Interviewing children and adolescents

Children should be engaged in the interview to the degree that their development allows, (4.9 whether they are there for their own care or accompanying their parents. Although the parent of a preschool child undoubtedly will provide almost all of the historical information, a 3-year-old can describe where a pain is located, and can draw on a picture where he or she hurts. A 5-year-old often can provide an accurate description of his or her symptoms, and remarkably insightful descriptions of family dynamics. Intensity of symptoms, comparisons to prior experiences and temporal course can be described by an 8-year-old.

Choose a medium and style of communication that suits the child. Non-verbal communication will be more important to young children than choice of words. The clinician should be positioned to make eye contact with parent and with child. Some suggestions for engaging children are as follows:

• ask the child to draw a picture of his or her family, and then to describe what is happening in the picture

• use indirect questioning by asking the parent to ask the child a question

• be playful, but not coercive

• engage the child's interest with an object or a gift.

With the 12- to 18-year-old group, physicians frequently face a tension between maintaining the adolescent's privacy and confidentiality on the one hand and facilitating open communication within the family on the other. Although there are laws governing the care of children, they are not specific enough to deal with many common situations in practice. It is helpful to discuss with parents how important it is for the adolescent to be able to share his or her concerns confidentially. Most parents will agree to leave for at least part of the interview when it is presented this way. If there is significant resistance, there may be unspoken concerns that need to be explored further. For further information about interviews with children, see Chapte£i9.i1.i4.

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