CHILD INTERVIEW

Child: Harlea M.
Date of Birth: March 7, 2006
Age: 8

Parent/Guardian: Christi and Steve M.

School: Canmore Elementary School
Grade: 4

Interviewer: Melissa Martin

Unable to focus on lessons,
Reason for Referral:

difficulties paying attention, gets

frustrated about not understanding
math and troubles with reading,
writing, and spelling

CONFIDENTIALITY AND PURPOSE OF INTERVIEW

Were going to spend some time today talking together so I can get to know
you and learn about what you like and dont like. I am going to write a
report about what I learn in our talk today, and I will also be meeting with
your parents (guardians) and teachers to talk about what I learned about
you. At the end of this talk, we can discuss (review) what I will be saying.
Learn your perspective on your own functioning (learning), and
intervention options.
Investigation into strengths & weaknesses
Goal is to gather specific & new information to better understand
you and improve your current functioning or learning.
Together we will collaborate to ensure you are prepared for any
changes in routine (or transitions)
Information is only shared with the required school personnel (its
private & confidential)
I am required by law to contact the appropriate agencies if there is a
reason to suspect that you were going to hurt yourself, hurt someone
else, or if someone has hurt you.
Do you have any questions? Okay, now Id like to continue by hearing more
about you.

CHILD INTERVIEW
ACTIVITIES & INTERESTS
What do you like to do for fun when

RESPONSES/COMMENTS
-Play with friends, play games (video

youre not in school?

games: Minecraft), soccer, yoga,

baseball, listen to music, draw

Do you participate in any

-soccer, baseball, yoga, art

sports/hobbies/clubs?

Of all the things you do, what do you Loves playing games and sports.
like doing best? Least?

Doesnt like doing home work or

studying, especially with reading and

How much TV do you watch in a

math.

day? What are your favourite

- About an hour a day, a few hours on

programs? What do you like about

weekends. Loves Teenage Mutant

them?

Ninja Turtles and Spiderman (lots of

action).

Do you play video games? What are

your favourite games? How much

- Yes, Minecraft. Plays a few days a

do you play in a day?

week for an hour or two.

Do you like music? (If yes) What kind

of music? What are your favourite

-Yes, pop music (Katy Perry, Demi

groups?

Lavato, Taylor Swift)

CHILD INTERVIEW

Now lets discuss how you feel about school and homework.
SCHOOL & HOMEWORK
School

RESPONSES/COMMENTS
I hang out with friends, work on

Tell me how you spend a usual day

assignments in class and play games

at school.

in phys ed or draw/paint in art.

Art, science, phys ed, recess. I like

What (subjects) do you like best

being able to move around and be

about school? What do you like

creative.

about _____?
Math, ELA, and social studies. I dont
What (subjects) do you like least

understand how to do math problems

about school? What dont you like

and Im not good at reading. I dont

about _____?

like sitting and listening to the

teacher all the time in social and all
the writing we have to do.

I do okay except for math and ELA.

What kind of grades do you get?
No
Do you participate in any activities

CHILD INTERVIEW
at school?

Likes teachers but sometimes they

get mad when shes not paying

How do you get along with your

attention or if her work isnt done.

teacher(s)?
Friends Jessie and Sarah

Is there anyone at school who is

Yes

especially important to you?

Falling behind, not being able to read
Do you ever worry about school?

as well as others, being labelled as

stupid, not being able to complete

What do you worry about?

homework

Sometimes, when I am talking when I

Do you ever get into trouble at

shouldnt be or not getting along with

school?

others. Also when my homework is

not finished when its due.

Sometimes I have to stay in at lunch

if my assignments are finished and I
complete them with my teacher. If I
What kind of trouble?

get into arguments with other kids I

CHILD INTERVIEW
might have to leave the classroom.

More time to work and talk with

others instead of listening to the
If you could change something

teacher all the time, more recess and

about school what would it be?

gym, less homework.

- A lot, its too much but I do fall

Homework

behind. I guess the amount is fair

How much homework do you usually

but I wish I could have less.

have?
How do you feel about that amount
of homework? Does that amount
seem fair or unfair?

-After school or after supper at home.

Sometimes at lunch with my teacher

When do you usually do your

if its not done on time.

homework?
-Kitchen table or in my room

-I usually take half an hour

Where do you usually do your
homework?

-No, most of my homework doesnt

get finished.

CHILD INTERVIEW
How long does it usually take?
-I might get 0% or will have to work
Do you usually get homework done

on it with the teacher to finish and

on time?

get late marks taken off.

-Yes, I dont understand what to do

What happens when you (or other

with math problems and I dont like

kids) dont get homework done on

reading too many pages. I get

time?

confused and then I start to get mad

and I dont want to work anymore.
-My mom sometimes helps if shes

Do you have any trouble with

not busy or working. But its not too

homework? (If yes, probe further)

often and I usually need help.

What kind of trouble?

