturbances and adult psychiatric disorders.
ADDITIONAL ASSESSMENT: It is believed that the family plays an etiologically
significant role in patient's somatization. Although research indicates many
high symptom reporters come from dysfunctional homes, very little is known
about the more specific aspects of daily family functioning that may heighten
the risk of physical symptomatology at different developmental levels.
Assessment of John's family system and their dynamics is highly recommended.
It is often the case that identification of multiple-problem youngsters
also identifies families with a high incidence of similar problems. Parental
somatization, substance abuse, and antisocial symptoms often predict
children's somatization. Children in families with somatizing siblings often
exhibit patterns of frequent emergency room use, more suicidal behavior, and
more disability. Current research indicates that children in families of
somatization disorder adults have almost 12 times as many emergency room
visits as less severely affected somatizers, and miss nearly nine times as
much school.
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I have lots of energy - Never
- I feel dizzy - Sometimes
- It is hard for me to breathe - Sometimes
- My stomach hurts - Sometimes
- My head hurts - Often
- I feel very tired - Almost Never
- My hands and feet feel sweaty - Often
SOCIAL WITHDRAWAL
Raw Score = 37
CLINICAL IMPRESSIONS: John has scored VERY HIGH in this category which is
intended to measure a degree of a child's reluctance to engage in
interpersonal relationships, social situations and interactions, excessive
fear of unfamiliar stimuli, and behavioral withdrawal and isolation. Such
behavior is considered to be one of the major correlates of introverted
tendencies, depression, anxiety, and certain personality traits such as
schizoid personality disorder.
Children and adolescents scoring as high in this area as John did, often
feel inadequate and inferior, and may express discomfort at meeting other
teenagers, going to parties or functioning in social situations. Those with
high scores have feelings which are easily hurt, often resulting in great
defensiveness and projection to help them bolster their weak ego and sense of
low self esteem.
Sensitive youth may be argumentative, but usually can not defend their
position effectively and give in, feeling weak and despising themselves later.
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
Character traits associated with this syndrome include shyness, preference for
a limited number of peers, rather than a group, withdrawal, depressive
feelings, self-consciousness and limited social skills.
ASSOCIATED FEATURES: At this score level, it is possible that John may be
experiencing additional symptomatology which is beyond the scope of this
instrument to detect. This may include hypersensitivity to criticism, negative
evaluation, or rejection; difficulty being assertive; and low self-esteem or
feelings of inferiority. He may manifest poor social skills (e.g., poor eye
contact) or observable signs of anxiety (e.g., cold clammy hands, tremors,
shaky voice). Such children often underachieve in school due to test anxiety
or avoidance of classroom participation.
They may underachieve at school because of anxiety during, or avoidance
of, speaking in groups, in public, or to authority figures and friends and
schoolmates. In more severe cases, they may drop out of school, have no
friends or cling to unfulfilling relationships, completely refrain from
forming intimate interpersonal relationships, or remain with their family long
into adolescence and adulthood.
COURSE: Symptoms exhibited by John may be indicative of Social Phobia which
sometimes emerge out of a childhood history of social inhibition or shyness.
Some individuals, like John report an onset in childhood. Onset may suddenly
follow a stressful or humiliating experience, or it may be slow and
insidious. The course of Social Phobia and social withdrawal is often
continuous. Duration is frequently lifelong, although the disorder may
attenuate in severity or remit during adulthood. Severity of impairment may
fluctuate with life stressors and demands.
DIAGNOSTIC CONSIDERATIONS: Psychiatric diagnostic considerations may
include: social phobia, paranoid tendencies, depression, schizoid
personality disorder, schizophrenia, narcissistic personality disorder,
sexual adjustment disorders and substance or alcohol abuse.
DIFFERENTIAL DIAGNOSIS CONSIDERATIONS: Panic Disorder With Agoraphobia;
Agoraphobia Without History of Panic Disorder; Generalized Anxiety Disorder;
Specific Phobia; Separation Anxiety Disorder; Avoidant Personality Disorder;
Social anxiety and avoidance associated with other mental disorders;
Nonpathological Shyness;
NOTE: Some of the DSM-IV diagnostic categories listed here are specific to the
adult patients only. However, their inclusion in the context of this profile
is based on numerous clinical studies indicating that there is strong evidence
of continuance between child and adolescent emotional and behavioral
disturbances and adult psychiatric disorders.
