Child Interview and History Taking

Dra. Bautista - Department of Neurology and Psychiatry USTFMS 08

Referral
- Consider goals and context
- Goals with the psychiatric assessment
o To determine if psychopathology is present (establish
differential diagnosis)
o To determine whether treatment is needed (develop
treatment plants and recommendations)
- Understand clearly the reasons

Problems home, school, parents

Consent
- parental consent is required when the referral comes from
another source
- if in an emergency, when the referral comes from another
source, the consultation should go forward while the parents
are being sought

Parent Interview and History Taking
- Parents are most often interviewed first, especially in the case
of young children
- Adolescents may be given the choice of being present during
the initial interview with the parents
- Each parent should be interviewed individually
- Seeing patient and parents together able to observe family
interactions
- Specific questions: age, sex, legal status, birth history,
developmental milestones, previous illnesses
- Open indirect questions: data about feelings and relations
- Data should be gathered from as many objective sources as
possible:
o Hospital records
o School reports
o Other observers
- Description of the problem as seen by the parents
- Why help is being sought
- What previous attempts at obtaining help have been made
- Personal and developmental history of the child
- History of previous illness
- School history
- History of biological functions
- Description of childs relationship with the nuclear and
extended family and with peers
- Description of significant events
- Accounts of the previous and present medical and
psychological status of parents
- Parenting skills, style and parental expectations
- Childs temperament

Child Interview and History Taking
- Clinician must be familiar with normal development to place
the childs responses in the proper perspective
- Interviewer first task = establish rapport and engage child
- Should inquire about the childs concept of the purpose of the
interview and should ask what the parents have told the child
- Provide an opportunity to explore the childs over view of the
presenting problem
- History taking with child covers many of the same elements as
the developmental history taken from the parents only with
emphasis on the childs perspective or the history
- Depends on the childs developmental, cognitive and linguistic
level

Direct Questioning
- Requires TACT
- Requires attention to the childs cognitive and language
level
- Clinician should use terms comprehensible to the child
- Avoid overly abstract questions

Play, Projective and Indirect Techniques
- Useful in eliciting concerns(?) and feelings of children who
may be reluctant or unable to reflect and report in detail
- Useful means of facilitating interview process by helping to
place the child at ease and introducing an element of fun
- Books, movies, television shows are useful to observe
the childs interests, preoccupations and degree of
parental supervision
- What the child would like to be when he or she grows up
self-esteem and competency, aspirations and values

Infant and Preschool Children
- Parents should be present to place the child at ease and render
the child most likely to function at his best
- Observe parent-child interactions
- General characteristics to be assessed
o Parents self-esteem, competence, flexibility
o Parents ability to provide a safe, nurturing and
stimulating environment

Specific Objectives
- Sensitivity and accuracy of parents perceptions of infants
needs
- Amount of effective support, encouragement and
assistance the parent can provide
- Quality of play
- Parent ability to respond to infants needs
- Goodness of fit between parent and child

Infants Less than 18 mos
- Observe spontaneous, free play

Children: 18 mos - 3 yrs
- Participate fully in regulated play
- Play items should be realistic, limited capacity for
abstractive and symbolic play

School Age (6-12 years)
- Requires sufficient time
- Requires suitable space
- Requires availability of play items (crayons, paper
dollhouse and puppets)
- Elaborate, highly structured games are likely to interfere
with the evaluation
- Interviewer greets child from a reasonable physical
distance
- Interviewer should introduce himself to the child
- Interviewer should invite child to come into the office
while reassuring the child that his parents will be waiting
on his return
- Interviewer should ask for childs preferred name and
should make sure the child knows the interviewers name
- Interviewer should clarify what is the understanding with
why the child has come and the interviewer should give his
own understanding
- Interviewer will tell child what will take place
- Interviewer should clarify the extent of confidentiality
- Interviewer should avoid leading questions or any kind of
demanding interrogation
- Open-ended questions are better
- Inquire about areas of difficulty or worry that have
brought child (?)
- Inquire about what the child does for fun and about
activities he is good at doing

Adolescents
- Require a direct and explicit approach
- Clinician should show a genuine interest in the
adolescents view
- Clinician should not try to be deceptive or phony
- If the adolescent talks in terms of a 3
rd
person clinician
should answer in the same third person way
o allows room to move and they will not feel so
much on the spot
- Rejection, even outright hostility toward the clinician on
the first few visits is common
o clinician should be patient and not jump to
conclusions
o test how much he clinician can be trusted
o defense against anxiety
- Silence should not be allowed to continue too long
- Not rigid about the length of the interview
- Clear about the extent of confidentiality
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