Sylvia Opperl Universiti Sains Malaysia

In recent years, the clinical method has become an important tool for re-

searchers in mathematics education. At the same time, the clinical method is as

yet imperfectly understood. The purpose of this paper is to examine th~.otigins,

nature, and logic of that method.


The origins of the clinical method coincide with Piaget's early investi-

gations into children's thinking (Ginsburg and Opper, 1969). In the mid-1920's,

at the start of his career, Piaget worked in Simon's psychological laboratory in

Paris where one of his duties was to standardi:z;e a French version of a series of

Burt's reasoning tests (Piaget, 1966). While engaged in this work, Piaget

became particularly interested in the incorrect responses given by the younger

children and decided tQ carry out cognitive studies in order to discover the

underlying reasons for incorrect answers in younger children and correct ones in

older children. He therefore abandoned his investigations of standard tests so

as to pursue his exploration of the thought processes of children of different

ages. As he wrote: "The ohj ect of these studies , initially, was not to establish

a scale of development and to obtain precise determination of age as regards


Author'S address: Center for Educational Studies, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia.


stages. It was a question of trying to understand the intellectual mechanisms used in the solution of problems and of determining the mechanisms of reasoning" (Tanner & Inhelder, 1956).

In order to carry out this project Piaget felt he needed a method that would allow the child to verbalize freely, and thus provide the researcher with the opportunity of inferring the covert intellectual processes. Neither of the two. most widely used research methods of that time, naturalistic observation and standardized testing, were suitable for this purpose.

Naturalistic observation involves the recording of the child's spontaneous behavior in the natural setting. If, und~r these circumstances. the child happens to verbalize or otherwise provide an indication of the relevant thought processes, the researcher is provided with the valuable data. An example is Ginsburg's (1977) naturalistic observations of his children's counting, But naturalistic observation is not an entirely suitable method since it is very slow and since the child· may not exhibit behavior relevant to the researcher's interest. Standard testing, with which we are all familia; is also unsuitable, in Piaget's view, since it is too rigid. Although valuable for providing norms concerning children'S general level of performance, its inherent inflexibility prevents standard testing from yielding sufficient detail on the underlying intellectual mechanisms.

Since no adequate research method existed for the type of studies he wished to conduct, Piaget created his own. Familiarity with the clinical interviews._ used in the medical field led him to design a simliar method for the study of reasoning in children. Since its inception the clinical method has undergone

a number of alterations and revisions to make it more appropriate for use in

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cognitive psychology, One outcome has been the partially standardized clinical method which is frequently used by Piagetian researchers today.


The clinical method is a diagnostic. tool applied to reasoning in children.

It takes the form of a dialogue or conversation held in an individual session between an adult, the interviewer, and a child, the subject of study., It is not a method that can be used in group testing.

The essential character of the method is that it constitutes a hypothesistesting situation, permitting the interviewer to infer rapidlY a child's competence in a particular aspect of reasoning by means of observation of his performance at certain tasks. The inferences are drawn in the following manner. The interviewer presents to the child an "experiment" that has been selected

as suitable for the study of the specific aspect of cognition of interest. For the most part the experiment involves both a concrete situation with objects placed in front of the child and a verbally presented problem related to this situation. The objects and the problems will, however, differ from one experiment to another, depending upon what is being studied. At the start of each session, the interviewer has a guiding hypothesis about the types of thinking that the child will engage in. A number of items are presented to the child, each of which is an attempt to shed light on the hypothesis by exposing one or more facets of the child's reasoning. These items frequently consist of physicai or spatial manipulations performed on the materials, either by the interviewer or by the child. For each item the interviewer then asks a series of related questions which are aimed at leading the child tc;> predict, observe, and explain



the results of the manipulations performed on the concrete objects. It is

these predictions, observations and explanations that provide useful information on the child's views of reality and his thought processes. The verbal explanations are particularly valuable for inferring the underlying mental processes, and the interviewer consequently makes every effort to encourage the child to elaborate on and support his statements or judgements about the different items presented. The child's verbalizations are, however, not the sole source of information on his thinking and may be supplemented or even at times replaced by observations of the child's actions and manipulations of the experimental objects.

