The Clinical Assessment Process

To assess a person with suspected OCD or other Anxiety Disorder it
is crucial to use a systematic and thorough approach which allows both the
child or teen and the parents/family members to tell ‘their side of the story’.
This step is very important because OCD/Anxiety symptoms can often remain hidden
from family members (e.g. especially ones that are related to "bad thoughts" aggressive
or sexual obsessions), and also because children or teens may understate the impact
their OCD and/or Anxiety Discorder may have on their lives often due to them feeling
related guilt and/or shame.

During my sessions the younger children often prefer to have their parents in
the room to help with providing a history, whereas adolescents frequently wish
to be seen alone. In these cases, I feel it is important to also obtain a
separate parent history to provide a more complete range of perspectives. The
key components of clinical assessment include the history of present illness,
co-morbid symptoms, past psychiatric history, family psychiatric history, social
and developmental history, medical and substance history, medications and drug
allergies, and the mental status examination.

During the time I collect information regarding the history of the child's present illness,
I also want to learn about the duration and severity of the OCD/Anxiety symptoms and their
precipitating and exacerbating factors will be determined. Some common examples
of exacerbating factors may include family (e.g. moving into a new home) or
school (e.g. changing schools or entering middle school) may add additional
stress which could be a factor that triggers their OCD/Anxiety. Some examples of
the tools that I use during the assessment process include, "The Children’s
Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and checklist I find are helpful
to record the severity and presence of specific symptoms. Learning about the
functional consequences of Anxiety symptoms in the home, school, and social
environments and the level of insight, resistance, and control over symptoms are
also assessed.

Talking with family members to learn what their insights of the
illness are and how they might be unknowingly accommodating their child's
anxiety disorder causing a worsening the child's symptoms. A common example of
this is when a family member is compliant with their child's wishes such as the
parent or caregiver is asked by the child to please flick the light switch up
and down twice or something bad may happen, and in that moment the
caregiver/parent who wants to decrease their child's anxiety complies only to
start the beginning of a downward spiral that often times doesn't end.

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