NADD Bulletin Volume VIII Number 4 Article 3

Complete listing

In memory of John Jacobson, Ph.D.: Sources for Information on Screening/Assessment of Mental Health/Psychiatric Information in Children and Adolescents with Developmental Disabilities

Ann R. Poindexter, M.D.

 

With the present federal emphasis on screening children and adolescents in the general population for mental health conditions, I've attempted to put together a list of references that I, as a pediatrician/primary care physician, have found to be helpful over the years. Most of these references do not deal specifically with young people with developmental disabilities, but much of the material can be relatively easily transferred to this population. (I am not listing these references in any particular order of importance.)

 

American Psychiatric Association. (1995). Diagnostic & statistical manual of mental disorders, 4th ed., primary care version. Washington, DC: Author.

This volume outlines algorithms for common primary care presentations of various symptom clusters, as well as a discussion of psychosocial problems which may impact symptom presentation. One chapter discusses briefly disorders which are usually first diagnosed in infancy childhood, or adolescence. A checklist is included for psychosocial/environmental problems which appears to have potential to be very usual for evaluation of individuals with developmental disabilities.

 

American Academy of Pediatrics. (1996). The classification of child and adolescent mental diagnoses in primary care: Diagnostic and statistical manual for primary care, child and adolescent version. Elk Grove Village, IL: Author.

This has been an extremely helpful volume to me, primarily because of its practical approach to development of diagnostic postulates. One of the early discussions deals with consideration of the severity of clinical need-four dimensions are outlined, including symptoms, functioning, burden of suffering, and risks/protective factors. Assessment of environmental situations includes challenges to primary support group, changes in caregiving, other functional change in the family, community or social challenges, educational challenges, parent or adolescent occupational challenges, housing challenges (including homelessness), economic challenges, inadequate access to health and/or mental health services, legal system or crime problems, and other environmental and health-related situations.

Each cluster of symptoms is assessed as to whether it is a common developmental variation, a problem, or a disorder. Careful assessment in this way may prevent many children from receiving unnecessary medication, but also may facilitate medication treatment when it is really needed by the young person. (Behavior which is merely a nuisance to others probably shouldn't be treated anyway-who's problem is it?)

The appendix of this volume includes ten diagnostic vignettes, which illustrate the book's approach to diagnostic assessment.

 

Jellinek, M., Patel, B. P., & Froehle, M. C. (Eds.). (2002). Bright futures in practice: Mental health-Volume I. Practice guide. Arlington, VA: National Center for Education in Maternal and Child Health.

This is an exciting (to me) book designed to introduce primary health care professionals to ways to promote mental and emotional health and well being of all children and adolescents. Note is made that this is quite significant in today's complex society, in which many of the concerns that families bring to primary care health professionals relate to developmental, psychosocial, or specific mental health issues. The goal of this first volume, as well as the second, is to provide a vision, framework, and practical set of resources and tools to help address these concerns. The importance of partnerships with families and communities is strongly stressed.

 

Jellinek, M., Patel, B. P., & Froehle, M. C. (Eds.). (2002). Bright futures in practice: Mental health-Volume II. Tool kit.

This book is designed to accompany the narrative volume, described above. Volume II includes a large number of tools, both for health care professionals and for families. (The latter may be quite helpful for non-family members such as teachers who work with children/adolescents with developmental disabilities.) Further information on these volumes may be obtained from www.ncemch.org.

 

Substance Abuse & Mental Health Services Administration. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings (Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-3964). Rockville, MD: Author. (Accessible electronically through http://www.samhsa.gov or http://www.oas.samhsa.gov.

This report outlines population-based data on the use of a variety of drugs, including tobacco, alcohol, and various drugs. For those of us who are quite concerned about these issues in persons with developmental disabilities, this material is a "wake-up call," hopefully leading to increased screening, assessment, and treatment for people with these problems. A short overview of the findings of the survey is available from the sources listed above.

 

McLellan, T. & Dembo, R. (1995). Screening & assessment of alcohol- and other drug-abusing adolescents (Treatment Improvement Protocol (TIP) 3). Rockville, MD: U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration. (This and other TIPs may be ordered from [800] 729-6686 free of charge.)

This TIP includes discussions of preliminary screening, comprehensive assessment of adolescents for referral and treatment, legal issues in the screening and assessment of adolescents, and screening and assessment of adolescents in juvenile justice systems. A variety of sample screening instruments are included in the appendix. (Many of these appear to have potential for usefulness in observer reporting of symptoms, and probably can be used for adults with developmental disabilities as well as adolescents.)

 

A number of websites are available to assist in screening/assessment of behavioral/psychiatric problems in children and youth. One of the most exciting to me is from the National Center on Birth Defects and Developmental Disabilities, http://www.cdc.gov/ncbddd/autism/actearly. This site points out the importance of tracking children's development as well as physical growth. Free materials are quickly accessible for parents, health care professionals, and partners. Fact sheets are described, and materials may either be downloaded or ordered. Since much recent data has indicated that children with intellectual disability and/or pervasive developmental disorders such as autism do much better when diagnosed and treated early, this site, which is quite new, should be very helpful to the field.

 

Sleep disorders make up a very common medical condition often presenting as behavioral problems-in my experience only secondary to medication reactions and physical discomfort. A recent issue of Journal of the American Medical Association (May 18, 2005, pp. 2327-2329) describes the developing field of pediatric sleep medicine and notes that a variety of recent educational efforts target both children and adolescents. Garfield (that infamous comic strip character) serves as "spokes cat" for the "Star Sleeper" program of the National Center on Sleep Disorders Research (http://www.nhlbi.nih.gov/health/public/sleep/starslp/) and the National Sleep Foundation offers "Time to Sleep With P. J. Bear" (http://www.sleepforkids.org/html/pjbear.html) . The National Institutes of Health offers a 5-unit curriculum supplement for grades 9-12 titled Sleep, Sleep Disorders, and Biological Rhythms (http://osedev.od.nih.gov/supplements/nih3/sleep/default.htm). The materials offered to this adolescent age group look quite sound, and probably would be helpful to many adults interested in the topic.

 

For further information: dapoin@cyberback.com.