Respond to your colleagues by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.
**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**
Reply #1
Lauranne Brown
Discussion-Initial Post
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Depression in children and adolescents is a significant problem that involves multiple dimensions and treatment options. In this evaluation of depression and anxiety in an adolescent male, several aspects of the practitioner’s intervention techniques will be explored in addition to various aspects of depression assessments and treatment.
Practitioner Analysis
The practitioner did an adequate job in asking specific questions to pinpoint the patient’s symptoms of depression and/or anxiety. This was evidenced by the practitioner asking about the client’s mood, feelings about school, substance abuse and eliciting the trigger for the client’s depression (YMH Boston, 2013). Particularly important was the clinician’s assessment for suicidal symptoms which was completed during the interview (YMH Boston, 2013). The practitioner could improve by developing a rapport with the client initially that includes getting to know the patient by asking about hobbies, interests, support systems, strengths and exploring any other concerns from the client’s perspective (Thapar et al., 2015). Moreover, additional questions regarding the patient’s sleep and eating patterns should be ascertained during the interview (Hilt & Nussbaum, 2016). Compelling concerns were raised towards the end of the video when the patient expressed, “I don’t even want to be alive” then admitted to thoughts of wanting to hurt himself (YMH Boston, 2013). The next question that should be asked would be if the client has developed a specific plan on how he would hurt himself, if he has had self-harm behaviors currently, and if he has ever had a suicide attempt or self-harm behaviors in the past (Hilt & Nussbaum, 2016). If the answer is yes, the methods used and how long ago would be important to determine (Hilt & Nussbaum, 2016). The reason for these questions is to determine the current and past level of suicide risk (Hilt & Nussbaum, 2016).
The Psychiatric Assessment
A thorough psychiatric assessment is important for a variety of reasons. According to Bernaras et al. (2019), many factors may contribute to a child’s feelings of depression or anxiety and includes biological factors such as a depletion of serotonin or tryptophan, recent stressors, parenting style, challenging interpersonal relationships, social and cultural concerns, and the child’s developmental level. This article is considered scholarly as it is peer reviewed and is a comprehensive meta-analysis of related theories and research articles related to depression in children (Bernaras et al., 2019).
Rating Scales
Two rating scales that may be useful in evaluating a child or adolescent for depression involves the Children’s Depression Inventory-II (CDI-II) as this is based on the Beck Depression inventory (BDI) (Bernaras et al., 2019). Nevertheless, this scale has been criticized due to its inability to distinguish depression from other disorders although its scale is effective in determining treatment results (Thabar et al., 2015). Another useful tool to measure childhood depression is the Children’s Depression Rating Scale-Revised (CDRS-R) that is administered by the clinician to assess the child’s depression and suicidality (Thabar et al., 2015). This scale involves both parent and child responses for a more accurate determination of depressive symptoms (Thabar et al., 2015).
Treatment Options
Treatments for depression that may be used with children that are not used with adults include psychodynamic play therapy where the child engages in non-directive play with engagement and observations by the clinician (Wheeler, 2020). Nevertheless, an analysis of several randomized controlled studies using several database articles determined that while psychological interventions may be more effective for adolescents, there were no definitive results suggesting psychological therapies are effective in treating or preventing major depressive disorders in children under 12 (Cuijpers et al., 2021).
Another useful intervention in treating suicidality in adolescents that is not used with adults includes Developmental Group Psychotherapy which addresses repeated self-harm in teenagers (Iyengar et al., 2018). An analysis of several randomized controlled research studies which proved scholarly in nature due to the previously described technique revealed that teenagers that engaged in suicidal behavior reduced their self-harm by 26% after participation in Developmental Group Psychotherapy (Iyengar et al., 2018).
Caregiver/Parental Input
The importance of interviewing the parents or caregiver of the child when completing a psychiatric assessment of children or adolescents is important for several reasons. Parents or caregivers can describe behaviors and the timelines of symptoms that a child may not be able to verbalize due to the child’s developmental age or due to the child being guarded when exposed to a new adult (Hilt & Nussbaum, 2016). As a result, parents or adults may be able to provide a more comprehensive description with timeframes and symptoms that a child may not be able to express (Hilt & Nussbaum, 2016).
In conclusion, the psychiatric assessment of the child involves many layers of information and requires a comprehensive format. Psychiatric Mental Health Nurse Practitioners should be aware of the dimensions of assessment, rating scales, and treatment options to develop an accurate diagnosis and appropriate treatment for children with psychiatric symptoms.
References
Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: a review of theories, evaluation instruments, prevention
programs, and treatments.
Frontiers in Psychology, 10, 543. doi:10.3389/fpsyg.2019.00543.
Cuijpers, P., Pineda, B., Ying, M., Weisz, J., Munoz, R., Gentili, C., Quero, S., & Karvotaki, E. (2021). A meta-analytic review: psychological
treatment of subthreshold depression in children and adolescents.
Journal of the American Academy of Child and Adolescent Psychiatry, 60(9),
1072-1084. https://doi.org/10.1016/j.jaac.2020.11.024
Hilt, R. J., & Nussbaum, A. M. (2016).
DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
Iyengar, U., Snowden, N., Asarnow, J. R., Moran, P., Tranah, T., & Ougrin, D. (2018). A further look at therapeutic interventions for suicide attempts
and self-harm in adolescents: an updated systematic review of randomized controlled trials.
Frontiers in psychiatry,
9, 583.
doi:10.3389/fpsyt.2018.00583.
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowing, M. J., & Taylor, E. A. (2015).
Rutter’s child and adolescent psychiatry (6th ed.). Wiley
Blackwell.
Wheeler, K. (Ed.). (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to-guide for evidence-based practice (3rd ed.). Springer
Publishing.
YMP Boston. (2013, May 22). Vignette 5
. Assessing for depression in a mental health appointment (Video). YouTube.
https://www.youtube.com/watch?v=Gm3FLGxb2ZU.
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