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Step 2: Clinical Interviews

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

Detailed history from caregivers, teachers, and child

3D figures with chat bubblesThe initial evaluation usually begins with interviews about personal, family, and educational history. Caregivers, teachers, and child all participate. Most practitioners meet with each person after they complete a checklist on behalf of the child. This sequence gives the evaluator time to analyze the data; and, to identify what additional information may still be needed. Evaluators gather detailed histories so they can understand the problem from everyone's [different] perspective. In a sense, each person holds pieces to the puzzle. The evaluator then puts together the puzzle to form a more complete, whole, understanding of the child.

Interviews with parents or other caregivers:

Details from the parents or other caregivers will provide information about:

1. the age when symptoms first appeared;
2. the progression of the symptoms;
3. the impact of symptoms on the child and family;
4. the severity of the functioning difficulties, in which settings; and,
5. an understanding of the family's current abilities to cope with its circumstances.

Teachers are often the first to suggest that a child has ADHD. Caregivers are usually the first people to suspect that a problem exists. It is a difficult decision to decide to have your child evaluated for ADHD, or any other childhood disorder. Once the decision has been made, caregivers should be prepared for what follows. The process can be a long one. It can also be stressful or emotional at times. Therefore, caregivers should try to find a psychologist or another ADHD specialist with whom they feel most comfortable. It may pay dividends to spend time choosing the right person. A solid, trusting relationship with a qualified helping professional ensures things proceed as smoothly as possible. Recognize that you may need your own support. Don't feel odd. Many people find this kind of additional support invaluable. It's just another way you are trying to do the best you can for your child.

Living with a child with ADHD places extreme pressure on caregivers. Nobody wants something to be wrong with their child. Many caregivers cope with this painful reality by minimizing the impact of problems. It is difficult to come to terms with these issues. It may also be quite painful to discuss these concerns in a frank and honest manner. Conversely, some people find it a great relief to finally talk to someone who understands.

These conversations with the family provide the clinician with essential information regarding the child's wellbeing. All of this information will be helpful in determining a correct diagnosis and subsequent treatment plan. 

Interviews with the child

After interviewing the caregivers, the clinician will interview the child. Children often have their own concerns about their behavior and the consequences of their behavior. Among those concerns is the fact they are now talking to mental health professional.

Interviewing children can be a challenging process. It is often more difficult for children to talk about their problems than it is for adults. Despite this stumbling block, a child's perspective is very valuable. Interviews help to inform clinicians and caregivers about the child's own perspective on school, home, and friends. The interview also helps to clarify what the child hopes to gain from treatment.

Each child's perspective will vary depending upon their age and the challenges they face. Some children have very little insight about their difficulties, while others are extremely insightful. Insightful or not, children do not typically volunteer their ideas about what's wrong unless encouraged to do so. However, even the brightest young child does not have an accurate, adult understanding of their problems. Nevertheless, valuing children's unique understanding is a vital step in obtaining a commitment to the treatment process. Adults often dismiss the views of children as inaccurate and immature. However, discovering the child's unique understanding of the situation provides important clues about what might motivate them to successfully participate in their own treatment. An interview also provides an opportunity for the child to ask questions, and become more comfortable with the assessment process.

The child interview is designed to elicit information about the child's own understanding of the problematic behavior. The clinician is also interested in learning what the child thinks causes those problems. The interview will typically explore the child's emotions surrounding the concerns of their caregivers and teachers. In addition, the clinician will assess the child's functioning, strengths, and limitations. As mentioned above, it is critical that the child feels comfortable and relaxed with the clinician. This familiarity maximizes the likelihood of an accurate diagnosis and a successful therapeutic outcome. All information gleaned from these discussion becomes very helpful during treatment planning stage.

Interviews with teachers and other educators:

The final diagnostic interview is usually conducted with the teacher. Teachers are in a unique position to provide useful information. They have knowledge of normal child development and a familiarity with a child's social circle.

Some professionals rely solely on a written report or an ADHD checklist. However, a direct conversation with the teacher is invaluable. Meeting with the teacher helps the evaluator to understand the teacher's point-of-view about the child's problems. The teacher can describe the extent of problems in the classroom (severity). Meanwhile, the clinician can ask follow-up questions to get more detail, if needed. The interview also enables the evaluator to consider many factors that may influence a teacher's report about a child's behavior. These include: values, expectations, knowledge, experience, attitudes, etc. All of these different factors influence how we interpret other people's behavior.

These days, teachers are being asked to do more with less. Therefore, a teacher interview may not be most practical. Despite this difficulty, it should still be attempted after the ADHD checklist is completed and reviewed by the clinician. If the teacher cannot meet face-to-face, a phone or email conversation can provide some of this valuable diagnostic information. If a child's teachers, and/or other members of the evaluation team, have trouble connecting, sometimes caregivers can help facilitate a meeting or phone call.