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I am shy - Often
- I feel cheerful - Almost Never
- I feel important - Never
- I feel lonely - Often
- I believe I am good at lots of things - Almost Never
- I feel like I have made too many mistakes - Often
- Other kids like me - Sometimes
- I do things as well as other kids - Often
- I like the way I look - Often
- I feel sorry for myself - Sometimes
- I laugh and smile as much as other kids - Sometimes
- My feelings get hurt easily - Almost Never
- Nothing is fun for me - Often
- I feel happy - Never
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
- I do not feel like doing anything - Sometimes
- I like myself - Often
- I worry that people will not like the way I do things - Almost Never
- I hate it when I am the center of attention - Sometimes
- I feel like playing with my friends - Sometimes
- I can't do anything right - Often
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
CONDUCT DISORDER
Raw Score = 34
CLINICAL IMPRESSIONS: John's scores in this category are moderately high,
indicating a need for further assessment and clinical consideration.
DIAGNOSTIC CONSIDERATIONS: The early onset type is associated with a poorer
prognosis, male gender, more aggressive behavior, and, later, antisocial
personality disorder. Conduct disorder should be differentiated from
adjustment disorder, mental retardation, organic syndromes, and psychosis.
Conduct disorder also demonstrates significant comorbidity with Tourette's
disorder, attention-deficit /hyperactivity disorder (ADHD), major depressive
disorder, and substance abuse. In younger children, conduct disorder should be
differentiated from oppositional defiant disorder. Children with diagnosed
conduct disorder and coexisting ADHD or oppositional defiant disorder are more
aggressive and usually continue to demonstrate more antisocial behaviors.
ADDITIONAL ASSESSMENT: Children who begin the antisocial behavior early and
who engage in diverse behaviors have a worse long-term prognosis. They can
present a considerable challenge to clinicians because of heterogeneity and
resistance of the disorder to intervention. Comprehensive assessment and
proper therapeutic interventions are especially important for
neurobiologically impaired conduct disorder youths suffering from a variety
of associated disorders such as major depression, ADHD, organicity, or
psychosis.
The role and significance of John's family should also be assessed. The
family's response to delinquent behavior is an important prognostic indicator.
Some problematic families role-model violent solutions and may under- or
overreact to the child's antisocial behavior. Other families offer little
structure or consistency in the home. They may not provide adequate
supervision, and the child does not learn to be responsible. Some parents may
overindulge and overprotect the child on the one hand, and refuse to believe
anything bad about the child's behavior on the other. Other parents may blame
the system for frustrating the child and bringing out the bad behavior.
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- Things are hard for me - Often
- I have lots of energy - Never
- I have trouble sleeping - Sometimes
- I believe I am good at lots of things - Almost Never
- Other kids like me - Sometimes
- When there is a problem, it is my fault - Often
- I do things as well as other kids - Often
- I worry that something bad will happen - Sometimes
- It is hard for me to sit still - Sometimes
- It is hard for me to think - Never
- I laugh and smile as much as other kids - Sometimes
- Nothing is fun for me - Often
- I have a hard time making up my mind - Often
- I do well in school - Sometimes
- It seems that no one cares about me - Often
- I hate it when I am the center of attention - Sometimes
- Bad things happen to me - Often
- I feel like playing with my friends - Sometimes
- I can't do anything right - Often
ANTISOCIAL BEHAVIOR
Raw Score = 48
CLINICAL IMPRESSIONS: John's scores in this category are moderately high,
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
indicating a need for further assessment. His expressions of aggressive
behavior may be associated with anger, irritation, or annoyance by others or
specific situations. His behavior may range from openly hostile to repressed
and meek with outbursts under periods of stress or annoyance at an event
which, under different condition, may seem trivial.
