The Case Formulation in Child and Adolescent Psychiatry

Diagnosis in developmental–behavioural paediatrics: The art of diagnostic formulation

“…There are not only potential benefits of the use of diagnostic labels, but also risks to the child and family. These themes are explored in Tables 2 and 3, respectively 4,11,17–35 . Awareness of the advantages and limitations of categorical diagnostic schemes can help ensure that such labels are used judiciously, by clinicians and organisations alike.…”

“…The process of diagnostic formulation goes beyond simply restating symptoms or recapitulating a factual patient history. Diagnostic formulation is a method of integrating the complex and interacting features of the child and their family that have combined to create and maintain the presenting clinical problems 4 . A particular emphasis is placed on identifying strengths rather than deficits alone 4 .…”

“…The focus is on deficits or illness, and the patient is viewed as a passive recipient of treatment 1 . Engel's biopsychosocial model signified a shift away from a narrow biomedical understanding of illness 4,5 . Furthermore, Bronfenbrenner's ecological theory 6 and family systems theory helped to understand the dynamic interactions between children and the social systems in which they are embedded 7–11 .…”

“True Enough” Formulations: The MAPS Approach

“…These dynamic documents are constantly being updated and revised as more clinical data become available or as "travel conditions" change. 3 Case formulation has been touted as the most critical and challenging of clinical activities, 3,4 yet only one-third 4 of residents receive guidelines for developing formulations, and clinicians often struggle with the process, as evidenced by many case conferences and by morbidity and mortality rounds. 6,7 When we consider the challenges to developing formulations, we identify three significant factors.…”

“…3,10 This explanatory model likewise uses a categorizing template, which organizes factors into predisposing, precipitating, perpetuating, and protective ones. The model offers limited guidance on how to comprehensively collect and prioritize the data and does not readily direct clinicians to specific treatment plans.…”