The interviewer then tests his original hypothesis on the basis of the child child's verbal responses and actions. If fUrther clarifications are required,

he asks additional questions or introduces extra items. Each successive response of the child thus guides the interviewer in his formation of new hypotheses and consequently in his choice of the subsequent direction of the experiment. The information at any point may substantiate or invalidate the original hypothesis. In the former case. the interviewer may ask additional questions so as to satisfy himself of the stability and consistency of the child's responses. or else he may pass on to the next item of the experiment. If. the original hypothesis is not confirmed, the interviewer reformulates it to take into account the child's responses and asks further questions or introduces additional items to clarify these responses. This procedure continues until the interviewer feels he has explored the child's thinking as far as possible, within the con- '.' straints of the particular situation, and has developed a reasonable explanation of the child's behavior. At this point the interview is completed.


The above description is an idealized version of the method. In such a

case the interviewer has complete freedom to use whatever means he feels are

suitable to study the concept of interest and to tailor the experimental situ-

ation to fit the requirements of each particular child. Practically. of course,

this freedom is limited. In any scientific study some systematisation is re-

quired to ensure comparability of results. In order to take account of this

requirement the version of the clinical method commonly used today, particularly

in replication studies of Piaget's work, is a partially standardized one. In

this version, the subjects are presented with a standard problem and material

and certain identical manipulations are applied to this material. The subjects

are then asked a number of identical questions relating to both the material and

the manipulations. At the same time, the partially standardized version still

retains some of the freedom of the clinical method in that, once having presented

these identical situations and questions. the interviewer may then conduct the

experiment as he deems appropriate. For instance, he can re-word the original

questions should he feel that the child's responses indicate a lack of verbal

comprehension. This applies particularly to younger children who might not yet

have fully acquired the concept under study and as a result might not understand

the meaning of certain abstract words. In such cases, the interviewer may re-

phrase the questions so as to retain their meaning using simpler words that

belong to the vocabulary of younger children. The interviewer can also pursue

a line of response that appears to be interesting for his study as, for instance,

when a child provides an unusual but relevant answer. The interviewer can

follow up this novel answer with questions that are not included in the standard-

ized version and in this way may possibly obtain precious information on the

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child's thinking. He can also introduce additional items when there are obscure

po~nts or inconsistencies in the child's previous responses. Extra items can

also be used in cases where the interviewer has doubts as to the stability or

authenticity of a particular response or feels that the child might have only a partial grasp of the concept, or be repeating what he has heard from others. In

all the above instances further probing and questions may lead to a better under-

standing of what the child really thinks about the problem under consideration.

This freedom for the experimenter to adjust to the level of each particular

child is extremely important in investigations with young children whose grasp of

language and concepts is not identical to the adult's and who as a result need to

be approached somewhat differently in the experimental situation. The partially

standardi~ed version of the clinical method is therefore an attempt to combine the

more structured approach of standardized testing with the flexibility of the

clinical method and hence satisfy both the requirements of systematic observation

and those of conducting research with young children.


It is evident from the above that the clinical method. even partially

standardized, is a delicate instrument which, in order to assure valid results,

demands that the interviewer possess considerable skill and experience. He must be mentally active throughout the interview sessions. constantly formulating ap-


propriate hypotheses and questions. creating situations whiCh will elicit the

necessary information, inferring the occurrence of mental processes, testing his

original hypothesis in the light of the information obtained. and adjusting this hypothesis to the findings of each experimental item. Competence in the use of



the method requires an attitude of exploration. An investigator cannot

predict beforehand all the sd tuatd.ons that he might encounter during the indi-

vidual interviews. Some children will come up with unexpected and novel re-

sponses and the interviewer must be able to make the best use of this information.

