The successful pediatric psychosomatic medicine assessment results in a developmentally informed biopsychosocial understanding and plan for children and their families. The assessment should determine where the child falls along a mental health continuum ranging from normal to developmental variation to problem to disorder (Wolraich et al. 1996). The assessment must take into account physical symptoms that may occur with emotional distress and consider the physical conditions that may mimic psychiatric dysfunction. Also, the assessment should identify patient and family strengths that promote resiliency as well as maladaptive coping strategies that impair functioning and adherence.

The biopsychosocial formulation describes the "why" of the child or adolescent on all levels. It serves both as a guide to the comprehensive care of the patient and family and as the foundation for the working alliance with patients, families, and health care providers. This chapter outlines the critical steps in the pediatric psychosomatic medicine consultation process to guide the mental health consultant in the assessment, diagnosis, and care of patients and their families in the pediatric setting (see Table 3-1).

The psychosomatic medicine assessment of children and adolescents in pediatric settings should cover all the components contained in the "Practice Parameters for the Psychiatric Assessment of Children and Adolescents" (American Academy of Child and Adolescent Psychiatry 1997) as well as the "Practice Parameter for the Psychiatric Assessment and Management of Physically 1ll Children and Adolescents" (see Table 3-2) (American Academy of Child and Adolescent Psychiatry 2009). The formulation can be framed in a series of concentric, nesting, interrelated domains of functioning, with biology at the core, followed by the child's experiences, then those most proximally involved with the child (parents, siblings), then the child's health care system, and finally the child's "outside world" of school and peers (see Figure 3-1). The concentric model emphasizes the interrelated elements of each domain and the critical task of the consultant to integrate them into the formulation.

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