-Yes, I usually dont hear the
teachers instructions and I have
Does anyone help you with

trouble paying attention. I usually

homework or schoolwork? How

have to get someone else to tell me

does that work out, having _____

what to do or the teacher has to

help you?

repeat the directions.

Attention & Concentration at School

Do you have any trouble following

- I get distracted a lot so I usually

what your teacher says? (If yes)

dont finish my assignments. Other

CHILD INTERVIEW
What kind of trouble do you have?

people distract me, I like to talk to

them.

-Yes, I like moving around. I usually

Can you complete your

get in trouble for not sitting still in

assignments, or are you easily

class.

distracted? (If distracted) What

seems to distract you?
-Yes, I cant work on homework for
Do you have a hard time sitting still

very long.

for a long time? (If yes) Tell me

about the trouble youre having.

-Yes, I dont write very fast and I can

write stuff down and listen at the

Do you need a lot of breaks when

same time. Too overwhelming.

working?
Sometimes, especially with math
Do you have any trouble copying

rules and going over something I

what your teacher writes on the

read. I also have a hard time

board? (If yes) What kind of trouble

remembering the teachers

do you have?

instructions for a lesson.

Do you have trouble remembering

Its okay when I am doing something

things? (If yes) Tell me about the

I like. I have a hard time

CHILD INTERVIEW
trouble youre having.

concentrating on homework for too

long. I usually need breaks or I start
to get angry if its too difficult so it
wont get finished.

How is your concentration?

Do you like to keep at your work

-Yes, I have trouble with math and

until its done? Tell me more about

ELA tests. I take too long on

that.

questions and if Im stuck on a

question, I spend too much time on it
and I wont move on to the next one.

Do you have trouble taking tests? (If

yes) Tell me about the trouble youre
having.

Lets move on to talking about your friends and classmates.

FRIENDSHIPS & PEER

RESPONSES/COMMENTS

RELATIONS
Friends

-Jessie and Sarah. I also have my

Do you have friends? (If no, tell me

friend Rebecca across the street.

about not having friends).

Robert in my class is okay but we

How many friends do you have?

sometimes argue.

Tell me about your friends.

About 4. Jessie and Sarah think Im

CHILD INTERVIEW
funny. Rebecca likes to do what I
want to do and Robert is sometimes
nice to me but when we fight, I have
What do you like to do with your

to stay away from him.

friends?
Do they come to your house?

-play video gams, watch T.V., play

Do you go to their houses? How

soccer, listen to music. Jessie and

often?

Rebecca come over to my house

about once a week. I go over to their
houses about once a week.

When you are with your friends, how

do you feel?

-Good, they think Im funny. Except

Robert makes me feel mad and sad

How are your friends treating you?

sometimes.

-Okay. Rebecca can get upset

sometimes if she doesnt like
something that I want to do. But she
usually does it anyway. Robert and I
Who is your best friend? Tell me

can yell at each other if he gets mad

about him/her.

or annoyed with me.

Rebecca, we knew each other since

CHILD INTERVIEW
Social Problems

we were 5. She sometimes says Im

How do you get along with your

too bossy but most of the time we

classmates?

get along.

Do you have problems getting along

-Okay, some of them are nice but

with other kids?

others tease me. They say Im too

loud and bossy. A couple of them

What kinds of problems do you

tease me about being dumb when I

have?

have trouble in a lesson. But Sarah

and Jessie hang out with me.

- Sometimes. I will yell at some

What do you try to do about _____?

students who tease me, especially

Robert. Some of the other students I
wont talk to.

- I try to stay away from those

Do you ever feel lonely or left out of

students who tease me but I have a

things?

hard time ignoring them. I can get

What do you do when that happens?

very angry and start yelling at them.

Do you ever get into fights or

- Yes, I try to stay away but I dont

arguments with other kids? (If yes)

like being left alone so I try to be nice

CHILD INTERVIEW
Tell me more about that.

and will try talking to them to get

Are they yelling fights or hitting

them to like me.

fights?

-Yes, I yell at them if theyre teasing

Does that happen with only one

me or making me feel bad. I dont

other kid or with a group of kids?

hit. It happens with about 5 other

What usually starts the fights?

students but mainly with Robert.

How do they usually end?

Teasing me and telling me to be quiet

is usually what starts the fights. I

What are some ways you could

usually have to be separated by the

solve that problem besides fighting?

teacher for it to end.

- Try and ignore them? But I have a

hard time doing that.
Now lets talk about your home.
HOME SITUATION & FAMILY

RESPONSES/COMMENTS

RELATIONS
Who lives with you at home?

-My mom, dad, and cat Marley.

Tell me about _____(persons at

-Dad works during the week in

home).

Calgary so I dont see him that often.

Mom works on the weekends so dad
will look after me. Mom and I will go

CHILD INTERVIEW
for walks and play in the park. Dad
and I sometimes go fishing or play
catch.
What does your (father) do for work?
What does your (mother) do for

-Dad is a salesman, mom works in a

work?

store.

