Clinical assessment of child and adolescent personality and behaviour by Frick, Barry, & Kamphaus (fourth edition) – Chapter 13 summary

History taking is essential in child psychological assessment for several reasons:

• It allows the clinician to conceptualize a case by providing information about the developmental course of the child’s difficulties.
• It provides information on the specific presentation of the individual child’s difficulties.
• It provides information on risk and protective factors.
• It provides information on important contextual influences on the child’s functioning.

It consists of several aspects:

• Age of onset
  This is crucial for diagnosis and conceptualization.
• Course and prognosis
  This is used to assess the stability of symptoms and to determine whether contextual factors play a primary role.
• Impairment
  This gives information on impairment experiences in daily life and environmental consequences of the problems.
• Aetiology
  This gives information on a potential diagnosis or effective interventions.
• Family psychiatric history
  This is crucial as it can impact the age of onset (1), differential diagnosis (2) and treatment (3)
• Previous assessment/treatment/intervention
  This can be used in guiding interpretation of current findings (e.g. more severe symptoms than in the past despite having received treatment indicates the need for more intensive treatment) and can guide future treatment options. It can also focus the attention on comorbid disorders.
• Contextual factors
  This is crucial as it may influence the course of the problems or may explain the aetiology.

It is important to take the goodness of fit between the child’s characteristics and the context into account in which one is expected to function. The content of history taking often includes complaints/symptoms (1), developmental history (2), family history (3), social functioning (4), academic functioning (5), family relations (6), interests and strengths (7) and views of the problem (8).

Genograms refer to a family tree that allows the clinician to document the family structure (1), the relationships among family members (2), critical events (3) and any particular variables of interest (4). It presents information graphically in a manner that is quickly interpreted.

There are several behaviours that should be observed by the clinician during history taking:

• Perspiration, blushing, paling.
• Controlled, uneven or blocked speech.
• Plaintive voice or talking in a whisper.
• Posture.
• Tics.
• Affirmative nodding or negative shaking of the head.
• A sudden glance at the interviewer after a statement by somebody else.
• Clenching, rubbing, wringing hands, searching, nail-biting.
• Dress and personal grooming.
• Reddening of eyes or crying.
• Frowns, smiles.
• Inappropriate affect.
• Interactions among parents, child and clinician.
• Developmentally inappropriate behaviour.
• The way in which the child is held or helped during the interview.
• The parent’s ability to have the child respond to a request.
• Frequent swallowing, tenseness, fidgeting, preoccupation, avoidance of eye contact, social distance.