Clinical Manual for the Psychiatric Interview of Children and Adolescents

502 Pages·2009·2.96 MB·English

by  Claudio Cepeda

Clinical Manual for the
Psychiatric Interview
of Children and
Adolescents
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Clinical Manual for the
Psychiatric Interview
of Children and
Adolescents
Claudio Cepeda, M.D.
Senior Child and Adolescent Psychiatrist
Southwest Mental Health Center, San Antonio, Texas
Associate Clinical Professor, Department of Psychiatry
University of Texas Health Science Center at San Antonio
Note: The author has worked to ensure that all information in this book is accurate at the time
of publication and consistent with general psychiatric and medical standards, and that information
concerning drug dosages, schedules, and routes of administration is accurate at the time of
publication and consistent with standards set by the U.S. Food and Drug Administration and the
general medical community. As medical research and practice continue to advance, however,
therapeutic standards may change. Moreover, specific situations may require a specific therapeutic
response not included in this book. For these reasons and because human and mechanical errors
sometimes occur, we recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views and opinions of
the individual authors and do not necessarily represent the policies and opinions of APPI or the
American Psychiatric Association.
Dr. Cepeda has no competing interests to disclose.
Copyright © 2010 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
13 12 11 10 09 5 4 3 2 1
First Edition
Typeset in Adobe’s Formata and AGaramond.
American Psychiatric Publishing, Inc.
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Cepeda, Claudio, 1942–
Clinical manual for the psychiatric interview of children and adolescents / Claudio Cepeda. —
1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-343-3 (alk. paper)
1. Interviewing in child psychiatry. 2. Interviewing in adolescent psychiatry. I.Title. [DNLM:
1. Interview, Psychological—methods. 2. Adolescent Psychiatry—methods. 3. Adolescent. 4.
Child Psychiatry—methods. 5. Child. 6. Mental Disorders—diagnosis. WM 141 C399c 2010]
RJ503.6.C45 2010
618.92'89—dc22
2009015497
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
To my oldest brother, Hernando, for his love and perennial support;
to my children, Rene and Mary, Adrian, Joe and Carole; to my
grandchildren, Madeline and Juan Diego; and most of all, to Rosalba,
my loving and devoted wife.
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Contents
List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Claudio Cepeda, M.D.
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . xxv
1
Diagnostic and Therapeutic Engagement . . . . . .1
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Factors That Facilitate Engagement of Family. . .10
Other Factors That Facilitate
Engagement With Child and Family . . . . . . . . . .12
Obstacles to Development of Engagement . . . .12
Reverse Engagement . . . . . . . . . . . . . . . . . . . . . .13
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Recommended Readings. . . . . . . . . . . . . . . . . . .15
2
General Principles of Interviewing. . . . . . . . . . .17
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Interview Setting . . . . . . . . . . . . . . . . . . . . . . . . . .17
Preparation for the Psychiatric Examination. . . .18
Interview Process . . . . . . . . . . . . . . . . . . . . . . . . .19
Maintaining Dependency Ties
During the Interview. . . . . . . . . . . . . . . . . . . . . . .20
Conducting the Individual Interview. . . . . . . . . .22
Creating Engagement. . . . . . . . . . . . . . . . . . . . . .22
Basic Aspects of the Psychiatric Examination. . .23
Phases of the Psychiatric Examination . . . . . . . .24
Modalities of the Psychiatric Examination . . . . .33
Strategies for Evaluation of Preadolescents . . . .35
Technical Issues of the Diagnostic Inquiry . . . . .37
Technical Issues in the Evaluation of
Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Physical Contact . . . . . . . . . . . . . . . . . . . . . . . . . .45
Activity, Structuring, and Support
During Psychiatric Examination . . . . . . . . . . . . . .48
Carrying the Psychiatric Examination . . . . . . . . .50
Enactments During the Psychiatric
Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Qualities of the Diagnostic Interview . . . . . . . . .52
Validity of the Psychiatric Examination . . . . . . . .55
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Recommended Readings. . . . . . . . . . . . . . . . . . .58
3
Special Interviewing Techniques . . . . . . . . . . . .61
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Gathering Collateral Information. . . . . . . . . . . . .61
Limit Setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Physical Holding . . . . . . . . . . . . . . . . . . . . . . . . . .63
Confrontation as an Engagement Technique. . .65
Listing the Good and the Bad . . . . . . . . . . . . . . .67
Interviewing in Displacement. . . . . . . . . . . . . . . .68
Role Reversal. . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Role Enactment. . . . . . . . . . . . . . . . . . . . . . . . . . .72
Double Chair Technique. . . . . . . . . . . . . . . . . . . .73
Nonverbal Interviewing Techniques . . . . . . . . . .77
Drawing Techniques. . . . . . . . . . . . . . . . . . . . . . .79
Play and Playing Techniques . . . . . . . . . . . . . . . .95
Prospective Interviewing. . . . . . . . . . . . . . . . . . .106
Approaching Regressive Behavior . . . . . . . . . . .108
Humor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Recommended Readings. . . . . . . . . . . . . . . . . .110
4
Family Assessment . . . . . . . . . . . . . . . . . . . . . .111
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
Presenting Problem. . . . . . . . . . . . . . . . . . . . . . .112
Marital Conflict. . . . . . . . . . . . . . . . . . . . . . . . . . .113
Intergenerational Conflict. . . . . . . . . . . . . . . . . .114
Deaths in the Family. . . . . . . . . . . . . . . . . . . . . .114
Illnesses in the Family. . . . . . . . . . . . . . . . . . . . .115
Financial Stressors. . . . . . . . . . . . . . . . . . . . . . . .117
Family Conflicts With Other Systems. . . . . . . . .117
Observations of Family Behavior
During the Family Interview. . . . . . . . . . . . . . . .118
Areas of Family Assessment
That Need Specific Inquiry . . . . . . . . . . . . . . . . .128
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
5
Providing Postevaluation
Feedback to Families. . . . . . . . . . . . . . . . . . . . .131
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Recommended Readings. . . . . . . . . . . . . . . . . .141
6
Evaluation of Special Populations. . . . . . . . . .143
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Children With Serious Acute or
Chronic Medical Illness. . . . . . . . . . . . . . . . . . . .143
Children With Burn Trauma . . . . . . . . . . . . . . . .144
Children With Sensory Deficits. . . . . . . . . . . . . .146
Children With Neurodevelopmental
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
Children Living in Poverty. . . . . . . . . . . . . . . . . .155
Minorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156
Children in Out-of-Home Placement. . . . . . . . .157
Migrants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Displaced and Refugee Children. . . . . . . . . . . .160