Clinical Assessment of Child and Adolescent Personality and ...

404CHAPTER 17 Assessment of Attention Deficit Hyperactivityproblems in emotional regulation can leadto very impulsive and unplanned aggressiveacts for which the child may be remorsefulafterward but that he or she still hasdifficulty controlling. It can also lead to achild being susceptible to becoming angry(i.e., emotionally aroused) due to perceivedprovocations from peers, leading to violentand aggressive acts within the context ofhigh emotional arousal.This developmental framework has anumber of implications for the assessmentprocess for children with severe conductproblems (McMahon & Frick, 2005). Itsuggests that, not only do interventionsfor children with severe conduct problemsneed to be comprehensive in targeting alarge number of diverse causal influences,but these interventions also need to be tailoredto the unique needs of specific subgroupsof children with conduct problems(see Frick, 2006 for a more a extendeddiscussion of this issue). In order to implementsuch a comprehensive and individualizedapproach to treatment, there needsto be a comprehensive assessment of thechild that identifies the most appropriatetargets of treatment, given the individualchild’s specific developmental history.Implications for AssessmentThis body of psychological researchforms the basis for designing an appropriateassessment for children with conductproblems. In Table 17.5, we summarizethe critical areas of research and their relevanceto the assessment process. In Box17.5, we provide a case study of a comprehensiveevaluation of a child with severeconduct problems. As is evident fromTable 17.5, assessment of conduct problemsshares several important characteristicswith the assessment of ADHD. Thecomplex and pervasive nature of conductproblems requires a comprehensive evaluationthat assesses many aspects of thechild’s functioning and psychosocial environment.Further, conduct problems andother relevant aspects of a child’s psychosocialfunctioning should be assessed usingmultiple informants and multiple assessmenttechniques.Table 17.5 Key Research Findings and Their Implications for the Assessment of Childrenwith Conduct ProblemsResearch Findings1. Core symptoms and subtypes: Conduct disordersrepresent a heterogeneous categorywith widely varying levels of impairmentand many important subtypes2. Common comorbidities: Conduct disordersare often accompanied by several comorbidtypes of problems that influence thecourse and treatment of conduct disorders3. Correlates with potential causal roles:Conduct disorders develop through acomplex interaction of numerous factorswithin the child and his or her psychosocialenvironmentImplications for Assessment1a. Assess a wide range of conduct problems1b. Assess the level of impairment associated withthe disorder2a. Assess for the presence of ADHD2b. Assess for the presence of anxiety anddepression (including suicidal ideation)2c. Assess for substance use and abuse3a. Assess important aspects of a child’s oradolescent’s family environment3b. Assess child’s intellectual level, academicachievement, learning style, and socialproblem solving(Continues)