NRNP 6645 - Discussion Week 1
ligiarivera
Reply2_Week1_NRNP6665.docxInstructions:
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**
Abigail Penichet
Week 1 Abby Initial Post
Top of Form
When evaluating the video by YMH Boston Vignette 5 there are many things to consider with this patient’s care. When taking care of children and adolescents it is important to be able to differentiate the care plan differences between them and adults. The purpose of this discussion is to discuss this patient’s case but also how the care between children and adults differs.
Video
The practitioner I felt like listened to the patient very well. She asked a question and then followed up the answers he gave. She also repeated back the answers he gave and allowed him to elaborate further on the answers he gave. Sadock, et al. (2015) explains that it is important to establish the child or adolescents’ hobbies, relationships with family and friends and any recent events that precepted changes that lead to the interview. The practitioner did a good job or asking questions about what had been happening in his life and if he was still finding joy in the things he must do. I do not think there was much she could have improved on during the short interview I saw. The questions about his mood she came back to in a different line of questioning that he ultimately opened up more with.
Concerns
The most compelling concern would be that he expressed the feelings of not wanting to be alive. When pushed further on if he is having thoughts of hurting himself, he stated yes. It would be important to explore further if he has a plan or has made an active attempt of suicide recently or ever in the past. Moon, et al. (2020) explains that death by suicide is the second leading cause of death for youth and adolescents in the United States with a continued trend up. Being diligent about the comments the patient makes is important because we as the providers need to gauge the seriousness of the concern.
Children / Adolescent Assessment
A thorough psychiatric assessment in child and adolescents is important because it will be the basis of the work that the clinician will do in the future. Building trust and rapport lead to a strong therapeutic alliance that will better serve the child and the family. Things to consider when making an assessment include the family dynamics and relationships within the family, the child’s developmental level, medical history, and adversities faced all should be considered when making assessments (Thapar, et al., 2015). It is important for the provider to understand that many factors may play a role in why the child was brought in for an assessment.
Symptom Rating Scales
There are a few different scales that can be used when assessing children and adolescents. The first to consider is the Achenbach Behavior Problem Checklist. Brown, at al. (2018) explains this checklist that includes 113 items that evaluate problem behaviors the child has been experiencing over the last six months. Along with internal, externalizing and behavior syndromes. A con of this scale is the number of questions that need to be answered in total.
Another option of a rating scale for children or adolescents is the Brief Impairment Scale. This is much shorter scale of only 23 questions that has been recently developed (Sadock, et al., 2015). These 23 questions encompass three areas of interpersonal relations, school functioning, and care or self-fulfillment. Other scales often used include the Children’s Depression Inventory and the Revised Children’s Manifest Anxiety Scale for more direct questions related to symptoms.
Treatment
When treating children and adolescents the treatment options differ from adults. One option that may be used in children but not in adults is play therapy. One form of play therapy is Adlerian Play Therapy (AdPT). Dillman Taylor, et al. (2022) discusses how in AdPT the therapist uses toys, play materials, art, storytelling, movement, and sand tray experiences to educate and communicate with the child. This would not be an age-appropriate treatment choice for an adult.
Another treatment that may be utilized with children and not in adults is applied behavioral analysis (ABA) therapy. This is a therapy choice often used in children with autism but is not stretching out to children with ADHD also. It would not be used in adults because the theory revolves around teaching behaviors in multiple smaller steps.
Parents / Guardians
Parents or guardians are often the ones who make the decision to initially bring a child in. The problems seen by the adults in the child’s life sometimes are not considered an issue to the child. It is important to include the children and adults in a group discussion about why they are there. This can include what the goals are for the child and the family or what the symptoms are that initiated the meeting. Things that should be discussed include the child’s current problems, past medical history, school progress, relationships within the family and peers, and early developmental milestone (Thapar, et al. 2015).
References
Brown, L. K., Tarantino, N., Tolou-Shams, M., Esposito-Smythers, C., Healy, M. G., & Craker, L. (2017). Mental Health Symptoms and Parenting Stress of Parents of Court-Involved Youth. Journal of Child and Family Studies, 27, 843–852.
Dillman Taylor, D., Thompson, K. A., & Kottman, T. (2022). Strengthening the efficacy of Adlerian Play Therapy through the measurement model. International Journal of Play Therapy, 31(3), 165–173. https://doi.org/10.1037/pla0000176.supp (Supplemental)
Moon, S. S., Kim, Y. J., & Parrish, D. (2020). Understanding the Linkages between Parental Monitoring, School Academic Engagement, Substance Use, and Suicide among Adolescents in U.S. Child & Youth Care Forum, 49(6), 953–968.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
