Diagnosing Young Adults in Residential Treatment
“After six months of erratic behavior—including two hospitalizations—our new psychiatrist took our daughter off of Prozac. The change was immediate and miraculous. Our Katie is back.” ~Susan P.
“Our therapist chalked up Marnie’s dramatic outbursts to normal adolescent acting out. But they never got better, only worse. It wasn’t until she was 19 that we got an accurate diagnosis of borderline personality disorder. But it was too little too late. She’s non-compliant with treatment, so we’ve effectively missed our window to intervene as parents. We feel like we’ve lost our daughter.” ~Mark L.
Misdiagnosed behavioral and emotional issues are common among adolescents and young adults. Mental health diagnoses are relatively subjective and the data used to make them—behavioral observations in various settings, psychometric assessments, and self-reported symptoms—are often unreliable or incomplete.
Teen mental-health diagnostics are further complicated by the fact that adolescent neurology is in flux. Developmental changes can mimic, or sometimes obscure, the symptoms of actual psychological disorders. Teens are, therefore, particularly vulnerable to misdiagnosis. Misdiagnosis, in turn, can lead to treatment approaches that are too aggressive, not aggressive enough, or wrong altogether.
For teens or young adults whose emotional or behavioral problems have been chronically misdiagnosed, a residential setting can provide ideal circumstances for diagnostic observation and assessment. The following features of residential programs make them effective not just for delivering treatment, but for diagnosing issues and assigning a treatment plan in the first place.
Controlled Environment: Residential treatment facilities are structured around predictable routine and well-managed stimuli, minimizing external variables that might impact diagnostic observation. As a result, clinicians are better equipped to understand the young person’s baseline state of functioning. A controlled environment also allows the psychiatrist to safely adjust medication and reliably observe its impact with fewer environmental variables.
360 Degree Observation: At home or during out-patient treatment, it is virtually impossible to observe a young person at school, at home, with friends, etcetera. Residential treatment settings allow clinicians and other staff to accurately observe every part of the child’s life. Because of this, staff can construct a complete diagnostic picture from the puzzle pieces of peer relationships, medication compliance, school behavior, sleep patterns, dietary habits, et cetera.
Time: Clinicians in residential programs have the great advantage of time. A teen’s mood and behavior may morph inexplicably from one moment to the next, but this apparent behavioral randomness can fall into observable patterns over time. Often, these patterns can only be detected after days, weeks, or months of consistent observation. In a residential setting the treatment team can make these longitudinal observations. Time also allows treatment professionals to introduce and remove variables (such as medication adjustments) one at a time to observe their effects in relative isolation.
Case Management: Residential treatment has the additional advantages of a consistent team led by a single clinical case manager. This case manager—whether the clinical director or team leader—is responsible for putting all the pieces together and applying a forensic approach to diagnosis. A case management approach means that past assessments, parental insights, psychiatric analysis, and current observations from teachers, therapists, and other team members are integrated for a complete diagnostic picture.
photo by Helga Weber