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ESSENCE-Day 2 summary

On the 26th of August the second ESSENCE day took place in Gothenburg. This time the focus was on ESSENCE in clinical practice. The first speaker to take to the stage was Christopher Gillberg. Speaking about the development of the understanding of the concept of comorbidity over time, he referred to the ESSENCE concept as a reflection of the growing insight that comorbidity within neuropsychiatry is the rule rather than the exception. The talk then went on to deal with best practice in ESSENCE-related problems.

Svenny Kopp’s lecture was titled “ESSENCE and girls”, a heading that highlighted the fact that boys, within child neuropsychiatry, are treated as the norm from which girls deviate. Svenny Kopp concluded that girls with ADHD and ASD are diagnosed later than boys and called for awareness surrounding the different interpretations of girls’ and boys’ symptoms. In order to detect girls, efficient gender-specific assessment tools are needed. Clinicians need knowledge about the occurrence and manifestation of ADHD and ASD symptoms in girls at various ages. They also need knowledge about other co-occurring psychiatric diagnoses.

Bibbi Hagberg and Eva Billstedt gave a lecture about the work of the psychologist. Bibbi Hagberg highlighted the importance of working in multi-disciplinary teams when conducting development assessments of young children (physicians, psychologists, special education teachers, speech and language therapists and nurses). She also provided guidelines to facilitate development assessment (for example refraining from talking too much, being clear, not putting too much effort into trying to get an interaction going, and not insisting on making eye contact. Eva Billstedt spoke about assessment of school children and adolescents. She emphasised the importance of obtaining the child’s own experience of his or her functioning. She also stressed the need for clinicians to be aware of the formal test situation providing optimal testing conditions (in terms of results and interaction). A discussion on how to convey a diagnosis to a child or adolescent concluded the lecture.

Carmela Miniscalco finished the morning part of the day with a lecture on the work of the speech and language therapist. The lecture provided a review of the various components that should be included in a speech and language assessment: medical history, assessment of spontaneous speech, formal testing and observation at the clinic, in pre-school or at home. The importance of cross-disciplinary collaboration was stressed and the strong link between early language difficulties and ASD, concentration difficulties, motor difficulties and reading difficulties when children are followed-up over time were noted. Carmela Miniscalco noted that a child’s full set of problems must be taken into account and that co-existing problems require simultaneous, distinct interventions.

Gunilla Westman Andersson opened the afternoon with a lecture on the work of the special education teacher. Talking about the value of observations in everyday settings such as pre-schools and schools, she highlighted the importance of multi-disciplinary teams as well as the collaboration with pre-school and school environments. Gunilla Westman Andersson emphasised that observational instruments (such as ADOS) provide one part of the assessment, and that diagnosis also always require clinical observation.

Elisabeth Fernell’s lecture on the work of the physician dealt with the physician’s part in functional assessments, medical assessments and treatment as well as in the planning of support and interventions. Elisabeth Fernell addressed prenatal, genetic causes behind ESSENCE-related problems and gave a review of a range of diagnoses; Klinefelter syndrome, 22q11-deletion syndrome and Fragile X syndrome to name a few. A general problem that was highlighted is the tendency to grant support based on a diagnosis rather than basing interventions on the individual child’s functional problems.

Early intervention was the topic of Ulrika Johansson’s lecture. The lecture questioned the prevailing ”wait and see” approach within health services. Clinicians, Johansson argued, must focus on gathering all the information that is currently available instead of conducting targeted searches. Understanding the interaction between various symptoms was stressed as an important component in clinical work. As children and methods develop continuously, regular follow-ups are necessary. To detect early symptoms, everyone in a multi-disciplinary team must possess both broad and deep knowledge on a range of problems.

Rounding off the day was Ida Lindblad with a lecture on children born to parents with mild intellectual disability. Ida Lindblad stressed the need for national guidelines related to early intervention and assessment of parental ability, planning and follow-up of support. She also underlined the importance of continuously adapting support to the child’s development.

Summing up the day, Christopher Gillberg emphasised several of the themes dealt with throughout the day; the gender perspective, multi-disciplinary team collaboration, collaboration with pre-schools, schools and parents and broad, comprehensive overall assessments rather than targeted and specific assessments.

By Nanna Gillberg

Page Manager: Anna Spyrou|Last update: 9/3/2014

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