BEYOND THE CHECKLIST - PowerPoint PPT Presentation

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Title: BEYOND THE CHECKLIST


1
BEYOND THE CHECKLIST
  • YAI CONFERENCE
  • MAY 2004
  • PATRICIA MCGUIRE MD, FAAP
  • SPRINGTIDES, INC.
  • CEDAR RAPIDS, IA
  • WWW.SPRINGTIDES.ORG

2
DSM-IV CHECKLISTVANDERBILT
  • 1. Does not pay attention to details or makes
    careless mistakes with, for example, homework
  • 2. Has difficulty keeping attention to what needs
    to be done
  • 3. Does not seem to listen when spoken to
    directly
  • 4. Does not follow through when given directions
    and fails to finish activities
  • (not due to refusal or failure to understand)
  • 5. Has difficulty organizing tasks and activities
  • 6. Avoids, dislikes, or does not want to start
    tasks that require ongoing

3
DSM-IV CHECKLISTVANDERBILT
  • mental effort
  • 7. Loses things necessary for tasks or activities
    (toys, assignments, pencils,
  • or books)
  • 8. Is easily distracted by noises or other
    stimuli
  • 9. Is forgetful in daily activities
  • 10. Fidgets with hands or feet or squirms in seat
  • 11. Leaves seat when remaining seated is expected
  • 12. Runs about or climbs too much when remaining
    seated is expected

4
DSM-IV CHECKLISTVANDERBILT
  • 13. Has difficulty playing or beginning quiet
    play activities
  • 14. Is on the go or often acts as if driven by
    a motor
  • 15. Talks too much
  • 16. Blurts out answers before questions have been
    completed
  • 17. Has difficulty waiting his or her turn
  • 18. Interrupts or intrudes in on others
    conversations and/or activities
  • 19. Argues with adults

5
DSM-IV CHECKLISTVANDERBILT
  • 20. Loses temper
  • 21. Actively defies or refuses to go along with
    adults requests or rules
  • 22. Deliberately annoys people
  • 23. Blames others for his or her mistakes or
    misbehaviors
  • 24. Is touchy or easily annoyed by others
  • 25. Is angry or resentful
  • 26. Is spiteful and wants to get even
  • 27. Bullies, threatens, or intimidates others

6
DSM-IV CHECKLISTVANDERBILT
  • 28. Starts physical fights
  • 29. Lies to get out of trouble or to avoid
    obligations (i.e., cons others)
  • 30. Is truant from school (skips school) without
    permission
  • 31. Is physically cruel to people
  • 32. Has stolen things that have value

7
DSM-IV CHECKLISTVANDERBILT
  • 33. Deliberately destroys others property
  • 34. Has used a weapon that can cause serious harm
    (bat, knife, brick, gun)
  • 35. Is physically cruel to animals
  • 36. Has deliberately set fires to cause damage
  • 37. Has broken into someone elses home,
    business, or car
  • 38. Has stayed out at night without permission
  • 39. Has run away from home overnight
  • 40. Has forced someone into sexual activity

8
DSM-IV CHECKLISTVANDERBILT
  • 41. Is fearful, anxious, or worried
  • 42. Is afraid to try new things for fear of
    making mistakes
  • 43. Feels worthless or inferior
  • 44. Blames self for problems, feels guilty
  • 45. Feels lonely, unwanted, or unloved complains
    that no one loves him or her
  • 46. Is sad, unhappy, or depressed
  • 47. Is self-conscious or easily embarrassed

9
DSM-IV CHECKLISTVANDERBILT
  • IT ALSO LOOKS FOR LEVELS OF IMPAIRMENT BY ASKING
    ABOUT
  • ACADEMIC PERFORMANCE -
  • READING
  • MATHEMATICS
  • WRITTEN EXPRESSION
  • HOMEWORK COMPLETION

10
DSM-IV CHECKLISTVANDERBILT
  • CLASSROOM BEHAVIOR -
  • RELATIONSHIPS WITH PEERS
  • FOLLOWING DIRECTIONS/RULES
  • DISRUPTING CLASS
  • ASSIGNMENT COMPLETION
  • ORGANIZATIONAL SKILLS

11
BEYOND THE CHECKLIST
  • THE PROBLEM WITH A CHECKLIST IS JUST THAT
  • IT IS A CHECKLIST
  • IT IS NOT MEANT TO BE DIAGNOSTIC
  • IT IS MEANT TO BE THE STARTING POINT TO LOOKING
    AT THE WHYS OF THE BEHAVIORS

