History Taking in Child & Adolescent Psychiatry

History and interviewing the children and adolescents are not watertight compartments. Observation of the child/adolescent has to start soon as he/she first meets the clinician (from entry to exit from the clinic). Mental states in children and adolescents may have a higher intensity and frequency variation than in adults. For instance, depressive disorders in young people have preserved reactivity such that a depressed child may appear reasonably excited when given a toy to play with during examination. Serial examinations are more useful in getting a true picture of mental state characteristics.

Children and adolescents may also not be ready to immediately share their experiences, feelings, and thoughts. This may happen because of unfamiliarity and intimidation by the clinical setting or developmental unreadiness. The clinician must not make presumptions about the capacity of children to give information/participate in an interview. Children as young as 2–3 years old can answer simple questions about what they like, who they like, what makes them angry, etc. The clinician must make it a point to address the child and ask questions in age-appropriate language.

Expressive channels evolve from play in very young children to art and other creative methods, and finally to verbal dialogue in adolescents. The manner of exploration and engagement with children must follow this understanding. Therefore, waiting for preschool children to cooperate across an interview table may not be successful, whereas letting the child sift through toys, or be in a play area may reveal his activity levels, attention span, ability to tolerate frustration and cognitive abilities. Use colors, pens, paper, puzzles, pegboards, can all be used in the office to facilitate interaction with young children. Direct questions to a child should be short, precise, in simple words, dealing with one concrete issue at a time. For example, if a child is being bullied at school, asking him/her ” Does anyone trouble you at school?” would be better than asking, “Can you tell me about any problems you are facing at school?” shall be appropriate

Observing infants and toddlers can uncover a range of behavioral and developmental facets. Using play techniques, especially with toddlers, can clarify cognitive, linguistic, social, and motor developmental achievements. The child has to be in a calm, alert state for the best estimation of cognitive and socio-emotional development. Therefore, if the child is irritable, from hunger or some physical discomfort, the parents may be asked to attend to the immediate needs of the child and then resume the assessment process.

The physical health status of the child could give important clues to the possibility of underlying medical conditions as also under-stimulation and parent-child attachment. Height/length, weight, state of skin and hair, and the activity levels – curiosity, interest in the environment – can be easily observed during the first few minutes of the assessment.

Evaluation in child and adolescent psychiatry is layered and complex. Clinical impressions may change from the first contact to the next. It is useful to go over in detail the clinical history at least a few times. The “detailed work-up pro forma” systematically records information on all aspects of a child's life. As parents answer questions pertaining to different domains they too get clarity on the multi-factorial contributors to the child's difficulties.


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