Copyright 2013 American Psychiatric Association All R 544769

Copyright 2013 American Psychiatric Association All Rights Reserved

This material can be reproduced without permission by researchers and by clinicians for use with their patients. DSM-5 Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure—Child Age 6–17 Child’s Name: _________________________________ Age: ____ Sex: ï± Male ï± Female Date:___________ Relationship with the child: _________________________________________________________________ Instructions (to the parent or guardian of child): The questions below ask about things that might have bothered your child. For each question, circle the number that best describes how much (or how often) your child has been bothered by each problem during the past TWO (2) WEEKS. During the past TWO (2) WEEKS, how much (or how often) has your child… None Not at all Slight Rare, less than a day or two Mild Several days Moderate More than half the days Severe Nearly every day Highest Domain Score (clinician) I.

1. Complained of stomachaches, headaches, or other aches and pains? . Said he/she was worried about his/her health or about getting sick? II. 3.

Had problems sleeping—that is, trouble falling asleep, staying asleep, or waking up too early? III. 4. Had problems paying attention when he/she was in class or doing his/her homework or reading a book or playing a game? IV.

5. Had less fun doing things than he/she used to? . Seemed sad or depressed for several hours? V. & VI. 7.

Seemed more irritated or easily annoyed than usual? . Seemed angry or lost his/her temper? VII. 9. Started lots more projects than usual or did more risky things than usual? .

Slept less than usual for him/her, but still had lots of energy? VIII. 11. Said he/she felt nervous, anxious, or scared? . Not been able to stop worrying? .

Said he/she couldn’t do things he/she wanted to or should have done, because they made him/her feel nervous? IX. 14. Said that he/she heard voices—when there was no one there—speaking about him/her or telling him/her what to do or saying bad things to him/her? . Said that he/she had a vision when he/she was completely awake—that is, saw something or someone that no one else could see?

X. 16. Said that he/she had thoughts that kept coming into his/her mind that he/she would do something bad or that something bad would happen to him/her or to someone else? . Said he/she felt the need to check on certain things over and over again, like whether a door was locked or whether the stove was turned off? . Seemed to worry a lot about things he/she touched being dirty or having germs or being poisoned? . Said that he/she had to do things in a certain way, like counting or saying special things out loud, in order to keep something bad from happening? In the past TWO (2) WEEKS, has your child … XI. 20. Had an alcoholic beverage (beer, wine, liquor, etc.)? ï¯ Yes ï¯ No ï¯ Don’t Know 21. Smoked a cigarette, a cigar, or pipe, or used snuff or chewing tobacco? ï¯ Yes ï¯ No ï¯ Don’t Know 22. Used drugs like marijuana, cocaine or crack, club drugs (like ecstasy), hallucinogens (like LSD), heroin, inhalants or solvents (like glue), or methamphetamine (like speed)? ï¯ Yes ï¯ No ï¯ Don’t Know 23. Used any medicine without a doctor’s prescription (e.g., painkillers [like Vicodin], stimulants [like Ritalin or Adderall], sedatives or tranquilizers [like sleeping pills or Valium], or steroids)? ï¯ Yes ï¯ No ï¯ Don’t Know XII. 24. In the past TWO (2) WEEKS, has he/she talked about wanting to kill himself/herself or about wanting to commit suicide? ï¯ Yes ï¯ No ï¯ Don’t Know 25. Has he/she EVER tried to kill himself/herself? ï¯ Yes ï¯ No ï¯ Don’t Know Johnny MOTHER 9 X O O O O O O O O O O O O O O O O O O O X X X X X X Case Study: Johnny Johnny is a 9 year old boy brought to the emergency room where you are employed as a crisis therapist. The patient was transported by a crisis mobile team who was called by the school. The evaluation by the ER physician as well as the urine drug screen is unremarkable: there are no acute or chronic concerns with this patient. In the chart, you note the DSM-5 Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure—Child Age 6–17 form completed by the mother (attached). Admission paperwork identifies that Johnny has had numerous visits to the principal’s office in the past year, all triggered by various disruptive behaviors. Today’s crisis started when Johnny refused to follow directions regarding an in-class assignment. When the teacher attempted to redirect his behavior things escalated rapidly: Johnny yelled at the teacher, cursed at him using vulgar language, and when the teacher grabbed him by the shoulders to take him to the principal’s office Johnny impulsively stabbed the teacher in the arm with a pencil he was clenching in his hand. Johnny was escorted to the principal’s office who immediately called the police and Johnny’s parents. The police officer was compelled to contact the county crisis hotline who dispatched a crisis mobile team. The crisis clinicians made the determination that Johnny is a danger to others and he must be taken immediately to the nearest emergency room for emergency psychiatric evaluation. Johnny has refused to speak to the ER physician or his nurse. You gather most of your clinical information from his mother who is at the bedside. Johnny’s mother reports that he has always been a clever, charming, and very playful boy. She informed that for the past year Johnny has been increasingly stubborn, repeatedly challenging his mother’s and his teacher’s authority when compliance with home and/or classroom rules is required. Johnny used to be an A+ student. For the past year, however he has been averaging Bs in most subjects, grades that he earned effortlessly. His mother repeatedly assures you that his drop in grades is not due to lack of intellectual ability but rather because Johnny prefers playing over any type of work. His mother denies any changes in sleep, appetite, or any mood fluctuations. Furthermore, his mom reports that Johnny is a healthy and happy boy who is interested in sports, the outdoors, videogames, and that he wishes to become a software engineer when he grows up. She reports that the school counselor has mentioned that Johnny may be suffering from ADHD or even bipolar disorder. The thought of these diagnoses appear very disturbing to Johnny’s mom. She quickly assures you that she has not observed Johnny to ever struggle with depression, or distractibility, and reports that he has always been a good sleeper. She reports that Johnny has never made any statements amounting to thoughts or impulses to harm self or others. Johnny’s mother presents shaken by today’s events and she assures you that she will seek any treatment you recommend. At this time, Johnny looks up at you and with tears in his eyes; he states that he did not mean to stab his teacher explaining that he just got mad when he grabbed him. Johnny’s mother listens then states that while he obeys her most of the times, he has always been obedient to his father, who is a traveling salesman. In fact, Johnny has never challenged his father and, on the weekends when he is around, Johnny manages to catch up with his schoolwork in record time and enjoy spending most of his time with his father.