In order to do this, he should be prepared to devise rapidly situations and ad-

ditional questions appropriate for the task at hand; he must have a mental set

geared towards discovering how children think. This "discovery approach" in-

valves a number of considerations, some of which apply to all testing of young

children carried out in individual sessions, others which are unique to the

clinical method. Some of the characteristics of the clinical method that should

be borne in mind constantly by the interviewer are discussed below.

Introduction to interview

Before starting the actual interview, it is essential that the interviewer

make sure that the child feels at ease and psychologically prepared for the


The interviewer should not try to start the actual experiment until

he has established good rapport with the child. This can generally be done by

asking some personal questions, such ~s his name, age, whether he has any

brothers or sisters, etc. These more personal questions could then be followed

by questions about the experimental objects; for example, "Have you seen anything

like this before?", Or "Do you know what can be done with this ?'I etc. When the

child begins to relax a bit and seems to be talking freely, the interviewer can

then introduce the experiment. The child should not get the impression that

he is going to be tested in any way, since this might arouse feelings of anxiety

and could possibly interfere with his spontaneous replies. For the younger

children the experiment can be presented a1 a game; for the older ones as a discussion.

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Interview strategies

(a) The experimenter must refrain from trying to elicit what he believes to be the "correct" or desirable answer but must note wha.t the child says and does as objectively as possible. As already mentioned, Pi.agetian research is for the most part concerned with the discovery of cognitive processes in the areas of reasoning. memory, mental imagery, etc. One of the basic assumptions of such research is that there are no "Incor-rect;" response!;". Bvery" response given by a child, if it is authentic and not just invented on the spur of the moment te please the interviewer, is an expression .of the child's theught and may give an indicati.on of his level of development at that point in time. Although the response may not be correct when viewed in terms of the performance of a mature persen, it may give insight into the thinking processes of the child being interviewed and therefore should be carefully c.onsidered.

A particularly delicate aspect of·the·method, and one against which every interviewer must censtantly be on the alert, is the tendency to suggest answers to the child. Inexperienced interviewers, and semetimes even experienced ones, .often forget how easy it is to convey to the child cues as te how they expect him to react. This can be done either explicitly in the choice of words (e.g.

"Where is there more water?"which suggests that there must be more somewhere) and in the phrasing of the questions, or implicitly by the tone of voice, or even more subtly by a frown and lifting of the eyebrows te an "Lncor-rect;" .answer , and a smile to a "cor-rect;" one. These cues are rapidly picked up and interpreted 'by the child, who then adapts his behaviour to conform to what he believes tc be

the interviewer's expectations. It is essential, therefore. fer the interviewer to remain neutral during the interview session in order to pick up the


spontaneous thinking of the child, and avoid channelling the child's responses

in the direction he believes these responses should be expressed.

(b) The interviewer must adjust his language to the child's level. For

the beginning interviewer this will entail prior observation of children of the

same age as those he intends to interview in order to note their spontaneous

language and adjust his questions accordingly. First, the vocabulary" must be

simple and familiar to the child. Frequently words like "volume,1T "areal! or

even "number" that may not seem difficult to an adult are not within the spon-

taneous vocabulary of the younger child. These should be replaced by words or

terms that the child understands such as) for example, "as many as" for "same

number" or "as big as" for "same size," etc. The sentence structure should also

be suited to the child's level. If the task involves sentences that are too

long or too complex. they should be modified into shorter and simpler ones.

Sentences with several alternatives should be split up for the younger child

and each alternative presented separately so as to make it easier for him to

understand what is being asked. For instance a question like "Ls there as much


water in the two glasses or more somewhere or less somewhere?" could be broken

down into three separate questions. Care should be taken to vary the order of

the alternatives if the same questions are asked for several items of a task.

