Clinical Assessment of Child and Adolescent Personality and ...

350chapter 15 integrating and interpreting assessment informationBox 15.4Case Study to Illustrate the Multistep Interpretive Procedure: A 7-Year-Old Boywith Behavior ProblemsJake was a 7-year, 1-month-old boy who wasreferred to an outpatient psychological clinicfor a comprehensive psychological evaluationby his mother. His mother reported that Jakewas having great difficulty completing schoolwork and that he was extremely oppositionaland hard to manage at home. Jake was administereda comprehensive battery of tests thatincluded (1) an unstructured clinical interview;(2) an extensive family background assessment;(3) a psychoeducational assessment; (4)an assessment of his emotional and behavioralfunctioning through structured interviewsconducted with his mother and teacher andrating scales completed by his mother, histeacher, and by Jake himself; (5) a sociometricexercise conducted with his class; and (6) anobjective assessment of his classroom performance(e.g., amount of work completed, accuracyof work).Step 1: Document All ClinicallySignificant Findings on theChild’s AdjustmentOn a structured interview, the DiagnosticInterview Schedule for Children-Version4 (DISC-IV; Shaffer et al., 2000), Jake metcriteria for ADHD according to both hismother and his teacher. On the Child BehaviorChecklist (CBCL: Achenbach, 2001), hehad T-scores above 70 on both the ThoughtProblem scale and the Attention Problemscale according to the father and T-Scoresof 70 and 67 on the Attention problem andThought Problem scales, respectively, accordingto his mother’s report. On the teachercompletedComprehensive Behavior RatingScale for Children (CBRSC; Neeper, Lahey,& Frick, 1990), he obtained a T-score of 71on the Daydreams scale and a T-score of 65on the Motor Hyperactivity scale.Also on the DISC-IV, Jake met criteriafor oppositional Defiant Disorder (ODD)according to his mother’s report. Similarly, heobtained T-scores above 70 on the AggressiveBehavior scale of the CBCL by both motherand father reports.A final significant finding was the report ofa sufficient number of depressive symptomsto meet criteria for current Major Depressionaccording to maternal report on the DISC-IV.Step 2: Look for ConvergentFindings across Sources andMethodsIt was clear that there were convergent findingsfor significant problems of inattention–disorganization and impulsivity–hyperactivityassociated with ADHD, according to parentsand teachers and across structured interviewsand rating scales. However, for the oppositionalbehaviors, the teacher report gave no indicationsof these behaviors in the school environmenteither on rating scales or on structuredinterviews. For the parental report of depression,although Jake’s teacher did not reportsymptoms of depression of sufficient severityto warrant a diagnosis solely on her report, shedid endorse several symptoms, such as feelingsad and irritable, feeling bad about himself, andoften seeming as if he was about to cry. However,on the Children’s Depression Inventory(CDI; Kovacs, 1991), Jake did not report significantfeelings of depression.Step 3: Try to ExplainDiscrepanciesIn talking to Jake’s teacher, it appeared thatshe had a very structured classroom with ateacher’s aide who implemented behavioralprograms for students. Jake’s parents weredivorced, and his mother seemed quite distressedover Jake’s behavior. As a result, sheseemed to be very unsure of how to discipline(Continues)