Child Psychiatric Evaluations

Reasons Children Present for an Evaluation

Developmental disorders

Disruptive Behavior Disorders - most common reason children referred to a psychiatrist

Feeding and Eating Disorders - especially young women

Elimination Disorders - can’t control bladder or rectal tone Þ usually need behavioral treatment

Tic Disorders

Anxiety Disorders -Obsessive-Compulsive Disorder often presents in adolescents; Post-Traumatic Stress Disorder

Mood Disorders - 1/20 teenagers develop a mood disorder

Psychotic Disorders - usually related to Manic Depression Disorder

Other Disorders or areas of concern

Differences between Types of Child and Adolescent Psychiatric Evaluations

Office Evaluation

done in psychiatric office
Initiated by: usually parent
Psychiatrist role: to evaluate and treat personnel

School Evaluation

initiated by: teacher - usually because of disruptive behavior
parent consent obtained
Psychiatrist role: make recommendations to school
most Ritalin is prescribed by primary care physician

Court Evaluation

Initiated by: court
May be mandated
Psychiatrist role:
Child and guardians waive confidentiality so report shared with the court
Adult Court - justice and punishment
Child Court - intervention and correction

Hospital Evaluation

Initiated by: pediatrician or intern/surgeon
Parental consent obtained by medical team and charted
Psychiatrist role: evaluate child and make recommendations to the medical team
Focus often on child’s response to a medical illness

Confidentiality and Informed Consent

confidentiality is the clinician’s obligation to hold in confidence information obtained from the patient in the course of their professional relationship

legal guardians/parents may access child’s psychiatric files

confidentiality also waved when evaluation is performed for the court (as stated above)

informed consent requires the patient understand the nature of their condition, risks and benefits of the proposed treatment, risks and benefits of alternative treatments, and the likely consequences if the patient remains untreated

exceptions to informed consent: emergency situations, children who are unable to understand their need for treatment

consent is adapted to child’s level of comprehension

Patient Interview Structure

Chief Complaint

History of Present Illness

Past Psychiatric History

Developmental History (intrauterine conditions, length of pregnancy, date toilet trained, date walked, date spoke, etc)

School History (separation difficulties, learning capabilities)

Personal History

Medical History

Family History

Child Interview and Mental Status Exam

Infants and toddlers generally observed with parent Þ toys often useful for evaluation of children and used to put them at ease

Preschoolers and younger elementary aged children interviewed through play and drawing

Adolscents usually best if interviewed before parents

Formal mental status examination, differences between children and adults

For adolescent patients: begin with less stressful topics and work toward more difficult topics

school
family - "is there anything going on at home that I should know about"
friends
substances
sexuality - activity, with whom, birth control, abuse (1/8 boys and ¼ girls are sexually abused by 18 yrs)

Physical Exam

Lab studies:

blood work
EKG, EEG
neuroimaging

Psychological testing:

cognitive/developmental
projective/ personality