A Mental State Examination (MSE) is a part of every mental health assessment. Interpretation of the MSE must keep in mind the patient’s age and developmental level. The MSE is used to gain an understanding of the patient’s psychological functioning during a period of time. MSE needs to be intuitively done every time clinician interact with or observes the child
Mental status in children and adolescents may have a higher intensity and frequency variation than adults. For instance, depressive disorders in young people have preserved reactivity such that a depressed child may appear reasonably excited when given a toy to play with during examination. Serial examinations are more useful in getting a true picture about the mental state characteristics. Children and adolescents may also not be ready to immediately share their experiences, feelings, and thoughts. This may happen because of unfamiliarity and intimidation by the clinical setting, or a developmental unreadiness. The clinician must not make presumptions about the capacity of children to give information/participate in an interview. Children as young as 2-3 years old can answer simple questions about what they like, who they like, what makes them angry, etc. The clinician must make it a point address the child and ask questions in an age appropriate language.
Expecting and waiting for preschool children to cooperate across an interview table may not be successful, whereas letting the child sift through toys, or be in a play area may reveal his activity levels, attention span, ability to tolerate frustration, and cognitive abilities. Use of colors, pens, paper, puzzles, peg boards, can all be used in the office to facilitate interaction with young children. Direct questions to a child should be short, precise, in simple words, dealing with one concrete issue at a time. For example, if a child is being bullied at school, asking him/her “Does anyone trouble you at school?” would be better than asking, “Can you tell me about any problems you are facing at school?” Children are able to relate to, and identify with cartoon characters and animals better than they are able to talk about their own feelings and behaviors. Talking to them using these familiar themes may facilitate disclosure about their emotions, and experiences. Children may be intimidated by the clinical setting, and uncomfortable with direct questions. Use of paper and line diagrams, with both the clinician and the child looking at the paper and talking may be better than direct eye to eye contact.
The development of formal operational thinking in adolescents puts them in a position to be able to not only report their experiences, but also draw interpretations and hypotheses. It is important to interview the adolescent alone, since a developing self-awareness and self-consciousness may make them feel inhibited in front of family. Adolescents are also very concerned about not being believed, or being considered weak or different. They often put a lot of time and energy into “normalizing” their experiences, or denying them. The clinician must therefore make all attempts to make the adolescent feel comfortable and acknowledge their subjectivities. Confidentiality can be a big issue, especially in the context of substance use or sexuality. The clinician must avoid false promises of confidentiality just to get the adolescent to open up. Adolescents appreciate logical arguments and find comfort in predictability. It is, therefore, advisable for the clinician to be honest about the limits of confidentiality.
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Негізгі бет Mental Status Examination in Child and Adolescent Psychiatry (MSE in Children and Adolescents)
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