For example, "Are there as many sweets as blocks or are thore more b Iocks I!"

coufd be followed~ for the next item~ by "Are the"re more sweets or as many b Iocks

as sweets?" Young children sometimes have a tendency to select the last of a set

of choices, so that if the same order is maintained throughout the experiment

it becomes difficult to know whether the child really believes the alternative

he has chosen, or whether the order has determined his choice. Finally. adapting


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the language to the child also applies to older Children for whom the interviewer must avoid using "baby talk. I! Talking down to a child can affect the type of answer given and the child might respond to such language in a less sophisticated and mature manner than if language more suited to his level were used.

Another aspect of this adjustment to the child's- language is the previously mentioned freedom that the clinical method allows to an interviewer to repeat the question and also to rephrase it should he feel that a particula~ Ckild has not understood what is being asked. In this way the interviewer is able to sort out answers that reflect a serious lack of conceptual understanding from those that indicate mere unfamiliarity with the language used.

(c) In his efforts to communicate the interviewer must not only adjust his language to the child's level, but must also adapt the pace or tempo of the interview. Younger children frequently take more time than older ones to grasp the point of the questions being asked and to provide answers. The" interviewer must be aware of this and not try to hurry the child beyond his normal speed. By trying to go too fast through an interview session and not allowing the child sufficient time ~o reflect on the problem before giving his answer, by repeating a question too soon after its original presentation, or by moving on to another question before the child has had time to answer the previous one, the interviewer may either intimidate the child or not tap usefUl information. It is essential to bear in mind the differences in the speed of response between

different children and to adapt the interview strategies accordingly.

Cd) The child should be encouraged to elaborate on his answers and to support his judgements or predictions with explanations or arguments. Since



the main

objective of cognitive research is to attempt to discover the child's

reasoning processes, it is important that the child be given the opportunity to express these as much as possible. Merely asking for judgements or predictions regarding the physical properties of objects does not provide the child with

such an opportunity. The child should be given t~e opportunity to justify or

explain his statements as far as possible. These elaborations or explanations

are essential since they' form the basis for the interviewer' s Inferences as to

the child's thinking.

(e) One of the characteristics of the clinical method is the use of counter-

arguments or counter-suggestions. This involves asking questions or presenting

to the child arguments which contradict his own responses and asking him what he

thinks of these contradictory points of view. The counter-suggestions should not

be chosen at random but should generally correspond to arguments that younger

children who have not yet achieved the particular concept are apt to give in the

same situation. The arguments should be presented as those of younger children

and not as the views of the interviewer himself, since the latter situation

might make it more difficult for the child to challenge. Nor are these counter-

arguments presented systematically to all subjects of the st~dy. This strategy

is used only for doubtfUl or transitional cases when the interviewer is not sure

whether the child has really grasped the concept~ is merely guessing, or is re-

peating what he has heard or learned without any real understanding. They are

a means of determining the consistency of the child's point of view and in

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doubtful cases can help to ascertain whether a child really has acquired a

particular concept.


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Attitude of interviewer

Ca) The interviewer must attempt to take the child's point of,view. The purpose of the method is to allow the interviewer to attempt to follow the child's thoughts by means of observations of the latter's actions and verbal responses. But these actions and answers must be interpreted correctly. This', implies that the interviewer must try to understand their meaning within the child's own

frame of reference: he must not distort them to fit his own. In 'other words

he must attempt to assume the child's perspective, so as to understand what is being said as it relates to the child's experience, not necessarily his own. For example, what does it mean when a young child agrees that there are seven sweets and seven blocks on the table, but then says that there are more sweets than blocks because the former are laid out in a line and the latter bunched up?