DIFFERENTIAL DIAGNOSIS CONSIDERATIONS: Oppositional Defiant Disorder; Conduct
Disorder; Antisocial behavior due to substance abuse; Child/adolescent
antisocial behavior;
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I am shy - Often
- I feel cheerful - Almost Never
- I feel important - Never
- Things are hard for me - Often
- I feel lonely - Often
- I worry that I will hurt someone - Often
- I have lots of energy - Never
- I feel upset - Sometimes
- I believe I am good at lots of things - Almost Never
- I feel like I have made too many mistakes - Often
- Other kids like me - Sometimes
- When there is a problem, it is my fault - Often
- I do things as well as other kids - Often
- I like the way I look - Often
- I get scared for no reason - Never
- It is hard for me to sit still - Sometimes
- I feel like being alone - Almost Never
- I laugh and smile as much as other kids - Sometimes
- My feelings get hurt easily - Almost Never
- Nothing is fun for me - Often
- I do well in school - Sometimes
- It seems that no one cares about me - Often
- I like myself - Often
- I worry that people will not like the way I do things - Almost Never
- I hate it when I am the center of attention - Sometimes
- Bad things happen to me - Often
- I feel like playing with my friends - Sometimes
- I can't do anything right - Often
AGRESSIVE BEHAVIOR
Raw Score = 30
CLINICAL IMPRESSIONS: John has obtained moderately high scores in this
category. It is possible that a complex array of physiological, neurological,
psychological, familial, and environmental factors influence John' behavior.
Research indicates that a combination of difficult temperamental
characteristics, along with parental response patterns, frequently set the
stage for the beginning of a continuum in which the development of patterns of
adverse family structure and interactions escalate. Psychological and
behavioral characteristics within this spectrum usually include irritability
or acting out, temper outbursts, damage or destruction to property, verbal or
physical threats, bullying, fights, hurting others by hitting, biting, or
scratching, and frequent disobedience.
Children may show aggressive behavior very early in life. Although the
aggressive behavior in a child of any age should not be dismissed as just a
temporary phase, the parental concern may often be limited to a hope that
their child will grow out of it, and in many cases no professional
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
intervention is sought. Expression of aggression by children and adolescents
may encompass a wide range of behaviors such as: explosive temper tantrums,
physical aggression, fighting, threats or attempts to hurt others, use of
weapons, cruelty toward animals, fire setting, intentional destruction of
property and vandalism.
Among the known factors which contribute to the aggressive and violent
behavior in children and adolescents are: previous aggressive or violent
behavior, victimization by physical abuse and/or sexual abuse, exposure to
violence in the home and/or community, genetic factors, exposure to violence
in media, substance abuse, presence of firearms in home, combination of
stressful family factors such as poverty, severe deprivation, marital
breakup, single parenting, unemployment, loss of support from extended family,
and brain damage from head injury.
DIAGNOSTIC CONSIDERATIONS: Impulsivity and aggressive behavior in children
and adolescents may also be indicative of the early onset of the bipolar
disorder. In some cases a possibility of the genetic predispositions may
exist, especially in families with a history of substance abuse and bipolar
disorders. Clinical research indicates that the two often share common
pathophysiology.
TREATMENT CONSIDERATIONS: Indicators of the risk factors for aggressive
behavior usually include: intense anger, frequent loss of temper or blow-ups,
extreme irritability, extreme impulsiveness, low frustration thresholds.
Behaviors such as these require early therapeutic interventions by qualified
professionals. The goals of treatment may include: reduction of frequency of
aggressive episodes, early identification and reduction of frequency and
intensity of stress factors (family conflicts and crises, physical and sexual
abuse, school problems, exposure to media violence, and community issues),
expression of anger and frustrations in appropriate ways, learning and
assuming responsibility for own actions, and acceptance and appropriate
handling of consequences.
