Assessment 21be explained by several alternative diagnoses, and you then need to
review the evidence for and against each possibility before reaching a
conclusion on the likely diagnosis (or diagnoses), or suggesting further
assessments or investigations that will clarify the picture. Or perhaps
John has elements of several different disorders but does not meet
the full criteria for any of them – you may need to recognise that he
falls between the cracks of the current diagnostic systems. Or maybe
Amy’s distress about teasing at school, overcrowding at home and rows
between her mother and stepfather warrant recognition and help, but
do not warrant a diagnosis.
4 Causation, for example, Alan developed obsessive compulsive disorder
and tics following a streptococcal infection, probably mediated by an
auto-immune response; or Jane’s post-traumatic stress disorder fol-
lowed sexual abuse by a babysitter; or Michael’s disruptive behaviour
may reflect the combination of constitutional vulnerability linked to his
fetal alcohol syndrome, and suboptimal parenting linked to his mother’s
continuing alcohol problems and depression.
5 Management plan, including specific psychological or pharmacological
treatments, as well as psycho-educational work with the individual,
family and school. The plan should build on the individual’s and family’s
strengths, and boost these still further.
6 Predicted outcome, for example, Sarah’s specific phobia of dentists is likely
to resolve with a brief course of behavioural therapy, and will probably
not recur; Roger’s conduct disorder is likely to persist, carrying a high
long-term price for him and society, unless he receives appropriate
intensive treatment such as multi-systemic therapy.
It is not easy to produce a formulation that is accurate, brief and useful –
the best way to learn is by practising the skill and getting constructive
feedback from more experienced colleagues.
Subject review
Baird G, Gringras P. (2008) Physical examination and medical investiga-
tion.In: Rutter Met al.(eds)Rutter’s Child and Adolescent Psychiatry,5th
edn. Wiley-Blackwell, Chichester, pp. 317–335.
Le Couteur A, Gardner F. (2008) Use of structured interviews and ob-
servational methods in clinical settings.In: Rutter Met al.(eds)Rutter’s
Child and Adolescent Psychiatry, 5th edn. Wiley-Blackwell, Chichester,
pp. 271–288.
Taylor E, Rutter M. (2008) Clinical assessment and diagnostic formulation.
In: Rutter Met al.(eds)Rutter’s Child and Adolescent Psychiatry,5thedn.
Wiley-Blackwell, Chichester, pp. 42–57.
Further reading
Jones DPH. (2003)Communicating with Vulnerable Children: A Guide for
Practitioners. Gaskell, London.