A case formulation refers to a hypothesis about why the problem behaviour exists and how it is maintained. This should be based on the longevity of the problems (1), consistency of problematic behaviour across situational contexts (2) and family history (3). Problematic behaviour is characterized by the four d’s:

1. Deviance from the norm
   This refers to determining the degree to which behaviours are deviant from the norm. This can be assessed using informal testing (e.g. interview) or formal tests (e.g. test batteries).
2. Distress
   This refers to assessing the relative impact of a disorder after the disorder has been identified.
3. Dysfunctional
   This refers to assessing the distress that a disorder causes. For children, multiple sources of information may need to be used.
4. Dangerous
   This refers to assessing whether there is a risk for self-harm and a risk of harm to others.

The duration should also be taken into account. Clinical decisions are often taken based on measures of intensity (1), duration (2) and frequency of the behaviour relative to the norm. To have a valid diagnosis, several things need to be taken into account:

• It is important to have knowledge of normal behaviour and deviant behaviour during development.
• It is important to take equifinality (i.e. different factors having the same outcome) into account.
• It is important to take multifinality (i.e. the same factor leading to different outcomes) into account.
• It is important to make use of a multimethod approach (i.e. a variety of informants and procedures).

It is essential to take the developmental stage of a child into account when assessing behaviour. According to Erikson, children develop through psychosocial stages with socioemotional tasks that must be mastered to allow for positive growth across the lifespan (e.g. trust vs. mistrust). Behavioural theories state that behaviour is shaped by associations (i.e. contingencies) resulting from positive and negative reinforcement.

There are three questions that need to be answered by the clinician after assessment:

1. “What are the characteristics of the child’s problem?”
2. “How should the problem be evaluated?”
3. What are appropriate intervention strategies?”

The adaptation theory states that early attachment relationships have an impact throughout the lifespan. Triadic reciprocity refers to the dynamic system between the person, the environment and behaviour where all three influence each other.

Family systems theory states that the family is a system made up of subsystems (e.g. parent and child; parent and parent). The behaviours in a system are aimed at maintaining or changing boundaries, alignment and power. A family’s degree of dysfunction can be determined by boundaries that are poorly or inconsistently defined.

The DSM is a categorical diagnostic system. It makes use of clear-cut categories as this is needed for health care service (e.g. insurance). However, there are several problems with this:

About 5% of the children and 2.5% of the adults are diagnosed with ADHD. There are several requirements for a diagnosis:

1. There are at least six symptoms for at least six months. For people older than 17 years old, there need to be five or more symptoms.
2. The symptoms are present before the 12th year of age.
3. The symptoms exist in two or more areas (e.g. school; home).
4. The symptoms interfere with social, school or professional functioning.
5. The symptoms are not better explained by other disorders.

There are three subtypes:

• Predominantly inattentive subtype (i.e. ADD).
  • Careless attention to detail.
  • Problems sustaining attention over time.
  • A poor follow-through (e.g. schoolwork; homework; chores).
  • A poor ability to sustain mental attention (e.g. independent work at school).
  • The child loses necessary materials (e.g. assignment sheets).
  • The child is forgetful.
  • The child is easily distracted.
  • The child is poorly organized.
  • The child does not appear to listen.
• Predominantly hyperactive/impulsive subtype
  
  • The child demonstrates fidgety or squirmy behaviour.
  • The child has problems remaining seated.
  • The child shows excessive motion.
  • The child has problems engaging in quiet play.
  • The child is constantly on the go.
  • The child shows incessant talking.
  • The child blurts out answers or comments (i.e. impulsivity).
  • The child is impatient and has problems with turn-taking (i.e. impulsivity).
  • The child is intrusive to others (i.e. impulsivity).
• Combined subtype.

Children with the inattentive presentation are often misdiagnosed and misunderstood. It is often misinterpreted as a lack of motivation. The children may be characterized by a sluggish information processing style and there are problems with focused or selective attention. These children are unable to filter essential from non-essential details. This lack of attention may result from information overload and the inability to selectively limit the focus of attention. They have poor performance on tests because of this problem with attention and their poor concept of time and time management.

Children with the hyperactive-impulsive presentation experience academic problems due to their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all instructions. They are at social risk due to their impatient nature and they often have poor social skills and difficulties making and maintaining friends. They often gravitate towards other rule-breaking children.

A difficult temperament (1), poor sleep patterns (2), excessive activity (3), irritability (4) and a difficulty soothing the child when they are upset (5) are risk factors in infancy for the development of ADHD. During toddlerhood, the child may demonstrate higher levels of underregulated behaviours and a lack of self-control may persist during the transition to preschool.

The symptom presentation of ADHD differs with age. Inattention symptoms are consistent over time but the hyperactive/impulsive symptoms decrease over time. There is

The WISC-IQ test measures the following:

• It measures how well somebody can learn.
• It measures what somebody knows.
• It measures what somebody can do.
• It assesses what a person’s strong skills are.
• It assesses what a person’s weak skills are.