The interviewer must not project his own understanding of the situation. In the above case, the two statements are a contradiction for the adult but not for the young child. The interviewer must try to fathom what the child is really thinking and trying to convey by his answe'rs v-

(b) Despite the need to listen to and observe the child, the interviewer must avoid taking everything the latter says at face value,' He must retain a critical sense, and try to distinguish between what is an authentic expression of the child's own thinking, and what is not, Children may sometimes repeat parrotlike something they have learned verbally, either in school or from older children or parents, without having the real concept underlying this language. One example is the 3-year-old child who can count to 20, but who despite this has no idea of the basic concept of number. Some children may have just acquired the concept being studied, without yet having a firm mastery of it, or they may have


the concept in one situation but not be able to generalize their understanding to other situations, in which case their responses will be inconsistent. All these are instances of a somewhat fragile and unstable grasp of the concept involved and are typical of the child who is transitional between ·the stage when he lacks the concept entirely and that when he has truly acquired it. When questioned or challenged, the child whose concept is still somewhat unstable may revert to a more primitive type of response. One way the clinical. method tests the stability, consistency and authenticity of responses is by counterarguments or counter-suggestions mentioned above.

Role of Recorder

The interview may be recorded by a variety of means: a third person, mechanical devices, etc. The interviewer should not have to do the recording so

that he can apply his full concentration to the interview. If a third person is used as recorder. he should be as inconspicuous and as neutral as possible at all times and to try as it were to blend into the surroundings in order to avoid disturbing the dialogue between the interviewer and the child. This can be done

by sitting at a short. distance away from the actual experimental situation, for instance at another corner of the table, by refraining from staring too obviously at the child and by noting down the procedure as discreetly as possible. In practice it has been found that although the presence of a third person may inhibit an extremely shy child during the initial phases of the encounter, the majority of children adjust very rapidly to the situation with two adults. They'·· become involved with the material in front of the~ and with answering questions

and forget that there is a third person involved in the session. Only in very

rare cases is the child unduly upset by the recorder's presence and this occurs


all dis-





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mainly at the beginning of the interview. Even in these rare cases habituation rapidly takes place and soon the child appears to be oblivious of the recorder. or at any rate not to be excessively disturbed by him, provided the recorder does not draw too much attention to himself.

In brief. the clinical method consists essentially of a dialogue between the interviewer and the child. It is essential that the former be familiar with these characteristics of the method and be constantly awar.e that, such a dialogue requires a fragile balance among three major considerations: an attempt to pursue the child's thoughts. the danger of succumbing to the pitfalls of suggesting the responses that the interviewer would like to hear, and the necessity for the interviewer to remain in control of the testing situation and not let the child alone determine the course of the interview. In such a dialogue, answers which are totally irrelevant to the problem need not be pursued; others that at first glance might appear only slightly connected must be rapidly assessed to decide whether they warrant a follow-up; those that suggest that the child has not understood the language must be followed by additional questions or rephrased Versions of the. original ones. All these factors call for sensitivity. experience, imagination and a critical sense on the part of the interviewer. As mentioned previously, the interviewer cannot anticipate every specific situation that may arise during the interview. However, the guiding princ~ples of the clinical interview allow him to adapt to and improvise for most unforeseen possibilities.


Like most research tools, the clinical method has both strengths and weaknesses. One of the major advantages is the motivation it produces. The tasks

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are presented as a game, the questioning takes the form of a conversation. and the interviewer tries to make the child feel at ease. This informal situation reduces the anxiety that children usually feel in a regular testing situation. As

a result children are willing to cooperate and to talk as easily as they can. There are, of course, varying degrees of talkativeness amongst children and the clinical method, even in the hands of a skillful interviewer, will not make an articulate child out of a taciturn one. However, it seeks to provide a 'relaxed atmosphere in which children can express their thoughts and hence maximizes the information that can be obtained from even less talkative children.

Another advantage of the method is its flexibility of approach and consequent ability to uncover patterns of thought. As we mentioned above, the clinical method is open-ended, and this allows for the exploration of the child's thinking. There are no set limits to what the interviewer may ask, except that the questions be relevant to the situation at'hand, and this allows probing of what lies beneath a child's answer. Standardized testing procedures are far less useful

in providing an account of the child's thought processes.