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I am shy - Often
- I worry about things - Sometimes
- I feel important - Never
- I worry that I will hurt someone - Often
- I have lots of energy - Never
- I believe I am good at lots of things - Almost Never
- Other kids like me - Sometimes
- When there is a problem, it is my fault - Often
- I do things as well as other kids - Often
- I like the way I look - Often
- It is hard for me to sit still - Sometimes
- I feel like being alone - Almost Never
- I have a hard time making up my mind - Often
- I do well in school - Sometimes
- It seems that no one cares about me - Often
- I like myself - Often
- I worry that people will not like the way I do things - Almost Never
- I hate it when I am the center of attention - Sometimes
- Bad things happen to me - Often
- I feel like playing with my friends - Sometimes
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Raw Score = 38
CLINICAL IMPRESSIONS: John has scored SIGNIFICANTLY HIGH in this category
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
which is intended to measure a child's vulnerability to, and a potential for
development of Attention Deficit Hyperactivity Disorder. In view of his
scores, and due to the complexity, prevalence, and known persistence of this
disorder, further assessment of John and consideration of clinical
intervention is highly recommended.
DIAGNOSTIC CONSIDERATIONS: ADHD is a chronic disorder, characterized by a
triad of symptoms involving age-inappropriate problems with attention,
impulse control, and hyperactivity, that begins in early childhood and is
estimated to affect 6% to 9% of school-age children. Because of its impact on
cognitive, social, and school functioning, ADHD in children has generated a
considerable amount of research. Evidence from clinical studies of children
suggests that there are high levels of comorbidity between ADHD and conduct
disorder (30% - 50%), mood disorders (15% - 75%), and approximately 25%
anxiety disorders. Follow-up studies have shown that ADHD persists into
adulthood in 10% - 60% of childhood-onset cases. It is known to be associated
with a greatly increased incidence of antisocial personality disorder, of
drug abuse, institutionalization for delinquency, and increased risk of
incarceration.
In recent years, both epidemiological and clinical studies have documented
that ADHD is frequently comorbid with other psychiatric disorders. Some
reports suggest that comorbidity may be linked to the persistence of ADHD.
Research has shown that aggression or conduct problems in childhood predicted
persistence of ADHD into adolescence and young adulthood. Additionally, the
persistence of ADHD at a 4-year follow-up is predictable by
hyperactive/impulsive symptoms and by comorbid conduct disorder. Moreover,
ADHD frequently co-occurs with mood and anxiety disorders.
Predictors of persistence are usually familial prevalence of ADHD,
psychosocial adversity, and comorbidity with conduct, mood, and anxiety
disorders. The familial risk factors may be either environmental or genetic.
Children with ADHD often come from families that are disorganized and have one
or both parent who exhibits psychopathology. These families may create
pathogenic environments that mediate persistence.
Studies show that there are significant concurrent associations between
indices of exposure to parental conflict and parental psychiatric illness with
psychopathology and psychosocial functioning in the children. Research also
indicates that adversity may increase the risk for ADHD persisting over time.
Additionally, adversity, such as exposure to maternal and paternal
psychopathology, consequences of a low socioeconomic status, lack of family
intactness, the amount and severity of family conflicts, etc., is usually most
closely associated with persistence.
DIFFERENTIAL DIAGNOSIS CONSIDERATIONS: Age-appropriate behaviors in active
children; Understimulating environments; Inattention in Oppositional Defiant
Disorder; Impulsivity in Conduct Disorder; Inattention of hyperactivity
associated with Pervasive Developmental Disorders; Inattention or
hyperactivity caused by drugs of abuse or medications; Symptoms of inattention
due to other mental disorders such as Mood or Anxiety;
NOTE: Some of the DSM-IV diagnostic categories listed here are specific to the
adult patients only. However, their inclusion in the context of this profile
is based on numerous clinical studies indicating that there is strong evidence
of continuance between child and adolescent emotional and behavioral
disturbances and adult psychiatric disorders.
ADDITIONAL ASSESSMENT: A possibility exists that familial ADHD may indicate
an underlying biological vulnerability that is evoked and maintained by
adverse environmental circumstances. Therefore, further assessment of John
should also include a comprehensive assessment of his family system, its
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
dynamics, and possible history of psychophysiological disorders.
