<p>The standard of diagnosing and categorizing mental disorders in the United States has long been the Diagnostic and Statistical Manual of Mental Disorders (DSM), but the DSM has been criticized through evidence suggesting it lacks appropriate validity, reliability, and clinical utility. The Hierarchical Taxonomy of Psychopathology (HiTOP) has been offered as a solution to these criticisms. But the recommendation to replace the DSM and its categorical diagnostic system has been met with doubt and criticism by others in the field. A common sentiment in these critiques is a lack of evidence that the HiTOP dimensions are clinically useful or that clinicians would be open to applying them to their patients. The goal of the present study was to compare clinician perceptions of the HiTOP and DSM systems for the conceptualization of clinical cases. A sample of actively practicing clinicians (<i>n</i> = 143) rated one of three clinical vignettes using the HiTOP and DSM systems then rated the two approaches on seven indices of clinical utility. HiTOP was favored for overall clinical utility score as well as utility for formulating effective intervention, communicating clinical information to the client, comprehensively describing client psychopathology, describing global functioning, and ease of applying the system to the individual. There was no preference between HiTOP and the DSM for communicating with other mental health providers. The DSM was not favored for any clinical utility outcome. These results suggest interest in HiTOP and dissatisfaction with the DSM among clinicians.</p>

High quality assessment services are the linchpin connecting youth with mental health problems to diagnosis-specific, evidence-based treatments. The effort to improve assessment services is in its early days and faces a number of substantial challenges. This study was an initial effort to address these challenges through the development of a standardized, multi-dimensional Assessment Instrument evaluation tool—the Strength of Measure (SoM)—based on operationally defined criteria supported by decades of psychometric research. The SoM and other criteria addressing assessment practices were piloted with data from 32 consecutive assessment reports from a community mental health center’s Assessment Clinic. Results indicate that none of the Assessment Instruments used by the Assessment Clinic met the “Adequate” level of support on each of the SoM dimension. Additional results address Reason for Referral, Primary Axis I Diagnosis, Informants, and Method of Assessment. Implications and directions for future research are discussed.

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There are many challenges that come with diagnosing attentiondeficit/ hyperactivity disorder (ADHD), including shared symptoms with many similar disorders, high comorbidity of other mental disorders, and subjective bias from informant reports. Three clinical guidelines for diagnosing ADHD currently exist, published by the American Academy of Pediatrics (AAP), the National Institute for Health and Care Excellence (NICE), and the American Academy of Child and Adolescent Psychiatry (AACAP). However, these guidelines are outdated as they are based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and do not include more recent research. This project was intended to update these guidelines by incorporating the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as well as a selection of research on ADHD diagnosis published in the last ten years. This updated set of guidelines can be found in Appendix A of this document. Emphasis is on the evidence-based assessment model of using only psychometrically strong assessment measures and basing diagnostic decisions on posterior probabilities. Review of the literature also indicated a need to assess for differential and comorbid diagnoses in ADHD evaluations. Recommendations for doing so are discussed. Lastly, results of the review provided a strong argument against the use of continuous performance tests (CPTs) and other executive functioning measures in diagnosing ADHD, as their diagnostic accuracy is generally not acceptable.

