Additional assessment considerations in children and adolescents

The principles of psychiatric assessment of children and adolescents with developmental disability are similar to those in adults, with the following additional considerations:

• comorbidities are common (eg neurodevelopmental disorders) and symptoms can overlap
• presentation can be atypical and may be overlooked due to diagnostic overshadowing
• psychiatric disorders in young people may not be fully evolved
• sources of collateral information in children and adolescents include school as well as family
• developmental milestones occur later than in the neurotypical population.

A specialist multidisciplinary systems approach is needed to assess psychiatric disorders in children and adolescents, which considers the young person’s functional and adaptive abilities, as well as their family system and attachment behaviours. The diagnosis of a psychiatric condition is often not clear cut and complexity should be expected. The assessment approach outlined in challenging behaviour (which seeks to identify maladaptive behaviours and their function), may be a useful adjunct to psychiatric assessment to identify contributing factors and manage complex presentations in younger people.

Children with developmental disability often have multiple medical investigations and procedures throughout their life; every effort must be made to reduce the distress associated with these in childhood to minimise the likelihood of trauma related to care. A gentle approach supported by trusted carers is recommended. For strategies to support children who find examinations difficult, see Physical examination and investigations.