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 -end- -08united_irregs07- -AsM-