Step 2: Clinical Interviews
Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.Detailed history from caregivers, teachers, and child
The 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.
Resources
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Articles
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Childhood ADHD Overview
- Introduction to Attention Deficit Hyperactivity Disorder (ADHD)
- Signs & Symptoms of ADHD
- ADHD Signs and Symptoms: Attention Difficulties
- ADHD Signs and Symptoms: Hyperactivity
- ADHD Signs and Symptoms: Impulsivity
- Are There Different Types of ADHD?
- The Social, Educational, Financial & Occupational Impact of ADHD
- What are the Legal Rights of Caregivers and Their Children with ADHD (USA)?
- A Positive Spin: Is There Anything Good about ADHD?
- Signs of ADHD in Children at Home
- Signs of ADHD in Children at School
- Signs of ADHD in Children in Peer Relationships
- How Do I know if My Child Needs an ADHD Evaluation?
- What Should I Do If I Think My Child Might Have ADHD?
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ADHD Discoveries and Controversies
- ADHD: New and Exciting Brain Research
- ADHD: New and Exciting Brain Research - Part II
- Neurotransmitter Changes with ADHD
- Executive Functions
- Neurodiversity: Is ADHD a True Mental Disorder?
- ADHD Statistics
- Cultural and Gender Differences in Prevalence Rates
- Should Children with ADHD Be Medicated?
- New and Promising Areas of Research
- Causes of ADHD in Children
- ADHD or Another Condition?
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Diagnosis of ADHD in Children
- Who Can Diagnose ADHD?
- How Does ADHD Multi-Source Assessment Work?
- Assessment Instruments: Behavioral Checklists
- Assessment Instruments: Intelligence Tests
- Assessment Instruments: Achievement Tests (or Academic Tests)
- Assessment Instruments: Tests of Attention
- Assessment Instruments: Memory and Other Common Tests
- Step 2: Clinical Interviews
- Step 3: Physical Exam and Medical History
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ADHD Treatment in Children
- Multimodal ADHD Treatment Approach
- ADHD Medications
- Treating ADHD with Stimulant Drugs
- Commonly Prescribed ADHD Stimulant Medications
- Treating ADHD with Non-Stimulant Drugs
- Risks of ADHD Medication
- Risks of ADHD Medications - Part II
- Benefits of ADHD Medication
- Side Effects of ADHD Medications
- Medication Decisions and Medication Management
- How Long Should ADHD Medication Treatment Last
- Psycho-Education about ADHD and Its Management
- Family Therapy
- Individual and Cognitive Behavioral Psychotherapy for the Child with ADHD
- Skills Training
- Social Skills Training and Coaching
- Supports
- Alternative ADHD treatment: What Does NOT Work?
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Family and Personal Supports
- Effective Disciplinary Techniques
- Learn about Resources and Be Proactive
- Manage Stress, Self-Regulation & Provide Order
- Develop Routines, Organization and Expectations
- Communicate and Collaborate with Schools
- Express Confidence in Your Child's Abilities
- Help Children Improve Social Skills and Peer Relationships
- Avoid Homework Battles and Monitor Medication
- I Think I have ADHD. What should I do?
- I Think I Have ADHD - Part II
- Famous People with ADHD
- Adult ADHD Overview
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Diagnosis of Adult ADHD
- How is Adult ADHD Diagnosed?
- Diagnostic Challenge 1: Looking into the Past
- Diagnostic Challenge 2: ADHD versus Similar Disorders
- Diagnostic Challenge 2 - Part II
- Diagnostic Challenge 3: ADHD Symptoms
- Diagnostic Challenge 3 - Part II
- Diagnostic Challenge 4: A Concealed Disorder
- Specialized Tests and Tools
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Adult ADHD Treatment
- ADHD Medication Treatment
- Stimulant and Non-Stimulant Drugs for Adult ADHD
- Medication Timing, Dosage, Monitoring, and Duration of Treatment
- Weighing the Risks and Benefits of Adult ADHD Medications
- Psychotherapy for ADHD
- Coaching/Supported Employment for Adult ADHD
- Social Skills Training for Adult ADHD
- Psycho-Education and Cognitive Behavioral Therapy (CBT)
- ADHD Resources and References
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Childhood ADHD Overview
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Questions and Answers
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- Reclaiming Our Children
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- Ritalin Nation
- Running on Ritalin
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- The Explosive Child
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Links
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- ADHD in Preschoolers: What to Look For and How to Help
- FYI on ADHD Evaluations
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- Does my Child Have ADHD?
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- Is My High School Student Ready for College? (And Is My College Student Ready to Go Back?)
- Understanding and Applying the Science of Time Management
- ADHD Medication and College Students: Prevent Misuse, Abuse, and Diversion
- Improve Homework Time with Strategies That Work For ADHD
- Student Voices: What Really Matters to Young Adults With Learning and Attention Issues
- 5 Ways Nutrition can Impact ADHD Symptoms
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- When You and Your Child Have ADHD - Communication Skills to Resolve Conflict
- Guidance for Uncertain Times: Navigating Relationship Challenges
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- ADHD: Signs, Symptoms, Research
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- Health and Life Expectancy in ADHD
- Focus on ADHD
- Pediatrics: ADHD and Food Allergies
- ADHD: It's a Family Affair
- Does Your Child Have ADHD?
- ADHD in Children
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- Rise in ADHD Cases in Children
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- Video Games, Screens, and ADHD A Potent Mix
- Ask the Expert Helping Children with ADHD LD Conquer Chronic Stress
- Ask the Expert: Mindfulness, Stress, & Emotion
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- Ask the Expert Educator Edition: ADHD & Executive Functioning
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- Medication Treatment for ADHD
- Using Time Out
- Treating Childhood ADHD
- ADHD-friendly Summer Family FUNdamentals
- Preparing Older Teens for the Road Ahead
- Tips for Teachers: Tailoring homework to make a difference
- Your Active Preschooler: Could it be ADHD?
- Tips for Teachers: Creating a positive dialogue with parents of students with ADHD
- Helping Parents & Kids Understand the Social & Emotional Aspects of ADHD
- Social and Emotional Concerns of Children with ADHD: Strategies to Help
- Holiday Gifts for Children with ADHD
- Behavior Management and Combined Treatment for Children with ADHD
- Setting Realistic School Expectations for Students with ADHD
- On Their Own: Helping College Students with ADHD
- Children's Communication Challenges: Is it Attention, Language or Both?
- Out-of-School: Parenting During the Summer
- ADHD in the Workplace: Finding Success
- Emotions and Motivation in ADHD
- The Role of Medication in Managing Children's ADHD Symptoms
- Top Tips for Combating Stigma and Addressing Myths about ADHD
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- What To Do If Your Child Has ADHD?
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- Children, Meds, and Heart Safety: A Tale of ADHD and Public Health
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