The outline is based on the article Development screening and assessment instruments with an emphasis on social and emotional development for young children ages birth through five, published on the website of the Early Childhood Technical Assistance Center (Ringwalt, 2008).
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The four components of a mental status examination
The four components are the following: “fine motor-adaptive, gross motor, personal-social, and language skills” (Ringwalt, 2008, p. 8). Depending on the test, the names of the components might change or be divided into five (see DIAL-3), but mostly cover the same areas.
The developmental considerations in working with different age groups, such as infants, children/adolescents, and aging adults
The developmental considerations when working with infants are the following: since infants can experience fear and anxiety during an encounter with a stranger, the professional should ensure that parents can be seen and heard by the infant. This will help the professional avoid mistrust and skewed data from screenings and tests. Furthermore, infants are not capable of expressing emotions as adults, so an extremely careful interpretation of their behavior is necessary. It is advisable to ask the mother or the primary caregiver for help when interpreting the infant’s behavior. Any possible stressors such as loud noises, other strangers, rapid changes in the environment have to be avoided to get reliable results.
Children need a different approach. Although their expression of emotions is more skillful compared to infants, it is still inadvisable to conduct a test without parents’ presence. Nevertheless, if needed, the professional has to explain when the child’s parents will return. Be careful and try not to leave the child alone since children can experience fear and anxiety when left alone without support. It is advisable to address a child’s worries if he or she expresses those due to an unfamiliar setting or the necessity to talk to an adult stranger. Nutritional needs should not be ignored as well since they can adversely influence the screening (e.g. if a child is hungry/thirsty). As for adolescents, the professional should not forget that peer and parent relationships, as well as hormonal changes, are the primary influences on adolescents’ emotions. Therefore, the professional should bear this information in mind when evaluating screening or test results.
When working with older adults, the professional needs to remember that the speed of information processing is normally slower in older adults (although not in everyone). Aging adults might have more difficulties in switching their attention between different tasks; while the short-term memory of older adults does not always decline significantly, the long-term memory’s decline interferes with their ability to recall certain events (might be crucial for some of the assessments). Speaking slowly and distinctly is also advisable because some of the patients might have hearing loss. If the professional sees that the aging adult does not understand the question but is reluctant to ask for help, it is reasonable to repeat or explain the question.
Otherwise, the answer’s fidelity will be doubtful due to a misunderstanding. The professional needs to communicate instructions directly and respectfully. If the aging adult’s caregiver or relatives are present, the instructions need to be provided to them as well. Relatives or the caregiver can be included in the conversation if it is evident that the professional needs additional insights into the subject’s behavior. The professional should not start the test or screening if the older adult does not have all the needed adaptive devices such as glasses or hearing aid. Without those, the fidelity of the outcomes might be insufficient as well. The professional should remember that medications can influence the individual’s abilities and skills.
The four situational factors that could affect a patient’s responses to the mental status examination but have nothing to do with mental disorders
According to the author, “ethnicity, gender, age, and socioeconomic” status are the situational factors that have to be considered (Ringwalt, 2008, p. 8). Some of the researchers point out that geography (e.g. rural or urban areas) can also influence the responses (Ringwalt, 2008, p. 7).
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Age-appropriate evaluation tools:
- Child development inventories (CDI): the Infant Development Inventory (3-18 months);
- Ages and Stages Questionnaire (ASQ) – birth to 60 months;
- Child development inventories (CDI): the Early Child Development Inventory (18-36 months) and the Preschool Development Inventory (36-60 months);
- Kent Inventory of Developmental Skills – for infants up to 15 months;
- The Ounce Scale – birth through 42 months;
- Battelle Developmental Inventory Screening Test – 12-96 months;
- Bayley Infant Neurodevelopmental Screener – 3-24 months;
- The Screening Test of Developmental Disabilities – birth to 3 years;
- Brigance Screens – birth to approximately 90 months (Ringwalt, 2008);
- Denver Developmental Screening Test II (DDST-II) – 1 month to 6 years;
- Early Childhood Inventory-4 – 3 to five years;
- Early Screening Inventory-Revised (ESI-R) – 3-6 years;
- Infant-Toddler Developmental Assessment – Birth – 42 months.
Adolescents (+Young Adults)
- Pediatric Symptom Checklist – 4-16 years;
- Developmental Profile 3 (DP-3) – Birth to 12 years;
- ESP: Early Screening Profiles – 2-0 through 6-11 (Ringwalt, 2008);
- Carey Temperament Scales – 1 month – 12 years;
- Eyberg Child Behavior Inventory (ECBI) and the SutterEyberg Student Behavior Inventory – 2 – 16 years;
- Strengths and Difficulties Questionnaire (SDQ) – 3 – 16 years;
- Behavior Assessment System for Children, 2nd Edition (BASCII) – 2.0 – 21.11 years.