Diagnosing mental disorders in children and adolescents

Anamnesis and diagnosis belong in the hands of experienced child and adolescent therapists

The psychotherapeutic or psychiatric treatment of children and adolescents is about recognizing the exact mental illness, recording the causes and conditions that play a role, and deriving suitable measures for the treatment.

An important goal of child and adolescent psychiatry is to prevent mental illnesses at an early stage recognize and to initiate promising treatment as early as possible. At the same time, problems requiring treatment must be differentiated from only temporary, development-related difficulties that do not require special treatment.

In order to create favorable conditions for the treatment, the therapist will be sensitive, understanding and encouraging to all involved throughout the treatment, starting with the diagnosis.

Diagnosis

At the beginning, a comprehensive diagnosis is carried out in order to be able to precisely assess the type of psychological abnormalities and the factors that led to them. Both long-term factors and current loads are taken into account.

Even if a lot of information is requested during the diagnosis, it is never a question of who is "to blame". Rather, one would like to understand the disorder as precisely as possible in order to obtain the key to successful treatment.

The focus is on a detailed discussion with the child or adolescent and his parents. In order to get a comprehensive picture of the disorder, siblings, teachers, classmates or doctors can also be included in the diagnostic process with the consent of the parents or the adolescent. In addition, the behavior of the child or adolescent can be observed in specific situations in order to be able to better assess the symptoms. Depending on the type of disease, further medical examinations and psychological test procedures are carried out.

Diagnostic interview

In the conversation, the symptoms are first assessed:

What symptoms appear?
How difficult are they? and how they have been around for a long time?
They only occur in certain or almost all situations?

The practitioner also assesses whether the abnormalities can be normal at this age or are inappropriate for the age. Fears of separation or occasional wetting at preschool age can be normal and disappear over time, while they are unusual in school age children and can lead to significant problems.

At the same time, an assessment is made of how severely the child or adolescent is suffering from the symptoms. Does this impair social contacts or hinder normal development? It is also important how much the parents, other children or educators suffer from the child’s symptoms or feel affected by them. This can be the case especially with hyperactive behavior or with pronounced aggressive behavior and despite.

In the diagnostic discussion, the individual strengths as well as the resources of the child and the social environment are recorded – for example, good social skills of the child, supportive behavior of the parents or a stable social environment.

Further investigations: behavioral observation, medical examinations and psychological tests

To supplement the information from the diagnostic interview, behavioral observations, medical examinations and additional psychological test procedures can be carried out.

Behavioral observation makes it possible to obtain more precise information about the problematic behavior of the child or adolescent – for example about the frequency, the triggers and the consequences of a certain behavior. In this way, the mother can be asked to monitor her child’s eating habits or playing habits throughout the day and to record them in a log. The child or adolescent himself can also observe his behavior and use a protocol to record, for example, how often and in which situations anxiety or restless behavior occur.

The physical examination records whether physical disabilities, physical illnesses or delays in physical development are present. This is important if there is a presumption that physical factors could also influence the psychological symptoms.

Psychological diagnostics are used to use standardized tests to check whether the development of language, mental (cognitive) abilities or mobility corresponds to the age of the child or whether there are any abnormalities. In addition, special skills such as reading and spelling or arithmetic skills can be examined. In some cases, psychological tests also examine aspects of the child’s personality or relationships within the family.

Digression: Assessment of the disease using classification systems

Similar to adults, classification systems such as the "international classification of mental disorders" (ICD-10) or the "diagnostic and statistical manual of mental disorders" (DSM) are often used for diagnosis, with which mental illnesses can be systematically recorded.

In order to capture the various factors that play a role in mental illness in childhood and adolescence as precisely as possible, the so-called “multiaxial classification scheme” (MAS; German version: Remschmidt et al., 2001) is often used here. The mental disorder is shown on a total of six axes: In addition to the psychological disorder itself (axis 1), it is considered whether there are developmental disorders (axis 2) and physical illnesses (axis 4). In addition, the level of intelligence (axis 3), the current psychosocial circumstances (axis 5) and the psychosocial adjustment (axis 6) are assessed. Psychosocial adjustment measures, for example, how good the child’s or adolescent’s social contacts with other family members, peers and other adults are, how well he or she copes with school and what interests and leisure activities exist

Course and result diagnostics

In the course of therapy, the therapist can check from time to time whether the problematic behavior or the psychological problem areas have improved. In this way, he can give the child or adolescent and his parents feedback on the changes and, if necessary, initiate changes in the course of the therapy.

It is also important to assess changes to the The End Therapy: Here it is checked what has changed compared to the beginning and whether the goals of the therapy have been achieved. The child or adolescent and his parents are also asked how satisfied they are with the result of the therapy. In this way, it can be assessed whether further measures (e.g. continuation of therapy discussions at longer intervals) may be necessary.