Scribd Logo
Upload

Welcome to Scribd!

  • Examen Mental

    Uploaded by

    Denisse Miqueles Estay
    6 views12 pages
    Psiquiatria

    Original Title

    Examen mental

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Psiquiatria

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    6 views12 pages

    Examen Mental

    Uploaded by

    Denisse Miqueles Estay
    Psiquiatria

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 12
    Chapter 4 Clinical Interviewing with Children and Adolescents Adrian Angold THE PURPOSES OF THE DIAGNOSTIC INTERVIEW synial interview is the primary diagnostic tool in child Tint adolescent psychiatry. as in the rest of clinical medicine. gat purpose is to collet information that wil assist in the te feat making diagnosis and formulating and implementing Pepcsicnt plan. With the official adoption of a phenomeno- fngally based psychiatric nosology in the US. and the pessuction and increasingly widespread use of structured srrersiews, the diagnostic process has become more consistent nor the last decade of so. Phenomenological diagnosis sequires that information be collected in a coherent and Consistent fashion, and thus sets the predominant style of the Jnrerview. The basic format is one of sensitive guidance by the clinician, rather than a free format in which the child js encouraged to play or frec-associate. The clinician guides. corganizes and structures the collection aon in qh Rscnsitive to the child's problems and concerns. This Spmvech very different from that of the nondirective inter Siewer who attempts To acl as a Spinpathetic observer or sanding boand and interprets the matcriat presented Dy te “Chil It has been shown that even supposedly nondirective interviews are more clinical-directed than was once thought {Traux, 1966, 1968), because the use of “uh hubs’ and the timing of retlections on what the patient has said serve as sicong indicators of the clinician’s real interests. However, a. good interview also aims 10 achieve several ‘other objectives apart Irom discovering the facts_about_a “patcnt A diagnostic Interview is often the initial contact between chikl and clinician, and then it is the first step in GUD Ishing a treatment alliance with the clinical team. The SME Cnc May be the child's psychotherapist later on, SO the diagnostic interview also represents 2_first_step_in the formation of a therapeutic relationship. Alto Trequently the “nite Magnetic assessment is the only contact an individual oF Tamlly has with the clinical team, because many never feturn Tor treatin With this in_mind, it_is important to avoid Thercaying the barriers tw future treatment-secking by FARES go expe nce_of psychiatric services. For all ally ——— and Because of the need to ask about emotion- af Aenstve material. the clinician should approach the task lecting information in such a way as to assure the child The ¢ 51 of a genuine interest in his or her problems and sympathy with his or her difficulties. Under the best circumstances, the product of such an interview is not just a lot of relevant information. but also the child’s having a sense that something important about him or her has been understond by someone who cares and is willing (and perhaps able) (0 help. The child’s behaviour in the interview is another important source of diagnostic information. Thus, the art of good clinical inter- viewing lies in the ability to combine the efficient collection of reported information, an observant eye and the projection of interest and concern about the child’s problems. CHILDREN’S MEMORY: ‘A LIMITING FACTOR? Ichas been widely belieyed that children’s memory limitations place severe Consirainisoh what can be learned [rom question- ingthem directly (Goodman, 1984; Ross ¢tal., 1987). Howev the empirical literature on the subject has been slow to expand because carly findings indicated that there were rather few differences even between quite young children and adults ‘on mnemonic tasks. Interest in this question has now been PeMEWEA, av least in part because of the increasing use of children’s testimony in cases of suspected abuse, This ‘real world’ motivation for research has also led to studies that have attempted to use more realistic experiments, rather than highly artificial laboratory paradigms. Donat Though much remains wo be done, a-number of fairly consistent themes emerge from this work. First. from the age of 3 until the teenage years, there iy am igereape in the amount “WHintormation provided im Tree-fecall_ situations. However, though younger children provide less information, they are no less accurate in their recall than older children and adults Second, when structured, and especially forced-choice question Torta are used, younger children (and especially 3—6:year-oks)_can_wsually provide “more information (Bjorklund, 1987; Bjorklund & Muir, 1988; Dent, 1991: Ornstein et al., 1991). However. they are also more likely (0 provide erroneous information, alough the absoTute mat tude of this elfect is rather small after the age of 6 (Dent & Stephenson, T9797, Turd while the youngest age groups are porate erroneous material introduced more _likely to incor through repeated questioning, suggestion and Teading ques. memories OT epee evens nie Sips Tal BE 9 Reneralized Memory OT stch_events (Nelson «t al, 1963: Lions than older children (Loftus. 1979; Cohen & Harnick 19807 3 TERT his effec is probably more marked in ration to peripheral dtl Than to The aT ates of 1987 for reviews. Dod & Bradshaw, 1980; Yuille, 1980; Ceci al, 1987). 18 also seems that recall errors are not Wenly distnbuted across recalled material. since Dent and her co- workers (Dent & Stephenson, 1979, Dent, 1991) found that {in recalling filmed events, children made more errors about the appearance of people and things than about the sequence of events ponrayed. Funhermore, there is impressionistic evidence that children in the most ‘suggestible” age BroUps may often be aware that they: do not realy temember the suggested material but included it because they thought they were being asked 10. Such material apparently key 10 be offered rather tentatively. and rarely with the sort of clabor- ation that may accompany accurately recalled information (Goodman ¢7ai.. 1987). Fourth, though its possible to dempn- strate increased rates of forgetting in younger children through formal memory tests (Brainerd er al., 1990; Ornstein et al a2 at_rates of forgetting are not markedly different, at least from the age of 6 10 adulthood. Fifth, even Somme Sea that Occurred a5 much 3s 2-year before the intermiew Gee PMTemer & WHC. T989 fora review). Sixth in both _adulis and children, there is_a tendency to. Génflaie Saywitz. 1987), incorporating features from a_number of specific instances. Again. children undcr the age of 6 may fave more difficulty in reporting details of specific instances of such repeated events. and are likely to describe their script memones. but confirmation that this is so awaits studies of recall of material that is equally enscripted at different ages Seventh. young children respond poorly when asked 10 pet queMianT using Words they do-not understand (Dale cal a ‘All in all. these findings strongly refute the notion that children’s recall i subject to biases that invalidate the child as fn informant about the facts of his or her experience, By the age of 6-8, the recall abilities of children do not seem 10 be Tramaticalh different Irom those of adults. However. the. Fesults do point to the need 10 avoid Icading questions. and indicate that the use of free recall, at least 38 a first step. is likely to lead to the most accurate accounts, though with 3-f-ycar-olds these accounts can be expected to be very ‘Rerdhy. In clinical practice it is quite appropriate to use direct ucstions about past experiences, emouonal states and behay- Se i cali age: Homever- wth the youngest children particular care is needed to avoid loging questions. When the interviewer is unsure how much Tettaiee can be placed on a particular piece of information, asking the child how sure she is, and checking what she thought was being demanded of her may clarify the situation. tis also important to ensure that the child pays attention to what is being asked and understands 1) Coe bea cank oleae Chapter % search with both adults and children also ace ton much reliance On the precision of Hoag term real longer than about 3~4 months), The proces, aris formation means that. while a general picture of fapeated events may be available the specifics of c3ch inde a rciyent are likely to be unreliable. Even 2 general ou sae ine past history can be diagnostically important, so this'in no way undermines the stat us of this aspect of the 1 history Much information may Be lost in Yong-term le evidence that ever fin walt vc fork een the questions. Res reaches us not to ph «linial call, but there is invented. The past history is. therefore, hut positive reports of past sympromatology CO Us > are commoniy an insensitive tool, ually be

    You might also like