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Summary McConaughy 'Clinical Interviews for Children and Adolescents'
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Samenvatting ‘Clinical Interviews for Children and Adolescents’Written by McConaughy
Chapter 1 Clinical Interviews in the Context of Multimethod Assessment
Historical perspective on clinical interviewing
Purposes of clinical interviews
- Providing initial clinical assessments of children’s problems
o E.g. emotional disturbance (ED)
- Making psychiatric diagnoses
o E.g. DSM-5 diagnosis
- Designing school-based interventions and other mental health treatments
- Evaluating the effectiveness of current services
- Screening for at-risk status
Different approaches
- Traditional assessment focused primarily on underlying states or personality traits in the
individual as causes of behavior. Relied on clinical interviewing, self-report forms and tests.
o Nomothetic, because it compares an individual’s functioning with groups of other
individuals.
- Medical approaches focused on physical states, diseases or disorders in the individual.
- Behavioral assessment focused on observable, discreet problem behavior, and contingent
events in the environment that reinforced and maintained those behaviors, without any
assumptions about underlying causes in the individual. Relied on observations.
o Ideographic, because it focuses on target behaviors of individuals without
comparisons to other people or groups.
- Modern behavioral assessment is a combination of the traditional and the behavioral
assessment.
The nature of clinical interviews
A clinical interview involves face-to-face interaction between the interviewer and interviewee to
gather information about a person’s behavioral, social and emotional functioning (assessment) and
intervention planning. Clinical refers to gathering specific information regarding functioning, deficits
and problems.
Clinical interviews differ from ordinary conversation in the following
- The clinical interview usually takes place during a formally arranged meeting.
- The clinical interview has a specific purpose.
- The interviewer chooses the topics or broad content of the discussion.
- The interviewer and interviewee have a defined relationship – the interviewer asks questions,
the interviewee responds to these questions.
- The interviewer keeps attuned to aspects of the interactions – the interviewee’s affect,
behavior and style – as well as to the content of discussion.
- The interviewer uses questioning techniques and other strategies to direct the flow of
conversation.
- The interviewer accepts the interviewee’s expressions of feelings and factual information
without casting judgment on them.
- The interviewer sometimes makes explicit what might be left unstated in ordinary
conversation.
- The interviewer follows guidelines for confidentiality and disclosure of information.
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,Differences between clinical interviews and
- Psychotherapeutic interviews are used to relieve emotional stress, foster insight and promote
changes in behavior or affect that can lead to improvements in an individual’s life situation.
- Forensic interviews are designed to investigate specific questions about an individual or
family and to provide expert opinions for a legal decision.
- Survey interviews are designed to collect data relevant to specific questions or variables of
interest to a researcher.
Working assumptions of clinical interviews
Working assumptions
- Need for multiple data sources
o There is no gold standard for assessing children’s functioning.
o Comprehensive child assessment requires data from multiple sources.
- Situational variability
o Children’s behavior is likely to vary across situations and relationships.
o Environmental conditions influence children’s behavior.
- Limited cross-informant agreement
o There is likely to be only low-to-moderate agreement between informants who are in
different situations or different relationships with the same child.
o When there is no evidence of prevarication or intentional misrepresentation, you
should assume that each different informant contributes valid information that
represents one part of a bigger picture of the child.
- Variations in interview structure and content
o The structure and content of clinical interviews should vary in relation to the
informant and the goal of the interview.
Interview content and questioning strategies
Table 1. Content and questioning strategies for child, parent and teacher interviews
Questioning Informant and interview content
strategies Child interview Parent interview Teacher interview
Semi-structured Activities and interests Social functioning Academic performance
questions School and homework School functioning Teaching strategies Child’s
Friendships and peer Medical and strengths and interests
relations developmental history
Home situation and Family relations and
family relations home situation
Self-awareness and Child’s strengths and
feelings interests
Adolescent issues
Structured Symptoms and criteria for
questions psychiatric disorders
Behavior-specific Child’s view of problems Concerns about the Concerns about the
questions child child
Behavioral and School behavior
emotional problems problems
Problem-solving Feasibility of Feasibility of Feasibility of
questions interventions interventions. interventions.
Initial goals and plans. Special help/services
Initial goals and plans
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, Differences between the types of strategies
- Semi-structured questions are relatively open-ended and flexible to simulate a natural flow of
conversation. The encourage interviewees to express their views, opinions and feelings.
o Probe questions can be used to obtain more detailed information.
- Structured interviews have a standardized set of questions and probes focusing of specific
problems relevant for diagnosis.
- Behavior-specific questions are narrower in scope because the focus in on a limited number
of specific problem areas. These questions comprise the initial phases of behavioral
assessment, wherein the main purposes are to
o Identify and define problems of concern to parents and teachers (problem
identification)
o To examine antecedents and consequences that surround the identified problems
(problem analysis)
- Problem-solving questions focus on parents’ and teachers’ current concerns, with the goal of
developing interventions for identified problems.
Interviews as components of multimethod assessment
The advantages of interviews include flexibility, opportunity to observe the interviewee under
structured conditions, and opportunity to establish rapport and trust toward creating a therapeutic
alliance.
The disadvantages include the following. The flexibility of interviews also makes them vulnerable to
low reliability and inconsistencies or misinformation across informants. They also require more time
than other assessment methods.
Table 2. Data sources for multimethod assessment
Parents reports Teacher reports Cognitive Physical Direct assessment
assessment assessment of the child
Parent interview Teacher interview Standardized ability Medical exams Child clinical
and intelligence interview
tests
Standardized Standardized Standardized Neurological exams Observations
parent rating scales teacher rating achievement tests during child clinical
scales interview
Background Background Observations Illnesses, injuries Standardized self-
questionnaires questionnaires during test sessions and disabilities reports
Historical records Educational Curriculum-based Hospitalization Direct observations
records assessment in classroom,
playground and
other settings
Perceptual-motor Medication Personality tests
tests
Speech and
language test
Chapter 2 Strategies for Child Clinical Interviews
Purposes of child clinical interviews
Clinical interviews are useful for the following purposes
- To establish rapport and mutual respect between the interviewer and the child.
- To learn the child’s perspective on his/her functioning.
- To identify which of the child’s current problems would be appropriate targets for
interventions.
- To assess the child’s view of different intervention options.
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