Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Evaluation Process
When conducted by a mental health professional, the evaluation process usually consists of gathering information from several sources: the child, parents,
teachers, pediatricians, and hospital records. The mental health professional also makes observations of the child’s or teenager’s behavior and patterns of speech. Very often, additional testing is requested to assess the child’s or youth’s intelligence and learning abilities. Information about symptoms can be obtained more reliably by direct questioning (Gittelman-Klein, 1978; Gittelman, 1985).
A full evaluation may take several hours. By that time, the professional should have a good understanding of how the child is functioning at home, at school, and in society and some understanding of the family’s characteristics. With this information, the child or adolescent psychiatrist, clinical psychologist, or social worker can suggest further investigations and, if needed, initiate treatment of the child and provide counseling to parents and teachers on how to best assist the child or teenager to overcome problems.
There is a dearth of child psychiatrists, appropriately trained clinical child psychologists, or social workers (Thomas & Holzer, 1999). Furthermore, many barriers remain that prevent children, teenagers, and their parents from seeking help from the small number of specially trained professionals who are available. This places a burden on pediatricians, family physicians, and other gatekeepers (such as school counselors and primary child care workers) to identify children for referral and treatment decisions. These gatekeepers are unlikely to have the time and specialized training to do an evaluation requiring several hours. Their responsibility often is to“triage” cases, that is, refer children who need further evaluation to specialists. Many, however, are involved in treating children and adolescents. They may be greatly aided by various diagnostic aids such as brief questionnaires that can be completed in the waiting room of the pediatrician, the school counseling office, or some other community setting. Ideally, these screening questionnaires would be accompanied by a clear guide on interpreting results and identifying what kind of score or behavior would normally indicate a need for referral to a professional.
Some of the questionnaires that specifically address mood disorders are shown in Figure 3-1. Other questionnaires, such as the Adolescent Antisocial Self-Report Behavior Checklist (Kulik et al., 1968), the Eyberg Child Behavior Inventory (Eyberg & Robinson, 1983), and the Family Interaction Coding Pattern (Patterson, 1982), assess antisocial behavior. Adults and teachers can use instruments such as the Child Behavior Checklist (Achenbach & Edelbrock, 1983) to assess a relatively full range of behavioral and emotional symptoms and disorders from the perspective of adult informants. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Hathaway & McKinley, 1989) and the Millon Adolescent Personality Inventory (MAPI) (Millon et al., 1982) questionnaires may be used with adolescents to assess normal and abnormal personality function.
The advent of highly structured, computer-driven assessment tools, such as the NIMH Diagnostic Interview Schedule for Children, which comes in a spoken version that can be given through headphones to children and/or their parents (Shaffer et al., 1996a), promises to greatly improve the ability of professionals outside of the mental health field to obtain robust diagnostic information, which can guide them in decisions about further referral or treatment.
Figure 3-1. Questionnaires used to assess childhood mood disorders
| Title | Source |
| The Children's Depression Inventory (CDI) | Kovacs, 1985 |
| Beck Depression Inventory (BDI) | Beck, Ward, Mendelson, Mock & Erbaugh, 1961 |
| Reynolds Adolescent Depression Scale (RADS) | Reynolds, 1986 |
| Children's Depression Scale (CDS) | Tisher & Lang, 1983 |
| Center for Epidemiological Studies of Depression (CES-D) | Radloff, 1977 |
| Kandel Depression Scale (KDS) | Kandel & Davies, 1982 |
| Zung Self-Rating Depression Scale (SDS) | Zung, 1965 |
| Diagnostic Interview Schedule for Children (DISC) | Shaffer & Fisher, 1998 |
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