SPECIFIC RESPONSES TO TEST ITEMS IN THIS CATEGORY:
- I feel important - Never
- Things are hard for me - Often
- I feel lonely - Often
- I have lots of energy - Never
- I have trouble sleeping - Sometimes
- I feel upset - Sometimes
- I feel like I have made too many mistakes - Often
- When there is a problem, it is my fault - Often
- I do things as well as other kids - Often
- It is hard for me to sit still - Sometimes
- It is hard for me to think - Never
- My feelings get hurt easily - Almost Never
- Nothing is fun for me - Often
- I have a hard time making up my mind - Often
- I do well in school - Sometimes
- I worry that people will not like the way I do things - Almost Never
- I hate it when I am the center of attention - Sometimes
- Bad things happen to me - Often
- I can't do anything right - Often
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
FURTHER PSYCHOMETRIC CONSIDERATIONS
There are no specific clinical guidelines as to what constitutes over- or
under-assessment, or over- and under-diagnosis. Children, adolescents, and
young adults often present a formidable psychometric challenge due to the
complex, and often rapidly evolving nature of their psychodynamics. Reliance
on a single assessment instrument may present serious limitations in
obtaining necessary data for a comprehensive clinical picture based on which
therapeutic intervention can be formulated and initiated. Clinicians are
advised to always consider a combination of instruments in order to increase
diagnostic certainty. The following listing presents additional psychometric
instruments which are relevant to the type of profile presented by John Doe
during the administration of the Internalizing Symptoms Scale for Children
(ISSC).
DEPRESSIVE SYMPTOMS SPECTRUM
DEPRESSION:
- Children's Depression Inventory (CDI)
- Youth Depression Adjective Checklist
- Children's Depression Rating Scale, Revised (CDRS-R)
- Critical Items Scale for Children (CISC)
- Multiscore Depression Inventory for Children (MDI-C)
- Peer Depression Rating Scale
- Children Emotional Intelligence Test (EQ-C)
- Adolescent Emotional Intelligence Test (EQ-A)
- Emotional Behavioral Checklist
- Reynolds Adolescent Depression Scale
- Dimensions of Depression Profile for Children and Adolescents
- North American Depression Inventories for Children and Adults
- Reynolds Child Depression Scale
- Symptom Distress Check List
- Brief Psychiatric Rating Scale for Children
- Problem Behavior Inventory - Adolescent Symptom Screening Form
- Jesness Behavior Checklist
SUICIDE:
- Suicide Intent Scale
- Suicide Ideation Scale (SIS)
- Suicide Probability Scale
- Suicidal Ideation Questionnaire
- Inventory of Suicide Orientation-30 (ISO-30), Adolescent
- Evaluation of Suicide Risk Among Adolescents
- Beck Scale for Suicide Ideation
- Counselor Checklist for School-Based Suicide
- Suicidal Behaviors Questionnaire
- Hopelessness Scale for Children
- Suicidal Behavior History Form
BEREAVEMENT:
- Grief Experience Questionnaire
- Texas Revised Inventory of Grief
- Grief Experience Inventory
BIPOLAR DISORDER:
- Bipolar Trait Ratings
- Barratt Impulsiveness Scale
- Profile of Mood States, Bi-Polar Form
- Parent Rating Schedule
- Critical Behavior Scales
- Observer Ratings of Children, Revised
- Student Motivation Questionnaire
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
- Child Assessment Schedule
- Mood Thermometers
ADJUSTMENT DISORDER:
- Adjustment Scales for Children and Adolescents (ASCA)
- Classroom Adjustment Rating Scale (CARS)
- Classroom Adjustment Checklist
- Student Adjustment Inventory
- Child and Adolescent Adjustment Profile
- Walker-McConnell Scale of Social Competence and School Adjustment.
