Abstract / Summary
Abstract Cognitive disorganization in help-seeking youth can involve difficulties with attention, task sequencing, language access, or discourse organization alongside unusual experiences and functional decline. This Perspective proposes a transdiagnostic developmental approach to clinical formulation using four complementary questions: what is the young person’s developmental baseline; which functions vary within the person across load, context, and time; what is happening in the environment and how is threat interpreted; and do established clinical-risk indicators require formal assessment or referral? The questions address different assessment tasks, may be considered together, and constitute a proposed clinical heuristic. Assessment of genuine environmental harm, safeguarding needs, and urgent medical or psychiatric risk takes precedence over explanatory interpretation. The synthesis distinguishes direct evidence from adjacent findings and clinical hypotheses. Acute-stress research supports effects on specified executive outcomes under studied conditions; extrapolation to discourse organization, threat meanings, or reality testing in help-seeking youth remains insufficiently supported. Stress sensitivity is therefore a domain-specific formulation hypothesis to test, not an established property of the presentation. The proposed contribution is to organize established assessment domains around observable difficulties and documented uncertainty. Prospective studies should measure domains separately and assess reliability, incremental clinical value, and safety against explicit alternative explanations and falsification criteria.