12
BEYOND THE CHECKLIST
  • MOST OF OUR OTHER TOOLS ARE ALSO MEANT TO BE USED
    TO FOCUS IN ON AND NARROW THE POSSIBLE OPTIONS OF
    THE PROBLEMS
  • THIS WOULD INCLUDE SUCH TOOLS AS
  • CONNERS CHECKLIST
  • BASC
  • CHILD BEHAVIOR CHECKLIST CBCL (ACHENBACH)
  • CHAT (FOR AUTISM)

13
BEYOND THE CHECKLIST
  • CENTER FOR MENTAL HEALTH IN SCHOOLS
  • RESOURCE PACKET SCREENING/ASSESSMENT INDICATORS
    AND TOOLS
  • DISCLAIMER NOTE OF CAUTION
  • MOST SCREENING TOOLS ARE FIRST LEVEL
  • ARE EXPECTED TO OVERIDENTIFY

14
BEYOND THE CHECKLIST
  • DISCLAIMER CONTINUED
  • ERRORS ARE SUPPOSED TO BE DETECTED BY FOLLOW-UP
    ASSESSMENTS
  • SERIOUS CONCERNS WHEN SCREENING DATA ARE USED TO
    DIAGNOSE STUDENTS AND PRESCRIBE REMEDIATION AND
    SPECIAL TREATMENT
  • DO NOT ALLOW FOR DEFINITIVE STATEMENTS ABOUT A
    STUDENTS PROBLEMS AND NEEDS.

15
BEYOND THE CHECKLIST
  • LETS LOOK AT THE RESULTS OF 124 PARENT
    CHECKLISTS COLLECTED IN MY OFFICE BETWEEN 03/01
    AND 11/02
  • AGE RANGE FROM 3 TO POST HIGH SCHOOL (EARLY 20S)
  • 70 MALE AND 30 FEMALE
  • CONSECUTIVE NEW PATIENTS SO INITIAL COMPLAINTS
    VARIED BUT ALL WITHIN THE REALM OF DEVELOPMENTAL
    AND BEHAVIORAL PEDIATRICS

16
BEYOND THE CHECKIST
  • USING STANDARD DSM-IV CRITERIA
  • INATTENTION ADHD ONLY 43
  • IMPULSVIE ADHD ONLY 27
  • COMBINED ADHD ONLY 19
  • BEHAVIORAL DIAGNOSES 27
  • MOOD DIAGNOSES 30

17
BEYOND THE CHECKLIST
  • I USE A SLIGHTLY DIFFERENT METHOD OF
    SCORING,USING , BASED ON THE DSM-PC IDEA OF
    BEHAVIORS SEEN AS
  • DEVELOPMENTAL VARIATIONS
  • DEVELOPMENTAL PROBLEM/CONCERNS
  • MENTAL HEALTH DISORDERS
  • FOR TODAY I CONDENSED THE LAST 2 TOGETHER

18
BEYOND THE CHECKLIST
  • VARIATION GROUP
  • INATTENTION ADHD ONLY 2
  • IMPULSIVE ADHD ONLY 18
  • COMBINED ADHD 8
  • BEHAVIORAL DIAGNOSES 51
  • MOOD DIAGNOSES 44
  • THIS MEANS THAT SCORES WERE IN THIS AREA, IT IS
    NOT A DIAGNOSIS

19
BEYOND THE CHECKLIST
  • PROBLEM AND DISORDER GROUP
  • INATTENTION ADHD ONLY 29
  • IMPULSIVE ADHD ONLY 5
  • COMBINED ADHD 34
  • BEHAVIORAL DIAGNOSES 48
  • MOOD DIAGNOSES 55
  • THIS MEANS THAT SCORES WERE IN THIS AREA, IT IS
    NOT A DIAGNOSIS

20
BEYOND THE CHECKLIST
  • COMPARISON TO FINAL DIAGNOSES

21
BEYOND THE CHECKLIST
  • ONE NEEDS TO ASK WHAT CAUSES THESE VARIATIONS
    FROM THE CHECKLIST TO THE DIAGNOSES?
  • WHAT ARE OTHER FACTORS AFFECTING THE BEHAVIORS?

22
BEYOND THE CHECKLIST
  • FACTORS THAT AFFECT BEHAVIOR
  • HOME ENVIRONMENT
  • SCHOOL (CHILDCARE) ENVIRONMENT
  • TEMPERAMENT OF CHILD
  • CHRONIC ILLNESSES OF CHILD(PHYSICAL/MENTAL)
  • HEALTH (PHYSICAL/MENTAL) OF PARENT
  • PRENATAL EXPOSURES
  • LEARNING PROBLEMS/DISABILITIES
  • OTHER DEVELOPMENTAL DELAYS/DISORDERS
  • SUBSTANCE ABUSE OF CHILD

