Assessment and Diagnosis · 5 min read
Assessment and Diagnosis · Developmental Stages
Assessment and Diagnosis makes up about 22 percent of scored items. It covers how development shapes psychiatric symptoms across the life span, the medical and substance-related conditions that can mimic or cause psychiatric illness, DSM-5-TR criteria for the major disorders, and the interview, mental status examination, screening instruments, diagnostic tests, and risk assessments that guide nursing care.
A patient's developmental stage shapes how psychiatric symptoms appear and how care should be delivered. The psychiatric-mental health nurse compares each patient with the tasks and milestones expected for that stage, separating normal developmental challenges from emerging psychopathology.
| Stage | EriksonTask | PiagetStage | ConditionsThatOftenEmerge |
|---|---|---|---|
| Infancy(0–2years) | Trustvs mistrust . | Sensorimotor | Attachmentdisturbances;effectsof |
| adverseearlyexperiences | |||
| Toddlerhoodandearly | Autonomyvs shameand . | Preoperational | Autismspectrumdisorder;regressionunder |
| childhood(2–6years) | doubt(toddler);initiativevs . | stress | |
| guilt(preschool) | |||
| Middlechildhood(6–12 | Industryvs inferiority . | Concreteoperational | ADHD;separationanxiety generalized , |
| years) | (fromaboutage7) | anxiety specificphobias , | |
| Adolescence(12–18 | Identityvs roleconfusion . | Formaloperational | Depression(oftenirritable) suicidal , |
| years) | ideation substanceuse , | ||
| Youngadulthood(18–40 | Intimacyvs isolation . | — | Schizophrenia bipolardisorder social , , |
| years) | anxiety OCD , | ||
| Middleadulthood(40–65 | Generativityvs stagnation . | — | Midlifedepression;prescriptionopioidand |
| years) | benzodiazepinemisuse;alcoholuse | ||
| disorder | |||
| Lateadulthood(65+ | Integrityvs despair . | — | Neurocognitive disorders late-life , |
| years) | depression anxiety , |
Prenatal and Infancy (0–2 Years)
Brain development during the prenatal period lays the foundation for all later psychological functioning. The neural tube forms by the fourth week of gestation, and at birth the brain contains roughly 100 billion neurons. Synaptogenesis accelerates rapidly over the first two years, and by age two the brain reaches about 80 percent of adult size.
John Bowlby's attachment theory is the framework for infant mental health. Secure attachment develops when caregivers respond consistently and sensitively to the infant's needs. Insecure patterns are anxious-ambivalent, avoidant, and disorganized. Disorganized attachment carries the highest risk of later psychopathology and often results from frightening or abusive caregiver behavior.
➜
➜
6–8 weeks
About 8 months
Peaks 12–18 months
Failure to reach these milestones may point to a developmental disorder or environmental deprivation. The nurse assesses the quality of parent-infant interaction, feeding patterns, sleep regulation, and temperament. Adverse childhood experiences in infancy cause lasting changes in stress-response systems: chronically elevated cortisol impairs hippocampal development and memory formation. Intervention during this period produces the greatest benefit from neuroplasticity.
Toddlerhood and Early Childhood (2–6 Years)
Erikson described toddlerhood as autonomy versus shame and doubt. Children gain independence in self-care, language grows dramatically, and symbolic play emerges. The nurse assesses language development, social reciprocity, and imaginative play. Piaget's preoperational stage is marked by egocentrism, magical thinking, and animism; children cannot yet perform mental operations or understand conservation. These limits shape how young children process trauma and illness, so therapeutic approaches must fit concrete thinking.
Symptoms of autism spectrum disorder usually become apparent in this stage: deficits in social communication, restricted interests, and repetitive behaviors. Early identification allows intervention during peak neuroplasticity.
