Clinical assessment of child and adolescent personality and behaviour by Frick, Barry, & Kamphaus (fourth edition) – Chapter 5 summary

Non-specifics refer to contextual factors within which the techniques of psychotherapy take place (e.g. therapeutic alliance). During the assessment procedure, the reason for referral should be taken into account. The interpretations that one anticipates making at the end of the evaluation should guide the selection of tests for the assessment battery (e.g. hypotheses about the referral question and the problem behaviour). When the referrer is unsure about what can be done to help the child or unsure about the nature of the problems, the goal of assessment is to diagnose the source of the problems and make treatment recommendations based on this diagnosis.

It is always important to determine whether an evaluation is in the child’s best interest as a request is not sufficient reason to conduct the evaluation. A second opinion can be valuable although it needs to be taken into account whether it is will not only reinforce the parent’s disagreement with the outcomes or form unrealistic expectations about what the result of evaluation can be.

There are four primary sources of error variance that can affect the reliability of assessment:

1. Temporal variance (i.e. changes in behaviour over time).
2. Source or rater variance (i.e. differences in information due to characteristics of informant).
3. Setting variance (i.e. differences due to different demand characteristics across settings).
4. Instrument variance (i.e. unreliability inherent in individual instruments).

Aggregation refers to obtaining information from multiple sources and across multiple settings and can be used to control error variance and to increase reliability. Aggregation and reliability increase as the length of a test increases. However, the additional tests that are added should be reliable, as it otherwise decreases the reliability of the test battery.

The clinician needs to take several things into account when designing an assessment battery:

• The developmental stage of the child.
• Current research on developmental psychopathology.
• Multifinality and equifinality.
• Practical considerations (e.g. time).
• The aspects of the child’s environment that should be assessed.
• Potential comorbidities associated with the referral problems and the most likely factors that can lead to such problems.

Rapport refers to the interactions between the clinician and the client that promote confidence and cooperation in the assessment process (e.g. warm relationship). An attitude of acceptance (1), understanding (2) and respect for the integrity of the client (3) are essential for building rapport. The self-esteem and the consequences of testing for parents need to be taken into account (e.g. feel like a failure when a child has a disability). It is also important to take the time that teachers have into account and not monopolize it. The rapport with the teacher can be enhanced by calling the teacher and personally thanking them for their effort.

Building rapport with youth is often characterized by having multiple participants, such as parents and teachers (1), lack of motivation of the child (2) and a limited timeframe (3). This makes building rapport more difficult. It is also important to build rapport with the parents and teachers. There are several strategies for building rapport with children and adolescents:

1. Use a warm, friendly, respectful and interested communication style.
2. Take physical appearance into account (e.g. not too formal).
3. Attempt to match or pace the behaviour of the client (e.g. conform posture; movements; speed of speech; voice tone; volume).
4. Tailor vocabulary to the client.
5. Respect the views of the client.
6. Take time during testing to talk of experiences and interests that client and assessor have in common.
7. Occasionally adopt a one-down position (i.e. ask a child from a position of ignorance about something with which the child has expertise).

There are several things to take into account when explaining testing to adolescents:

• Do not come across as condescending.
• Normalize testing as they are busy with fitting in.
• Explain confidentiality to them.
• Understand that the adolescent may not want to be there.