Paper For Above instruction

Psychological assessment of children, particularly those involved in crisis situations like Johnny, requires a nuanced understanding of their behavioral, emotional, and developmental functioning. Drawing upon the DSM-5 Level 1 Cross-Cutting Symptom Measure and a detailed case analysis, this paper explores the complexities of pediatric mental health assessment, emphasizing the importance of multi-informant reporting, diagnostic considerations, and the role of context in interpretation.

Introduction

The mental health of children is a critical aspect of their overall development, encompassing emotional regulation, behavioral adjustment, cognitive functioning, and social integration. The assessment process often involves multiple informants—parents, teachers, clinicians—and a comprehensive approach to understanding the child's presenting problems. When children present with disruptive or aggressive behaviors, as in Johnny’s case, mental health professionals must carefully evaluate underlying factors such as attention deficits, mood dysregulation, behavioral disorders, and potential trauma or environmental stressors.

Role of Multi-Informant Assessments

The DSM-5 Cross-Cutting Symptom Measure provides valuable insight by capturing symptoms across multiple domains from the parent’s perspective. In Johnny's scenario, the mother reports a primarily stable mood, typical sleep patterns, and no prior suicidal ideation, yet notes increased stubbornness and disruptive behaviors over the past year. The absence of reported mood fluctuations minimizes the likelihood of bipolar disorder, though it does not eliminate the need for cautious consideration. Multi-informant ratings, including teacher reports and direct observations, are essential to obtain a full picture, especially as Johnny's school behavior, such as frequent visits to the principal and recent violence, indicates possible underlying conduct or oppositional defiant tendencies.

Diagnostic Considerations

Johnny’s case illustrates the importance of differential diagnosis. The recent escalation in disruptive behavior could suggest Oppositional Defiant Disorder (ODD), Conduct Disorder, ADHD, or mood disorders, including bipolar disorder. The mother's benign description of Johnny’s mood, combined with the abrupt violent behavior, underscores the complexity of diagnosis. Notably, the absence of mood swings or irritability outside of anger episodes diminishes the likelihood of bipolar disorder, yet the violent outburst raises concerns about severe impulse control issues. Criteria from DSM-5 suggest that diagnosis should be based on comprehensive assessment, including clinical interview, standardized measures, and collateral information.

Impulsivity and Aggression in Children

Impulsivity and aggression are common presenting symptoms in pediatric mental health, often associated with ADHD, conduct problems, or trauma-related disorders. Johnny's impulsive stabbing of the teacher, triggered by frustration and authority challenges, exemplifies this. The assessment should explore environmental stressors, such as family dynamics and school environment, as well as internal factors like emotional regulation abilities. Understanding whether such behaviors are situational or pervasive influences diagnosis and subsequent treatment, which may include behavioral interventions, family therapy, or medication.

Developmental Context and Family Dynamics

Johnny’s positive relationship with his father and consistent obedience at home suggest a supportive family environment. However, his increased stubbornness, defiance, and aggressive episodes indicate potential difficulties in emotional regulation, possibly exacerbated by developmental factors such as ADHD or oppositional tendencies. Family history, parenting styles, and the child’s temperament are critical components in treatment planning. Johnny’s mother’s distress and protective stance highlight the need for psychoeducation and family-based interventions.

Implications for Treatment

Effective management of Johnny’s behavioral problems requires a multidisciplinary approach. Behavioral therapies, such as Parent Management Training (PMT), aim to improve compliance and reduce oppositional behaviors. School-based interventions may include behavioral modifications and accommodations. Pharmacotherapy, particularly stimulant medications for ADHD or mood stabilizers if bipolar symptoms are suspected, could be considered following thorough diagnosis. Clinicians should also evaluate for trauma exposure, which can influence aggression and emotional dysregulation.

Conclusion

Johnny’s case underscores the importance of comprehensive, biopsychosocial assessments in pediatric mental health. While initial reports and observations guide diagnosis, ongoing assessment, collateral input, and careful consideration of environmental factors are essential. Recognizing the complexity of disruptive behaviors, clinicians must differentiate between various disorders, tailor interventions accordingly, and involve families in the therapeutic process to promote optimal outcomes for children like Johnny.

References

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