Assessment
ecologies. The dashed circles symbolize ‘gated’
bidirectional transactions among and across all the
main systems. That is, systems are not necessarily
open to all influences: for example, some indi-
viduals are more resilient than others; auditory
signals inaudible to people influence animals.
Within-system transactions occur and impact
on other systems. When parents collaborate,
rather than argue about the management of their
child, this can help the child to feel more secure
and confident at home, supporting the parents’
engagement. It also leads to the child being more
likely to respond positively to their teachers and
other adults outside the home.
The intra-individual elaboration on the right
of Figure 39.1 illustrates some of the main gen-
eral within-individual functional areas. These can
be differentiated if necessary, for instance, into
finer-grain temperamental characteristics [9]. The
model is superimposed on a developmental trajec-
tory symbolizing changes over time. The shading
indicates that factors operating pre-conception
(such as radiation exposure), can influence physi-
cal status and functional development of children
conceived many years later.
A model such as this has several advantages
for thinking about clinical problems and assess-
ment. It identifies potentially influential systems
interacting and giving rise to complexity in
clinical phenomenology. It provides a structure
for systematic assessment, reminding clinicians
of the factors within the individual and the
broader ecologies that need to be considered.
Assessment also needs to take account of typical
developmental changes, individual differences,
and the ways in which characteristics are manifest
in cultural and ethnic variants.
Assessment is commonly structured using a
mental or other aide memoir, identifying the
domains to investigate that are relevant to the
identified problems. Within each, certain features
may trigger more detailed probing, including
the use of psychological tests. Other areas might
be ignored. Investigations can entail family
meetings, home or school visits and the like,
where information from these contexts might be
useful. Importantly, the assessment process should
also identify the strengths within the individual
and the broader environments that protect and
support daily functioning. Such information aids
understanding of the presenting difficulties and
points to potential resources for intervention.
The proposed model thus emphasizes the need to
adopt a multilevel perspective in assessment while
leaving the clinician free to decide when, where
and what to explore in more detail.
Nevertheless, all practitioners, irrespective of
approach, must be familiar with and take account
of psychiatric and other relevant medical diagnoses
and treatments, partly for ethical reasons, partly
for risk management, and because the functional
impacts found in individuals with such diagnoses
commonly need to be managed. For example,
an individual with attention deficit hyperactivity
disorder (ADHD) whose activity levels and
concentration have benefited from medication
may still need psychological assessment and inter-
ventions to manage the personal and other impacts
on family life, education and peer relationships, of
growing up with ADHD characteristics.
Ultimately, as with other models, it is the
clinician who has to integrate the assessment
information into a coherent formulation with
implications for intervention. Formulations are
tentative explanations of the clinical phenomena.
They can change following feedback from clinical
encounters, from further investigations, and by the
ways in which the individual or family responds.
Depending on the assessment, the formulation may
lead to one or more individualized interventions,
ranging from focal to broad-based, implemented
within any or several of the environments where
there are significant functional impacts. This
approach again stems from recognizing that
multiple differing influences may be involved
in instigating and maintaining clinical problems.
Whether or not evidence-based interventions are
used will depend on the availability of suitable pro-
cedures, taking account of developmental status
and the circumstances of the child or young person.
Although there are differing views about the
contribution of psychological tests, when properly
used, tests can provide essential information to
aid clinical understanding and decision-making,
and can be an important source of outcome-
monitoring data.
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