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The format and extent of an assessment will depend on the nature of the presenting problem. The following scheme is taken from the book by Graham (1999), which should be consulted for further information. Graham suggests that clinicians with little time available should concentrate on the items in bold type

1 Nature and severity of presenting problem(s). Frequency. Situations in which it occurs. Provoking and ameliorating factors. Stresses thought by parents to be important.

2 Presence of other current problems or complaints.

(a) Physical. Headaches, stomach ache. Hearing, vision. Seizures, faints, or other types of attacks.

(b) Eating, sleeping, or elimination problems.

(c) Relationship with parents and siblings. Affection, compliance.

(d) Relationships with other children. Special friends.

(e) Level of activity, attention span, concentration.

(f) Mood, energy level, sadness, misery,

(g) Response to frustration. Temper tantrums.

(h) Antisocial behaviour. Aggression, stealing, truancy.

(i) Educational attainments, attitude to school attendance.

(j) Sexual interest and behaviour.

(k) Any other symptoms, tics, etc.

3 Current level of development.

(a) Language: comprehension, complexity of speech.

(b) Spatial ability.

(c) Motor coordination, clumsiness.

4 Family structure.

(a) Parents. Ages, occupations. Current physical and emotional state. History of physical or psychiatric disorder. Whereabouts of grandparents.

(b) Siblings. Ages, presence of problems.

(c) Home circumstances: sleeping arrangements.

Family function.

(a) Quality of parental relationship. Mutual affection. Capacity to communicate about and resolve problems. Sharing of attitudes over child’s problems.

(b) Quality of parent-child relationship. Positive interaction: mutual enjoyment. Parental level of criticism, hostility, rejection.

(c) Sibling relationships.

(d) Overall pattern of family relationships. Alliance, communication. Exclusion, scapegoating. Intergenerational confusion.

6 Personal history.

(a) Pregnancy complications. Medication. Infectious fevers.

(b) Delivery and state at birth. Birth weight and gestation. Need for special care after birth.

(c) Early mother-child relationship. Post-partum maternal depression. Early feeding patterns.

(d) Early temperamental characteristics. Easy or difficult, irregular, restless baby and toddler.

(e) Milestones. Obtain exact details only if outside range of normal.

(f) Past illnesses and injuries. Hospitalizations.

(g) Separations lasting a week or more. Nature of substitute care.

(h) Schooling history. Ease of attendance. Educational progress.

7 Observation of a child’s behaviour and emotional state.

(a) Appearance. Signs of dysmorphism. Nutritional state. Evidence of neglect, bruising, etc.

(b) Activity level. Involuntary movements. Capacity to concentrate.

(c) Mood. Expression of signs of sadness, misery, anxiety, tension.

(d) Rapport, capacity to relate to clinician. Eye contact. Spontaneous talk. Inhibition and disinhibition.

(e) Relationship with parents. Affection shown. Resentment. Ease of separation

(f) Habits and mannerisms.

(g) Presence of delusions, hallucinations, thought disorder.

(h) Level of awareness. Evidence of minor epilepsy.

8 Observation of family relationships.

(a) Patterns of interaction – alliances, scapegoating.

(b) Clarity of boundaries between generations: enmeshment.

(c) Ease of communication between family members.

(d) Emotional atmosphere of family. Mutual warmth. Tension, criticism.

9 Physical examination of child.

10 Screening neurological examination.

(a) Note any facial asymmetry

(b) Eye movements. Ask the child to follow a moving finger and observe eye movement for jerkiness, incoordination.

(c) Finger-thumb apposition. Ask the child to press the tip of each finger against the thumb in rapid succession. Observe clumsiness, weakness.

(d) Copying patterns. Drawing a man.

(e) Observe grip and dexterity in drawing.

(f) Jumping up and down on the spot.

(g) Hopping.

(h) Hearing. Capacity of child to repeat numbers whispered two metres behind him.


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