The focus of an IQ test is on school-based skills (e.g. language; math; understanding; spatial skills; planning; problem-solving; logical skills) and it also measures acquired knowledge and skills. This means that an IQ test does not only measure potential but also current intelligence. It is important to assess whether deficits are the results of lack of opportunities (i.e. deprivation) or limitations in capacity.

There is not a perfect relationship between school performance and IQ as school performance may be lower than somebody’s IQ due to socio-emotional circumstances (e.g. being bullied) or other issues making school performance more problematic (e.g. dyslexia).

An IQ score is not a school advice in the Netherlands. The schools give an advice and CITO scores and IQ scores could change this advice. The traditional view of giftedness holds that a child with an IQ of 130 is gifted. The current view of giftedness holds that there needs to be high ability but not necessarily an IQ score of 130 or higher. Somebody is not only gifted if somebody has potential but also if this person shows gifted behaviour.

According to Renzulli, giftedness does not depend on a single criterion (e.g. IQ) but refers to the interaction between three clusters of traits;

1. Above-average general abilities (e.g. IQ).
2. High levels of task commitment (e.g. perseverance).
3. High levels of creativity.

This definition is applicable to any valuable area of performance (e.g. music; arts) and not just academics. People who are gifted score above average on each of the clusters but not necessarily in the superior range. Whether somebody is gifted depends on the needs and values of a culture.

Persistence in the accomplishment of ends (1), integration toward goals (2), self-confidence (3) and freedom from inferiority feelings (4) are personality factors that predict achievement among individuals with high intellect.

While intelligence on IQ test is relatively stable it does not say anything about development. Giftedness focuses on exceptional behaviour. Gifted children need educational opportunities that are normally not provided in regular instruction. However, this may be needed for all children but the outcomes differ depending on talent.

According to Gardner, there are multiple intelligences. This includes the following:

• Linguistic intelligence.
• Logical-mathematical intelligence.
• Spatial intelligence.
• Bodily-kinaesthetic intelligence.
• Musical intelligence.
• Interpersonal intelligence.
• Intrapersonal intelligence.
• Naturalist intelligence.

According to this view, giftedness includes a biopsychological potential to process information. This can be activated by the appropriate cultural setting (e.g. teachers should present lessons through a variety of methods, such as music).

Sternberg’s

Specific learning disabilities are detrimental to one’s well-being. The repeated academic failure associated with this continues to haunt people for years after formal schooling.

A specific learning disability originally included a discrepancy-based definition. This included a discrepancy between IQ and achievement (e.g. high IQ, low reading achievement). However, the degree of discrepancy is arbitrary. This definition favours older children and children with a higher IQ. It is failure-based (e.g. waiting for children to show failure in academics).

The current definition is focused on identification with response to intervention (RTI). It includes achievement in key academic areas that is substantially below the age norm and in excess of sensory deficit (1), linguistic processes (2), attention (3) and memory (4). The prevalence rate is about 2% to 10%.

There are often social deficits in people with SLD but this may be because they get rejected and neglected by peers more often. People with SLD typically have low self-esteem and a poor self-esteem.

The DSM-5 definition of a specific learning disorder includes the following:

• Difficulties in learning and using academic skills for at least six months.
• The affected academic skills are substantially and quantifiably below those expected for the chronological age and lead to impairments in adaptive functioning.
• The learning difficulties begin during school-age years but may not fully manifest themselves until the affected academic skills exceed the individual’s limited capacities (e.g. in the case of a timed test).
• The learning difficulties are not better accounted for by other disorders (e.g. intellectual disability) or educational instruction.

The DSM-5 uses a discrepancy definition but not an IQ-discrepancy definition. There are three specifiers for severity:

• Mild
  This includes some difficulties in learning in one or two academic domains but mild enough to still function well when provided with appropriate accommodations or support services.
• Moderate
  This includes marked difficulties in learning skills in one or more academic domains. The individual is unlikely to become proficient without intensive or specialized training during the school years. Additional support may be needed.
• Severe
  This includes severe difficulties in learning skills in several academic domains. The individual is unlikely to learn those skills without ongoing intensive, individualized and specialized training for most of the school years. Performance may be inadequate even with a lot of support.

Positive psychology interventions (PPI) aim to enhance well-being by increasing positive affect, cognition and behaviour (e.g. developing hope; mastery of life). This includes teaching coping skills. This approach holds that dyslexics have unique strengths and there needs to be a focus on this. However, not all dyslexics have unique strengths and their problems need to be addressed. Positive behavioural interventions (PBI) are more common and focus on providing remedies for the problematic behaviours associated with a specific learning disorder. Changing one’s mindset can help in alleviating the negative aspects of a specific