There have been several criticisms levelled at the clinical method. One

of these is that it relies too heavily on language. Piaget himself has commented that it is sometimes difficult to interpret the child's verbalizations. The child may be "romancing"--making up interesting stories which fail to reflect his true beliefs. Sometimes too there are cases where the child talks too little;

even with the greatest effort on the part 9f the interviewer, verbal questioning fails and the child does not seem inclined to respond beyond the monosyllabic tlyes" or "no" or, when asked to explain his statements; replies "I don't know." These difficulties--romancing and inade~uate responses--may be at least partially

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overcome by the introduction of concrete objects and non-verbal procedures. The interviewer attempts to introduce situations where the child is required to manipulate objects or to produce a non-verbal response such as pointing. The interviewer can then use these non-verbal responses to supplement and to complement the perhaps faulty information obtained through verbal answers.

A further difficulty with the clinical method is the time it requires. Indeed some researchers reject the use of the method on the grounds ~b~t it is too time-consuming. The questioning is conducted in individual sessions and can be fairly lengthy if the child has difficulty in responding to a particular situation. If the sample comprises a large number of such children, the study can become

very aTduous for a single interviewer. Even if children respond well and easily, the research is still time-consuming if a large sample is required. There is no way around this· difficulty: either one interviewer must work long hours or several interviewers must be used.

This latter situation raises the problem of the degree or similarity of questioning ability between two or more interviewers. While a skillful interviewer can undoubtedly elicit a wealth of information on the child's underlying intellectual processes, an unskillful interviewer might not b~ able to obtain more in£orma,J.~9'lltl1an that which could be provided by a regular standardized test, and the latter is considerably easier to administer. The question is then whether appropriate training can be provided to level out individual differences in interviewing ability. There is no doubt that this is possible to a cert adn'> extent. Inexperienced and unskillful experimenters can improve their questioning techniques. Careful training which includes a good deal of practice, the acquisition of an understanding of SOIDe theoretical background of cognitive

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development res~arch, as well as familiarity with and constant application of the guiding principles mentioned above, can help to increase expertise in the use of method. At the same time, training is not a complete solution. There are differences among people in their degree of sensitivity to children and responsiveness to children's needs and reactions, just as there are differences among people in their sensitivity to others in general. Some will find it easier than others to establish rapport with the child and to conduct effective .interviews. However the majority of persons who are interested in u$ing the clinical method should be able to reach a reasonable level of competence and skill in questioning. This at least is our experience in training many students.

Another problem concerns the generality and comparability of the findings because of the lack of rigidly standardized procedural teChniques. The interview method appears to be deficient since it is not applied in exactly the same way to all children. But this is no criticism: the logic of the clinical method demands an absence of standardization. Standardized procedures lack the flexibility required to uncover children's thought processes. Since this is the method's chief aim, non-standardized questioning is required. Some children express their thoughts with ease, and in such cases the experimenter does n9t need to do a great deal of probing before feeling satisfied that he has elicited the maximum of information. Other children require a great many more questions and still

do not provide the experimenter with the same amount of information. Each child

needs to be treated in an individual way in order to acquire the maximum of

information conce~ing his thought processes. The interviewer must try every means ~vailable to him to gain access to each child's thought processes. These means are not, and indeed should not be, identical for all children.



The clinical method is a sound procedure, based on a coherent logic. It

should be actively used and investigated as a tool for research in mathematics



Ginsburg, H. Children's arithmetic: th~<learning process.

N.Y.: D. Van Nostrand Co., 1977.

Ginsburg, H. and Opper, S. Piaget's theory of intellectual development: an introduction. Englewood Cliffs, N.J.: Prentice-Hall, 1969.

Piaget, J. Autobiographie, In Jean Piaget at les sciences sociales. Vol. 10. Geneva: Librarie Droz, 1966.

Piaget, J. The child's conception of the world. London:

Routledge and Kegan Paul, 1967.

Tanner, J.P. and Inhelder, B. Discussions in child develop~. Vol. 1. London: Tavi~tock, 1956.

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