Sammanfattning: Introduktion: Tidig upptäckt av cerebral pares (CP) möjliggör tidig behandling, när hjärnans plasticitet är bäst, vilket optimerar barnets utveckling. I Sverige erbjuds alla barn motoriska utvecklingsuppföljningar inom barnhälsovården (BHV). Barn med kända riskfaktorer för CP följs dessutom inom neonatala uppföljningsprogram, där evidensbaserade bedömningsmetoder används vid motorisk bedömning. För en patientsäker vård behöver nedsatt motorik och CP tidigt identifieras, oberoende vart barnen följs. Syfte: Undersöka skillnader mellan barn med CP tillhörande högriskgrupp (HR) eller lågriskgrupp (LR), gällande första kontakt med fysioterapeut och motorisk bedömning, i Region Uppsala. Metod: Kvantitativ journalstudie med deskriptiv, retrospektiv och komparativ design valdes. Barn födda 2010-2016, diagnostiserade med CP 2010-2018 i Region Uppsala inkluderades. Barnen delades in i HR/LR för CP. Mätvariabler: motorisk nivå och kvalitet, funktionsnivå, typ av CP, ålder första kontakt med fysioterapeut samt ålder remittering till habiliteringsverksamheten. Deskriptiv statistik och icke-parametriska statistiska test användes, p-värde ≤0.05. Resultat: Trettiosju barn inkluderades, 22 HR/15 LR för CP. Barnen med högrisk bedömdes av fysioterapeut, erbjöds behandling samt remitterades till habiliteringsverksamheten signifikant tidigare. Barn med sämre funktionsnivå remitterades signifikant tidigare till habiliteringsverksamheten. Slutsats: Barn med CP i Region Uppsala har ojämlik tillgång till fysioterapeutiska bedömningar och behandlingar. Barn med högrisk för CP bedömdes av fysioterapeut och remitterades till habiliteringsverksamheten tidigare.  Barn med sämre funktionsnivå remitterades också tidigare. Evidensbaserade bedömningsmetoder verkar möjliggöra tidig upptäckt av motoriska avvikelser och därigenom möjlighet till tidiga interventioner. Ett sätt att erbjuda patientsäker och jämlik vård för barn med utvecklingsavvikelser, kan vara att använda evidensbaserade bedömningametoder inom verksamheter vars mål är identifiering av utvecklingsavvikelser. / Abstract: Introduction: Early detection of cerebral palsy (CP) allows for early treatment, when brain plasticity is at its best, which optimizes the child's development. In Sweden, all children are offered motor developmental surveillance in child health services. In addition children with known riskfactors of developing CP are enrolled in neonatal follow-up, using evidence-based assessment methods. In order to provide patientsafe and quality of care, early identification of impaired motor function and CP is needed, regardless of where the children are monitored. Aims: Investigate differences between children belonging to high or low riskgroup for CP regarding first contact with physiotherapist and assessed motorskills, in Region Uppsala. Methods: A quantitative journalstudy with descriptive, retrospective and comparative design was selected. Children born 2010-2016 diagnosed with CP 2010-2018 in Region Uppsala were included and divided into children with high or low risk to develop CP. Measures: motor performance, level of disability, type of CP, first visit at physiotherapist, age of reffered to habilitation-services. Descriptive statistics and non-parametric statistical tests were used, p-value ≤0.05. Results: Thirty-seven children were included, 22 with high-risk and 15 with low-risk for CP. Children with high-risk were assessed by physioterapist and referred to habilitation-services significantly earlier. Children with more severe disability were also referred significantly earlier. Conclusion: Children with CP in Region Uppsala have unequal access to timely physiotherapy and habilitation-services. Evidence-based assessment methods enable early detection of motor abnormalities and allows for early treatment. To provide safe and equal care, all professionals performing developmental surveillance should use evidence-based assessment methods.

Evidence-Based Practice (EBP), the philosophy underpinning professional service in the health care industry in the U.S.A. and U.K., has been accepted as a paradigm for psychological practice by the American Psychological Association (APA). The APA recommends that professionals base their clinical decisions on scientifically supported research and an understanding of their clients' specific ecological disposition. Clients are considered to have a right to efficacious interventions based on objective research findings, effective service and a high standard of care. Sub-divisions of EBP are Evidence-Based Treatments (EBT) and Evidence-Based Assessment (EBA). . South African educational psychologists have a meagre assessment ‘toolkit’ - outdated, culturally insensitive, non-standardised tests for culturally and linguistically diverse clients. Children from diverse backgrounds would have higher standards of care and more efficacious interventions were psycho-educational assessments to be culturally-sensitive. Without such instruments, ethical management of interventions is questionable, although universally, psychologists have found innovative ways of adapting their praxis to the difficulty. However, all practices and/or interventions are not based on research evidence, nor can be necessarily considered good practice. In the U.S.A. with its abundance of assessment instruments, EBA is a means of ensuring the scientific foundation for professional practice, consequently reliable, valid, culturally-sensitive assessment instruments have been produced. Findings in this study, derived from conversations with a sample of educational psychologists, revealed they were already accommodating cultural and linguistic diversity. Awareness of the value of EBA would support educational psychologists, bring them on par with worldwide praxis and enhance their professionalism. / Teacher Education / D. Ed. (Psychology of Education)

Evidence-Based Practice (EBP), the philosophy underpinning professional service in the health care industry in the U.S.A. and U.K., has been accepted as a paradigm for psychological practice by the American Psychological Association (APA). The APA recommends that professionals base their clinical decisions on scientifically supported research and an understanding of their clients' specific ecological disposition. Clients are considered to have a right to efficacious interventions based on objective research findings, effective service and a high standard of care. Sub-divisions of EBP are Evidence-Based Treatments (EBT) and Evidence-Based Assessment (EBA). . South African educational psychologists have a meagre assessment ‘toolkit’ - outdated, culturally insensitive, non-standardised tests for culturally and linguistically diverse clients. Children from diverse backgrounds would have higher standards of care and more efficacious interventions were psycho-educational assessments to be culturally-sensitive. Without such instruments, ethical management of interventions is questionable, although universally, psychologists have found innovative ways of adapting their praxis to the difficulty. However, all practices and/or interventions are not based on research evidence, nor can be necessarily considered good practice. In the U.S.A. with its abundance of assessment instruments, EBA is a means of ensuring the scientific foundation for professional practice, consequently reliable, valid, culturally-sensitive assessment instruments have been produced. Findings in this study, derived from conversations with a sample of educational psychologists, revealed they were already accommodating cultural and linguistic diversity. Awareness of the value of EBA would support educational psychologists, bring them on par with worldwide praxis and enhance their professionalism. / Teacher Education / D. Ed. (Psychology of Education)