Clinical Assessment of Child and Adolescent Personality and ...

chapter 15 integrating and interpreting assessment information353Therefore, when looking for convergentpieces of evidence, one should lookat the full range of scores, problems, orsymptoms. For example, suppose a childreports a high level of anxiety on a selfreportquestionnaire, passing a clinical cutoffpoint as required in Step 1. However,on a parent-structured interview there areno diagnoses of anxiety disorders reported,but the parent has reported three symptomsof overanxious disorder and two symptomsof separation anxiety disorder. Further, ateacher rated the child with a T-score of64 on the anxiety scale of a behavior ratingscale. If one just viewed scores thatexceeded a clinical cut-off, this patternwould look like the child’s self-report ofanxiety was unsupported by other informants,when, in fact, we would argue thatthere is fairly consistent support for thepresence of anxious behaviors, althoughthe anxiety is not being perceived as severeby parents and teachers.Step 3: Try to ExplainDiscrepanciesThe complexity of the assessment processis dramatically reduced when assessmentinformation is consistent across methodsand sources. This is the ideal casethat is the dream of every clinical assessor.Unfortunately, existing research andclinical experience suggest that this is notlikely to happen often. In most cases, therewill be numerous discrepancies between theinformation provided by the differentsources after steps 1 and 2. At this stage,one should take the information discussedin previous sections of this chapter and tryto develop explanations for the discrepancies.Can the discrepancies be explainedby different demands in the various settingsin which a child is observed? Can thediscrepancies be explained by differencesin the measurement techniques used orby certain characteristics/motivations ofthe informants? Can the discrepanciesbe explained by differing knowledge ofthe child’s behavior across informants? Asmentioned previously, if one can answerthese questions and account for discrepantinformation, one has gone a long wayin developing a good case formulation anddeveloping goals for treatment.Step 4: Develop a Profileand Hierarchy ofStrengths and WeaknessesBoth research and clinical practice indicatethat children rarely have problems thatare specific to one area. As a result, thenext step in the interpretive process is todevelop the profile of a child’s or adolescent’sstrengths and weaknesses across thedifferent domains of psychological functioningthat have been assessed. In addition,we feel that this process needs to gobeyond simply documenting the differentareas of strengths and weaknesses, to alsoprioritizing the different areas of concern.This prioritization should be both a conceptualand practical endeavor.Conceptually, one should consider whatproblematic area may be primary andwhich areas may be secondary, with secondarybeing defined as areas that seem to belargely a result of some other primary factor.For example, for a child who becomesdepressed because of his/her frequentschool suspensions and police contacts forantisocial behavior, the depression maybest be considered secondary to the antisocialbehavior.Practically, one needs to consider whatarea should be the primary focus of intervention.This may follow closely with thedetermination of primary and secondaryproblems, where intervention targetingof primary areas (e.g., antisocial behavior)