- Behavior in School Inventory
- Offer Therapist Adolescent Questionnaire
- Offer Parent-Adolescent Questionnaires
- Child Adaptive Behavior Inventory
CYCLOTHYMIA:
- Behavior Disorder Scale
- Children's Posttraumatic Stress Disorder Inventory
- Post-Traumatic Somatic Disturbances Inventory (PTSDI)
- Problem Checklist
- Rust Inventory of Schizotypal Cognitions (RISC)
- Short Alcohol Dependence Data
- Adolescent Diagnostic Interview
- Behavioural Inattention Test
- Children's Depression Inventory (CDI)
- Adolescent Behavior Checklist (ABC)
- Child Neuropsychological History
- Problem Behavior Inventory - Adolescent Symptom Screening Form
- Reiss Scales for Children's Dual Diagnosis
- Child Assessment Schedule
- Fear Survey Schedule for Children, Revised
- Impact of Events Scale
SCHIZOAFFECTIVE DISORDER:
- Pervasive Developmental Disorder Behavior Scales
- Rust Inventory of Schizotypal Cognitions (RISC)
- Problem Behavior Inventory - Adolescent Symptom Screening Form
- Reiss Scales for Children's Dual Diagnosis
- Child Assessment Schedule
- Emotional and Behavior Problem Scale
- Fear Survey Schedule for Children, Revised
- Impact of Event Scale, Revised
- Schedule for Affective Disorder and Schizophrenia for School-Age Children
- Psychosis Proneness Scales
- Psychotic Behavior Rating Scale
- Adolescent Symptom Inventory-4 (ASI-4)
- Child Assessment Schedule
- Problem Behavior Inventory - Adolescent Symptom Screening Form
- Reiss Scales for Children's Dual Diagnosis
SOMATIC DISTURBANCES SYMPTOMS SPECTRUM
SOMATIZATION:
- Medical Symptoms Inventory (MSI)
- Hopkins Psychiatric Rating Scale
- Symptom Distress Check List
- Missouri Children's Picture Series
- California Symptom Checklist
- Brief Symptom Inventory
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
- Critical Items Scale for Children (CISC)
- SCL-90-R
- Missouri Children's Behavior Checklist
- Manifest Anxiety Scale
SOMATOFORM DISORDER:
- Reiss Scales for Children's Dual Diagnosis
- Diagnostic Inventory of Personality and Symptoms
HYPOCHONDRIASIS:
- Illness Behaviour Questionnaire, Second Edition (IBQ)
- Health Concerns Questionnaire
EATING DISORDER:
- Eating Disorder Inventory
- Problem Behavior Inventory - Adolescent Symptom Screening Form
- Child Assessment Schedule
- Eating Practices Inventory
- Eating Patterns Questionnaire
- Disordered Eating Test
- Pervasive Developmental Disorder Behavior Scales
- Binge Scale
- Nutrition Attitude Scale
- ADHD Rating Scale
- Patient Activity Checklist
- Scales for Assessing Sources of Stress
- Parent's Questionnaire
- Adolescent Symptom Inventory-4 (ASI-4)
- Rust Inventory of Schizotypal Cognitions (RISC)
- Body Image Avoidance Questionnaire
- Nutrition and Food Attitude Scale - Lower Grades
- Nutrition and Food Attitude Scale - Upper Grades
- Nutrition Attitude Instrument for the Intermediate Grades
- Nutrition Attitude Instrument for Grades 7-12
SOCIAL WITHDRAWAL SYMPTOMS SPECTRUM
SOCIAL PHOBIA:
- Anxiety Disorders Interview Schedule for Children, Revised
- Social And Emotional Behavior Scale
- Social Support Scale for Children
- Children's Social Desirability Questionnaire
- Comprehensive Social Desirability Scale for Children
- Social Phobia and Anxiety Inventory (SPAI)
AGORAPHOBIA:
- Fear Questionnaire
- Reiss-Epstein-Gursky Anxiety Sensitivity Index (ASI)
- Anxiety Disorders Interview Schedule for Children, Revised
- Panic-Associated Symptom Scale
PERVASIVE DEVELOPMENTAL DISORDERS:
- Pervasive Developmental Disorder Behavior Scales
- Children's Mental Health Check-Up
- Critical Items Scale for Children (CISC)
- Children Emotional Intelligence Test (EQ-C)
- Adolescent Emotional Intelligence Test (EQ-A)
- Adelaide Version of Conners' Teachers Rating Scale
- Behavior Assessment System for Children
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
- Warshak Inventory for Child and Adolescent Assessment
- AAMD Adaptive Behavior Scale For Adults and Children
- Developmental Checklist
- Developmental History Checklist for Children
- Denver Developmental Screening Test
- Neuro-Developmental Observation
SCHIZOPHRENIA:
- Kiddie Schedule for Affective Disorder and Schizophrenia
- Schedule for Affective Disorder and Schizophrenia for School-Age Children
- Parent's Questionnaire
- Child Neuropsychological History
- Rust Inventory of Schizotypal Cognitions (RISC)
- Reiss Scales for Children's Dual Diagnosis
- Emotional and Behavior Problem Scale
