University of Hawaii Child and Adolescent Thought Disorders Program
- University of Hawaii Child and Adolescent Thought Disorders Program
- Assessment
- Treatment
- Family Services
The Child and Adolescent Thought Disorders Program at the University of Hawaii at Manoa was established in 2003 to provide comprehensive assessment and psychosocial interventions to youth with schizophrenia-spectrum disorders in Hawaii. The program is also designed to increase the understanding of thought disorders in youth through systematic collection of information. Funding for this program is provided by the Hawaii Department of Health Child and Adolescent Mental Health Division. The clinic was designed with the American Academy of Child and Adolescent Psychiatry practice parameters in mind and serves as an example of the assessment and psychosocial treatments available for youth with schizophrenia.
Assessment
Youth with suspected thought disorders seeking services from our program participate in a thorough mental health examination. The initial assessment battery provides a diagnostic and neuropsychological evaluation to verify diagnosis and identify strengths and relative weaknesses in functioning. The clinic employs a semi-structured interview designed to assess an array of psychopathology in youth, including psychotic processes (K-SADS, Kaufman et al., 1997). To provide more accurate and complete information, we interview the child, parent, and relevant adults in the child’s life (e.g., teacher, treating therapist, psychiatrist, etc.). Self-report questionnaires from various informants supplement interview information. Assessments particularly focus on identifying behaviors of impairment and strength through interview as well as direct observation to help determine specific treatment goals for subsequent intervention.
In addition to the diagnostic and functional components, we also offer a screening of neurocognitive functioning. Domains of functioning assessed include areas identified in the literature as potential deficits for youth with schizophrenia. We employ tests of executive functioning, attention, various forms of memory, and an abridged test of intelligence. The neurocognitive examination allows for an assessment of relative strengths and weaknesses in cognitive functioning and provides information useful for recommendations and treatment planning.
Treatment
There are currently no identified evidence based psychosocial interventions for schizophrenia among youth. We attempt to systematically study our on-going treatment cases to provide useful approaches to treating other youth with similar conditions. The varying expressions of the disorder from person to person, however, makes generalization from one individual to the next difficult. To address the issue of variability of individual presentation, we employ a modular approach to therapy containing specific sections for specific problem behaviors. This approach provides our clinicians with a range of strategies to address target behaviors. Our modules are derived from various areas including: cognitive and behavioral treatment for adult schizophrenia; empirically supported therapies for childhood anxiety, depression, and disruptive behavior disorders; social skills training; behavioral treatment for autism; community involvement; and motivational interviewing. Even if symptoms directly associated with features of schizophrenia (e.g., hallucinations and delusions) are resistant to treatment, a modular approach is often effective in treating comorbid and related conditions (e.g., specific phobia related to delusional beliefs).
Family Services
Additionally, our clinic also offers family therapy and multifamily group therapy. Collateral work with parents and close relatives is essential for the complete care of youth with schizophrenia-spectrum disorders. Additionally, multifamily therapy has been demonstrated effective in the treatment of adult schizophrenia. These groups focus on problem solving strategies and community building between families experiencing similar issues.
Related to work with the family is the importance of interdisciplinary coordination of services. Youth with schizophrenia often have many health care providers as team members. In addition to the parent(s), psychiatrists, psychologists, teachers, nurses, social workers, individual skills trainers, occupational therapists, and others are often involved in cases. Working collaboratively with all treatment team members is crucial to functioning and outcome of the child.
For all of our cases, we provide ongoing structured single case evaluation protocols involving multiple informants for therapists to track the effectiveness of specific interventions. Ongoing monitoring and assessment of progress throughout the course of treatment enhances the ability to determine the most effective techniques for specific symptoms in a particular client and enables the monitoring of overall progress.