The next consideration for therapeutic placement is the etiology of the disorder.  It’s absolutely critical to get Factor II right in determining appropriate therapeutic placement for your child.  In simple terms, “etiology” means looking at how the child’s issues were formed.

Dr. Bishop will evaluate your child’s issues and determine the degree to which biology or environment plays a role- and which type of treatment will therefore produce the best results.

Biological Factors consist of anything physical that can cause adverse effects on the student’s well being.  Possible factors under “biology” include genetics, prenatal damage, infections, exposure to toxins (maternal substance abuse), and brain defects or injuries.  Adopted children where little is know about the birth mother are at risk for biological factors.

Environmental Factors consist of any life experiences that contribute to mental illness.  This can be a major or minor trauma (sometimes called “big T-trauma or little t-trauma”- which is used to describe a named traumatic event or more perceived trauma like being bullied or not fitting in socially), poverty, family discord, sexual abuse, or any environmental stressor that causes a person to have difficulty functioning in life.

If the child’s issues were more biologically based we should look for a program with a strong medical component.  If the child’s issues are more environmentally based then we need to seek a more therapy based program.  Within environmentally based factors, we also need to make the distinction of a more relational approach and/or family systems approach would be best (appropriate for trauma and attachment) or if a more cognitive or dialectical behavioral therapy is best (appropriate for personality disorders).  If your child has not had psychological testing with an official diagnosis, it may be necessary to have this service performed first.

The below graphic illustrates disorders that can be more biologically based or resulting from life experience (environmentally based).  In reality most issues fall somewhere in the middle, where there was a biological predisposition, but the child’s life experiences created a tipping point for the disorder to surface.

Researchers continue to debate today the percentage of influence biology or the environment has on different disorders.  For example, Autism Spectrum Disorders are believed to be a biologically based neurodevelopmental disability with a genetic basis, but researchers are also looking at possible environmental causes as well.  Exceptions can be thought of for each diagnosis in the above graphic.  As a result, the graphic should not be taken as literal, but more of a range on a continuum where these disorders most likely fall in most cases.  The value of determining the etiology is then using this information to find the right treatment.

There are several focus areas treatment facilities may specialize in, and Dr. Bishop can help you understand which are more medically based versus therapy based:

Skills Based Programs: This is appropriate for individuals with serious mental illnesses like schizophrenia or an intellectual disability.  These individuals are not likely to benefit from interpersonal therapy, but they can benefit from learning life skills such as how to access resources or balancing a checkbook.  Treatment for autism spectrum disorder will often also include skills based treatment.

On the other side of the coin, if your child has issues such as general defiance and opposition (or the “I’m right, and everyone else is wrong” attitude), it would be inappropriate to place them in a facility geared towards skill building or medication adjustment only.  This is why Factor II is so critical to get right.

Medically Based Programs: For individuals with biologically based disorders (or the potential for biologically based disorders, such as adopted children who were exposed to drugs in utero) – treatment must include medical oversight.  This means looking at a residential treatment center with a board certified child and adolescent psychiatrist on staff.  Some programs incorporate both medical the therapy modalities simultaneously.

Therapy Based Programs: For individuals that have issues due to their life experiences, a therapy based program may be appropriate.  This is treatment to develop insight into cognitive distortions and learn new coping skills.  Cognitive Behavioral Therapy and Dialectical Behavioral Therapy based programs fall into this category.  For this category, an IQ in the Average range or above is required to be successful.  Medications are often simply just continued or maintained in the program type as focus is on the therapy process.

References for this page:

Catherine Griffin (28 February 2013). “Five Very Different and Major Psych Disorders Have Shared Genetics”. Science World Report. Retrieved 28 February 2013

Christensen MV, Kessing LV (2006). “Do personality traits predict first onset in depressive and bipolar disorder?”. Nord J Psychiatry. 60 (2): 79–88.

Link, B G; Phelan, J C; Bresnahan, M; Stueve, A; Pescosolido, B A (1999). “Public conceptions of mental illness: labels, causes, dangerousness, and social distance”. American Journal of Public Health. 89 (9): 1328–33.

Yolken RH, Torrey EF (1 January 1995). “Viruses, schizophrenia, and bipolar disorder”. Clin Microbiol Rev. 8 (1): 131–45

Click on a Factor below to explore the topic:

I. Severity of Issues

II. Etiology (how the issue was formed)

III. Diagnostic Cluster

IV. How the Child Handles Frustration and Discord

V. Child’s Belief System and Prevalent Issues

VI. Cost and Length of Stay, VII. Academics

VIII. The Child’s Interests, IX. Program Location, and X. Everything Else