AVOIDANT PERSONALITY DISORDER:
- Child Assessment Schedule
- Anxiety Disorders Interview Schedule for Children, Revised
- Rust Inventory of Schizotypal Cognitions (RISC)
- Schedule for Affective Disorder and Schizophrenia for School-Age Children
- Missouri Children's Behavior Checklist, Form P
- Personality Inventory for Youth (PIY)
- Personality Inventory For Children, Revised Format
- Children's Personality Questionnaire
- Childhood Personality Scales
- Eysenck Personality Questionnaire (Junior)
- Child's Personality Questionnaire
- Children's Apperceptive Personality Test (APT)
- Early School Personality Questionnaire
- Millon Adolescent Personality Inventory (MAPI)
PHOBIA:
- Scale for the Identification of School Phobia
- Specific Fear Questionnaires
- Current and Past Psychopathology Scales
- Anxiety Disorders Interview Schedule for Children, Revised
- Slingerland Screening Tests for Identifying Children with Specific Needs
- Disability Social Distance Scale
- Assessing the Behavior of Caregivers - I
- Assessing the Behavior of Caregivers - II
_______________________________________________________________________________
Client Id: John Doe 08/01/1999
CLINICAIN'S GUIDE
ASSESSMENT OF PATIENT'S WILLINGNESS TO PARTICIPATE IN TREATMENT:
- Patient has demonstrates understanding of the reasons
for proposed treatment ...................................... _______
- Patient has demonstrated understanding of risks,
benefits and alternatives to the proposed treatment ......... _______
- Patient's has demonstrated ability to rationally
weigh these considerations .................................. _______
- Patient has demonstrated ability to communicate
his/her decision and the basis of that decision ............. _______
- Patient has demonstrated willingness and continuity
of his/her participation in own treatment ................... _______
- Patient has demonstrated honesty of disclosure .............. _______
- Patient has demonstrated anticipation of treatment
success ..................................................... _______
- Patient has demonstrated adherence to and involvement
in treatment ................................................ _______
- Patient has participated in continuing assessment
of treatment, its impact and effectiveness .................. _______
ASSESSMENT OF TREATMENT EFFECTIVENESS:
- Significant exarcebation/reduction in patient's
symptoms prior to initiation of treatment ................... _______
- Stability in frequency and severity of patient's symptoms
after initiation of treatment ............................... _______
- Exacerbation of patient's symptoms during treatment ......... _______
- Significant reduction of somatic symptoms during treatment .. _______
- Significant reduction of psychiatric symptoms
during treatment ............................................ _______
- Discontinuation of high-risk health behaviors ............... _______
- Self-initiated regular attendance at prescribed
treatment activities ........................................ _______
- Discontinuation/reduction in self-medication practices via
substance use and/or non-prescribed medication of choice .... _______
- Discontinuation of substance use/abuse for any reason ....... _______
- Adherence to prescribed pharmacotherapeutic regimens and
significant reduction in frequency and severity of targeted
symptoms .................................................... _______
- Self-initiated reduction and regulation of socially
unacceptable behaviors and practices by patient ............. _______
ASSESSMENT OF ATTAINMENT OF TREATMENT GOALS:
- Continuous anticipation of successful completion of
treatment during both non-ambulatory and ambulatory phases... _______
- Participation in development, implementation,
and continuous assessment of treatment goals................. _______
- Participation in development of realistic and measurable
criteria for monitoring and assessment of attainment of
treatment goals.............................................. _______
- Completion of treatment goals within specified time frames,
or participation in adjustment and modification of such time
frames based on dynamics of intrinsic/extrinsic psychosocial
contingencies................................................ _______
- Patient's consistent manifestation of acceptance of
responsibility inherent in the role of recovery.............. _______