Middle Childhood (6–12 Years)
The central task is industry versus inferiority. Children build competence through school, peer relationships, and activities, and their self-concept becomes more differentiated and realistic. The nurse assesses school functioning, peer relationships, and emerging coping strategies. Around age seven, Piaget's concrete operational thinking appears: children reason logically about tangible objects and events and understand conservation and reversibility but still struggle with abstract, hypothetical ideas. These advances allow more sophisticated therapeutic interventions.
ADHD commonly presents in the early school years, when academic demands expose executive function deficits. Core symptoms of inattention, hyperactivity, and impulsivity occur across settings, so the nurse gathers information from parents, teachers, and direct observation. Anxiety disorders, including separation anxiety disorder, generalized anxiety disorder, and specific phobias, frequently emerge now and are often accompanied by somatic complaints. School refusal may signal anxiety, depression, or bullying.
Adolescence (12–18 Years)
Puberty brings gonadal hormone surges, physical growth, and brain reorganization. The prefrontal cortex keeps maturing into the mid-twenties, creating an imbalance between emotional reactivity and cognitive control that helps explain adolescent risk-taking. Erikson's task is identity versus role confusion: adolescents experiment with identities, values, and roles and make commitments about occupation, ideology, and relationships. Difficulty forming an identity may signal emerging personality pathology.
Peer acceptance strongly influences self-esteem and behavior. Social media creates new contexts for peer interaction with both positive and negative effects, and cyberbullying should be assessed. Depression rises sharply in adolescence, particularly among females, and often presents as irritability rather than sadness. Because suicide ranks among the leading causes of adolescent death, suicidal ideation requires careful assessment. Substance use disorders often begin in adolescence, and early initiation predicts poorer outcomes.
Young Adulthood (18–40 Years)
The task is intimacy versus isolation: establishing intimate relationships, consolidating a career, and possibly forming a family. The nurse assesses relationship patterns, occupational functioning, and life satisfaction.
| Condition | Young-Adult Presentation |
|---|---|
| Schizophreniaandother | Typicallymanifestinlateadolescenceandearlyadulthood;peakonsetistheearlytwentiesinmales |
| psychoticdisorders | andlatetwentiesinfemales Prodromalsymptomsmayprecedefrankpsychosisbymonthstoyears . , |
| and early intervention in first-episode psychosis improves long-term outcomes | |
| Bipolardisorder | Commonlypresentsnow Initialepisodesmaybedepressive withmanicfeaturesemerginglater and . , , |
| substanceusefrequentlycomplicatesthepicture Adetailedlongitudinalhistoryidentifiesmood . | |
| episodepatterns | |
| Anxietydisorders | Remainprevalent Socialanxietydisordercanimpaircareeradvancementandrelationships;OCD . |
| symptomsoftenintensifyduringmajorlifetransitions |
Middle Adulthood (40–65 Years)
Erikson's task is generativity versus stagnation: contributing to future generations through parenting, mentoring, and productive work. Failure leads to self-absorption and interpersonal impoverishment. Midlife can bring greater vulnerability to depression around children leaving home, career disappointment, divorce, caregiving for aging parents, and confronting mortality, so the nurse screens for these stressors in middle-aged patients with mood symptoms.
Cognitive changes begin but are modest for most people: processing speed declines while crystallized intelligence stays stable. The nurse distinguishes normal cognitive aging from pathological decline that needs evaluation. Substance use disorders may persist or emerge in response to stress; prescription misuse, especially of opioids and benzodiazepines, increases, and alcohol use disorder may intensify as tolerance grows.
Late Adulthood (65+ Years)
The final stage is integrity versus despair. Older adults review their lives and ideally reach acceptance and wisdom; failure brings bitterness, regret, and fear of death.
Increase substantially with age. Alzheimer disease causes
Underrecognized and undertreated. It may present with
about 60–70% of dementia cases; vascular, Lewy body, and
somatic complaints, cognitive symptoms, or apathy rather than
frontotemporal dementias are other common causes. Assess
sadness, and medical comorbidity complicates care. Suicide
cognition, safety risks, and caregiver burden.
rates are highest among older white men.
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