23
BEYOND BEHAVIOR
  • HOME ENVIRONMENT
  • WHERE IS THE CHILD LIVING
  • DOES HE HAVE TO SHARE A ROOM/BED
  • HOW MANY OTHERS LIVE AT SAME RESIDENCE
  • HOW DO THEY GET ALONG
  • WHAT IS THE NEIGHBORHOOD LIKE
  • ARE THERE ANY OTHER STRESSORS

24
BEYOND THE CHECKLIST
  • SCHOOL (CHILDCARE) ENVIRONMENT
  • CHILDCARE
  • IS IT A CENTER OR IN HOME
  • IS IT REGISTERED OR INFORMAL
  • HOW MANY KIDS ARE THERE
  • HOW LONG DOES THE CHILD SPEND THERE EACH DAY
  • ARE THERE ANY PROBLEMS THERE

25
BEYOND THE CHECKLIST
  • SCHOOL ENVIRONMENT
  • HOW FAR FROM HOME IS IT
  • HOW DOES THE CHILD GET THERE
  • ARE THERE PROBLEMS ON THE WAY
  • HOW MANY KIDS IN CLASS
  • HOW DOES THE TEACHER GET ALONG WITH THE CHILDREN
    THAT CHILD IN PARTICULAR
  • DOES HE HAVE ANY FRIENDS THERE
  • HOW DOES HE DO ACADEMICALLY BEHAVIORALLY

26
BEYOND THE CHECKLIST
  • TEMPERAMENT OF CHILD
  • TRAITS OF BEHAVIOR THAT WE ARE ALL BORN WITH
  • INHERITED
  • WITH THE INFLUENCE OF LIFE EVENTS, HELPS TO FORM
    PERSONALITY
  • 9 TRAITS BASED ON CHESS AND THOMAS

27
BEYOND THE CHECKLIST
  • MOOD
  • PERSISTENCE
  • DISTRABILITY
  • SENSORY THRESHHOLD
  • THE NINE TRAITS
  • ACTIVITY LEVEL
  • RHYTHMICITY
  • APPROACHABILITY
  • ADAPTABILITY
  • INTENSITY OF RESPONSE

28
BEYOND THE CHECKLIST
  • CHRONIC ILLNESSES OF CHILD(PHYSICAL/MENTAL)
  • ASTHMA
  • BRAIN INJURIES
  • CARDIAC PROBLEMS
  • ANXIETY
  • DEPRESSION

29
BEYOND THE CHECKLIST
  • HEALTH (PHYSICAL/MENTAL) OF PARENT
  • PHYSICAL DISABILITIES
  • ANXIETY
  • DEPRESSION
  • ALCOHOL/SUBSTANCE ABUSE
  • OTHER MENTAL HEALTH

30
BEYOND THE CHECKLIST
  • PRENATAL EXPOSURES
  • ALCOHOL
  • COCAINE
  • MARIJUANA
  • CIGARETTES

31
BEYOND THE CHECKLIST
  • LEARNING PROBLEMS/DISABILITIES
  • READING PROBLEMS
  • OTHER LEARNING PROBLEMS
  • LANGUAGE PROBLEMS
  • MOTOR COORDINATION DISORDERS

32
BEYOND THE CHECKLIST
  • OTHER DEVELOPMENTAL DELAYS/DISORDERS
  • FETAL ALCOHOL SYNDROME
  • FRAGILE X
  • KLINEFELTER SYNDROME
  • OTHER CHROMOSOME DISORDERS
  • OTHER GENETIC DISORDERS

33
BEYOND THE CHECKLIST
  • SUBSTANCE ABUSE OF CHILD
  • STIMULANTS
  • HYPERACTIVE IRRITABILITY
  • COCAINE
  • IRRITABILITY
  • INHALANTS
  • EUPHORIA DROWSY/STUPOR
  • MARIJUANA
  • EUPHORIA DECREASED CONCENTRATION
  • IRRITABILITY RESTLESSNESS
  • NARCOTICS
  • MOOD SWINGS POOR CONCENTRATION
  • CONFUSION
  • HALLUCINOGENS
  • DECREASED COMMUNICATION RESTLESSNESS
  • BARBITURATES
  • DECREASED ALERTNESS CONFUSED

34
BEYOND THE CHECKLIST
  • ALL BEHAVIORS HAVE A REASON
  • WE NEED TO BE ABLE TO ASK WHY WE ARE SEEING THE
    BEHAVIORS
  • CHECKLISTS ARE A STARTING POINT, NEVER AN ENDING
    POINT

35
BEYOND THE CHECKLIST
  • THIS POWER POINT PRESENTATION WILL BE AVAILABLE
    NEXT WEEK ON OUR WEBSITE
  • WWW.SPRINGTIDES.ORG
  • EMAIL pat_at_springtides.org
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