Tell me what your home is like.

- I get up early for school and have to
feed the cat. I have breakfast and
then mom walks me to the bus. At
school I hang out with my friends and
do schoolwork. After school, I work
on homework and mom is usually
cooking. After supper I might play
Do you have your own room? (If

video games or watch a movie.

shared who share with & how get

along).

-Yes

Do you have any special chores/jobs

at home?

Do you get allowance? (If yes) What

-Feed the cat and clean my room

CHILD INTERVIEW
do you have to do for it?

-Yes for doing my chores. But I get

money even if my chores arent
done.

Are there rules you have to follow at

home? Tell me about those.
-Yes, I have to do my chores and
homework. But I usually dont finish
When you get into trouble at home,

those. Be nice and ask permission if I

who disciplines you? Tell me how

want to go anywhere.

____ disciplines you.

-Mom usually does. She takes away
How do your parents/guardians tell

my video games or I will get

you or show you that they like what

grounded.

you have done?

How do you get along with the

-They tell me theyre proud of me.

people in your family/home?

What does your

-I get along with my relatives

(father/mother/sibling) do that you

like? Dont like?
Ask about relationship with each

-I like when mom and dad spend time

member of the family/home/other

with me together. I dont like it when

CHILD INTERVIEW
caregivers.

theyre working all the time or when

they fight. Sometimes they fight
about money and having to work too

When you have a problem who do

much.

you talk to? How does he/she help

you?

-Mom, she will listen to me and we

try to talk about how to solve the

In general, how would you describe

problem together.

your family?
-We get along well but I wish I had a
*Kinetic family drawing for younger

brother or sister.

children
Now Id like to hear a little about some of your thoughts and feelings.
SELF-AWARENESS & FEELINGS
Wishes

RESPONSES/COMMENTS
1. Wish I was smarter (I suck at math

If you had 3 wishes, what would you

and ELA), 2. Wish I could pay

wish for? Reasons for each?

attention in class and that people

wouldnt get mad at me all the time,
3. Wish we were rich so mom and
dad wouldnt have to work all the

What would you like to be when

time.

youre older/grown up?

Animal doctor. I love cats.
If you could change one thing about

CHILD INTERVIEW
yourself, what would it be?
My temper or my brain (be smarter)

Feelings
Tell me about how youve been
feeling lately.

-angry and frustrated when Im in

class. But Im happy when Im with

Do you have different feelings in the

my friends.

same day? (If yes) Tell me about

these different feelings.

-Sometimes, I get nervous for math

and ELA class cause I have troubles.

What kinds of things make you

I get excited about phys ed and art

happy?

and when school is over.

What makes you feel sad? What do

-sports, friends, music

you do when you are sad?

-failing a test, reading, doing math,
not understanding something, being
What kinds of things make you

behind everyone else in class

angry? What do you do when you

are angry?

- When I dont understand

something, math, reading, writing,
when people call me stupid or

CHILD INTERVIEW
What makes you scared? What do

annoying

you do when you are scared?

-When mom and dad argue, when I
get in trouble, when I dont
understand my schoolwork and
everyone else does. I usually get
What do you worry about?

frustrated and upset. I would rather

avoid doing work than working on it
and failing.

How do you feel most of the time?

-Falling behind everyone else in class,
people hating me, that Im stupid

Self-Concept

I feel okay outside of school. But I

What do you like best about

get nervous, angry, and sad in most

yourself? Anything else?

classes, especially math and ELA. I

am scared about being asked to read

Tell me about the best thing that

out loud.

ever happened to you.

-I think Im funny and my friends
What do you like least about

think Im nice.

yourself? Anything else?

-I got to go to my grandpa and

CHILD INTERVIEW
grandmas farm over the summer.
They have lots of animals.

-I feel stupid sometimes (esp. math

Screening Questions (Anxiety,

and reading) and I think I annoy

Depression, Suicidal Risk)

people. I dont like getting into

Do you have any problems with:

trouble.

Headaches
Feeling tired
Getting enough sleep
Feeling/getting sick a lot
Eating
Stomachaches
Any other kinds of body pains
Seeing or hearing things

(If yes probe for details; tell me

about that, how often, what do you
usually do)
-headaches, I am tired (sometimes
Do you take medicine every day? (If
yes) What do you take the medicine
for? What medicine do you take?
How often do you take the
medicine? How does the medicine
make you feel?

cant fall sleep until midnight).

Probably because I have a lot of
energy and like to run around, I can
get stomach aches, especially when I
worry. I usually worry about school
and getting into trouble or not
getting along with my classmates.

CHILD INTERVIEW

No.
Is there anything else you would like to tell me about yourself, or talk about?
Anything you think might be important for me to know? Do you have any
questions that you would like to ask me?
NO

SUMMARY
I just want to briefly review what we discussed
What I learned about you
What issues I want to discuss with parents (guardians) or teachers
Do you have any concerns about reporting any of the information we
discussed today?