Family functioning family history and family interviews

In adult psychiatry, assessments of family dynamics and family psychiatric history can be relevant, but they are not usually central to the diagnostic process. In child and adolescent psychiatry, the assessment of family history and functioning is often a key factor in the formulation of a treatment plan. Disruptive behaviour is often accompanied by disturbed family relationships, particularly interparental hostility and violence, hostile, inconsistent, and abusive child-rearing practices, and lack of parental attempts to control the child's behaviour. At the other end of the spectrum, a few parents become problematically overprotective or overinvolved with their child, and refuse to countenance the emergence of normal independence.

It is also apparent that parental psychopathology has a substantial impact on children's mental health through both genetic and environmental effects. (25) Thus, treatment of a parent for a psychiatric disorder can be an essential part of the treatment of the child. Without adequate assessment of parental mental states, it may be very difficult to implement an appropriate treatment plan for the child. On rare occasions the child is completely normal, and the supposed symptoms are the product of parental psychotic thinking or extreme misinterpretations of normal behaviour.

It is usually helpful to observe interactions among family members,(26) and many practitioners try to have at least one meeting with the whole family to get an idea of how it operates, and how its operation might be affecting the target child. This can often be difficult to arrange, but in most cases it is worth the effort. Conversely, if one or more family members refuses to be present, that does not mean that a meeting with the rest will be a waste of timeā€”far from it. However, one does have to remember that very important patterns of family interaction may be missing when a key member of the family is absent.

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