Clinical Assessment of Child and Adolescent Personality and ...

86 chapter 5 Planning the Evaluation and Rapport Buildingbehavioral and emotional adjustment, butit is also important that they include anassessment of the developmental processes(e.g., temperamental tendencies, familycontext) that may be related to the child’scurrent pattern of adjustment. This morecomprehensive assessment requires thatassessors maintain a current knowledge ofthe research related to the type of problemsthey encounter in their evaluations, sothat they have an adequate understandingof the processes that may be involved inthe development of these problems.This research provides the assessorwith some initial hypotheses regardingthe problems that led to a child’s referralfor testing. Measures are selected so thatthese hypotheses can then be tested in theevaluation. For example, there is researchto suggest that there are distinct subgroupsof children with conduct problems, someof whom react very strongly to peer provocationand emotional stimuli, and some ofwhom show a lack of reactivity to emotionalcues, leading them to ignore the potentialconsequences of their behavior on others(Frick, 2006). Solely assessing the child’slevel and severity of conduct problems andmaking a diagnosis of “Conduct Disorder,”without assessing the child’s affectiveand interpersonal style, would not allowone to distinguish between these differentsubgroups that may require differentapproaches to treatment (Frick & McMahon,2008).Secondly, it is important for the psychologistto consider the developmentalstage of the child to be assessed in designingan assessment battery. For example, itis important, when selecting tests for a battery,to determine whether the tests providegood norm-referenced scores for thedevelopmental stage of the child or adolescentbeing assessed. Because this is soimportant, a significant focus of the laterchapters (which provide reviews of specifictesting instruments) is on the descriptionof the instruments’ norm-referencedscores. It is evident from these reviewsthat the adequacy of these scores can varyacross developmental stages (e.g., havinga very limited normative sample for olderadolescents). In addition to specific tests,some testing modalities may be more orless appropriate depending on the developmentallevel of the child. For example,in the chapter on structured interviews, wediscuss research suggesting that the childself-report format on these interviews maybe unreliable before age 9.Determining the RelevantPsychological DomainsA fairly ubiquitous finding in researchon childhood psychopathology is thehigh degree of overlap or comorbidity inproblem behaviors (Jensen, 2003). Thatis, children with problems in one area ofemotional or behavioral functioning are athigh risk of having problems in other areasof emotional or behavioral functioning, aswell as problems in social and cognitivearenas. In addition, a key assumption to adevelopmental approach to understandingchildren’s adjustment is that all outcomesare influenced by multiple interactingprocesses. As a result, most evaluationsof children and adolescents must be fairlycomprehensive to ensure that all areas thatcould be relevant to treatment planningare assessed. In planning an evaluation, oneshould consider the most likely comorbiditiesassociated with the referral problemand the most likely factors that can leadto such problems, and design the evaluationto provide an adequate assessment ofthese areas. From the referral information,one may also gather some clues as to howintensive the assessment of these potentiallyimportant domains should be.For example, consider a referral of a7-year-old boy who is having significantproblems of being disorganized, being veryimpulsive, and having difficulty staying in