Domain 1 - Symptom severity and distress (Primary Domain)

Overview

This domain considers symptoms to include both internalised (emotional) problems experienced by the adolescent (e.g., anxiety and depressive symptoms) as well as externalised behaviours observable by or impacting on others (e.g., impulsive behaviours, perceived concerning or aggressive behaviours, appearing to ignore instructions from adults, seeming distracted or unable to concentrate).

Symptoms may be associated with distress, but this is not always the case and (for example) may present as somatic symptoms like headaches and stomach pain. Symptoms may indicate a particular diagnostic condition, but a diagnosis is not required for rating an individual on this domain, determining an appropriate level of care, or referring the person for mental health services.

Assessment of an adolescent on this domain should consider:

  • Current and past symptoms and duration.

  • Level of distress associated with the mental health issues.

  • Previous experience of a mental health condition.

  • Are symptoms improving/worsening, is distress improving/worsening, and are new symptoms emerging?

PRACTICE POINT - eating disorders

Eating disorders are mental illnesses accompanied by physical and mental health complications which may be severe and life-threatening. A person with an eating disorder can experience disturbances in behaviours, thoughts, and feelings towards body weight/shape or food and eating. A person with symptoms suggestive of an eating disorder requires a comprehensive eating disorders assessment and referral to appropriate services according to a person’s needs.

IAR-DST users should be familiar with their local eating disorder screening and assessment pathway. Contact the GP or state/territory mental health services for care instructions in the absence of a defined local pathway. For more information about eating disorders, visit the National Eating Disorder Collaboration - https://nedc.com.au/eating-disorders/.

Scoring

0 = No problem in this domain

1 = Mild Symptoms are likely to be sub-diagnostic and have been experienced for less than three months (but this may vary)

  1. Mild anxiety-related symptoms (e.g., occasional fears, worry, difficulty concentrating, body image issues, occasional unexplained somatic symptoms like headache and stomach pain) without significant avoidant behaviour.

  2. Mild mood-related symptoms (e.g., sadness, fatigue, apathy, some reluctance to participate in previously enjoyed activities, irritability, occasional disrupted sleep).

  3. Mild behavioural symptoms (e.g., distractibility, overactivity, occasional difficulty completing tasks, quick to anger, occasional concerning or aggressive behaviours, occasionally appearing oppositional, minor interpersonal difficulties).

  4. Currently experiencing a mental health condition associated with mild distress or mild reduction in quality of life.

2 = Moderate Symptoms are at a level that would likely meet diagnostic criteria and have been experienced for more than three months (but this may vary)

  1. Moderate anxiety-related symptoms (e.g., excessive worry, agitation, panic, difficulty concentrating, significant self-consciousness or significant concerns about body image, appearance or weight, frequent unexplained somatic complaints) with significant avoidance of anxiety provoking situations.

  2. Moderate mood-related symptoms (e.g., excessive sadness, apathy, exhaustion, frequent irritability, loss of interest and pleasure and/or frequent reluctance to participate in previously enjoyed activities, frequent sleep disturbance).

  3. Moderate behavioural symptoms (e.g., frequent impulsivity, hyperactivity, non-adherence to age-appropriate rules or social norms, frequent concerning or aggressive behaviours, significant interpersonal difficulties).

  4. Currently experiencing a mental health condition associated with moderate levels of distress and/or moderate reduction in quality of life.

  5. History of a diagnosed mental health condition earlier in childhood that has not responded to treatment, with continuing symptoms but only associated with mild to moderate levels of distress.

3 = Severe

  1. Severe anxiety-related symptoms are present most of the time, the adolescent has difficulty controlling or managing the symptoms and seeks to avoid anxiety provoking situations and/or experiences severe distress if asked to engage in anxiety provoking situations such that there is severe distress and/or significant disruption to the adolescent’s (and/or parent/family’s) life.

  2. Severe mood-related symptoms are present most of the time, the adolescent has difficulty controlling or managing the symptoms and the symptoms are associated with severe distress and/or significant disruption to the adolescent’s (and/or parent/family’s) life.

  3. Significant behavioural symptoms are present most of the time the adolescent has difficulty controlling or managing the symptoms and the symptoms are associated with severe disruption and/or distress for the adolescent, and/or their parent/family and interpersonal relationships.

  4. Currently experiencing other severe mental health symptoms or severe psychological distress (e.g., complex trauma responses, obsessions, compulsions, severely disordered eating). Symptoms may be ongoing or of more recent or sudden onset.

  5. Symptoms suggestive of an early form of a severe mental health condition (e.g., odd thinking/ behaviour/speech, abnormal perceptions, suspicious thinking, rapid mood swings, a substantial decrease in the need for sleep) or symptoms suggestive of an eating disorder.

  6. Has been treated by a specialist community mental health service or admitted to hospital for a mental health condition in the previous 12-months.

4 = Very severe

  1. Very severe and pervasive anxiety symptoms are present virtually all the time, the adolescent can rarely control or manage the symptoms and the adolescent refuses to engage in anxiety provoking situations or activities. The symptoms are associated with severe distress, significantly reduced quality of life and/or severe disruption to nearly all aspects of the adolescent’s (and/or parent/family’s) life.

  2. Very severe and pervasive mood-related symptoms are present virtually all the time, and the adolescent can rarely control or manage the symptoms. The symptoms are associated with severe distress, significantly reduced quality of life and/or severe disruption to nearly all aspects of the adolescent’s (and/or parent/family’s) life.

  3. Extreme behavioural symptoms are present virtually all the time, and the adolescent can rarely control or manage the symptoms. The symptoms are associated with severe distress, significantly reduced quality of life and/or severe disruption to nearly all aspects of the adolescent’s (and/or parent/family’s) life.

  4. Currently experiencing very severe symptoms (e.g., disordered thinking, extreme mood variation, obsessions, compulsions, extreme avoidant behaviour, extreme interpersonal difficulties, extremely disordered eating with associated physical symptoms). Symptoms may be ongoing or of more recent or sudden onset.

  5. Highly unusual and bizarre symptoms/behaviours indicating a severe mental illness (e.g., hallucinations, delusions). Symptoms may be ongoing or of more recent or sudden onset.