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During the course of the interview, some clinicians also conduct a mental status exam (Sadock & Sadock, 2015). The mental status exam is a brief assessment of the child’s current functioning in three broad areas: (1) appearance and actions, (2) emotions, and (3) cognition.

With respect to appearance and actions, the clinician examines the child’s overt behavior during the session. She is especially interested in the child’s dress, posture, eye contact, quality of interactions with others, and attitude toward the therapist.

With respect to emotions, the clinician assesses the child’s mood and affect. Mood refers to the child’s long-term emotional disposition. Mood is usually assessed by asking the child and his parents about the child’s overall emotional functioning. Moods can range from shy and inhibited, to touchy and argumentative, to sanguine and carefree. Affect refers to the child’s short-term, outward expression of emotion. Affect is usually inferred by watching the child’s facial expressions and body movements during the session. Affect can include tearfulness, displays of anger, and social withdrawal. Some children show a range of affective displays, whereas others show very little emotional expression. The clinician is especially interested in whether the child’s affect fits his or her self-reported mood or the given situation. For example, a child who laughs while talking about a parent’s death displays incongruent affect.

The clinician assesses the child’s cognition in several ways. One aspect of cognition is thought content—that is, the subject matter of the child’s cognition. For example, some children are preoccupied with certain topics or hobbies, whereas other children’s thoughts are plagued by persistent worries or fears. In severe instances, children have delusions or bizarre thoughts that do not correspond to reality. Another aspect of cognition is thought process—that is, the way in which the child forms associations and solves problems. Thought process is usually inferred from the child’s speech. For example, the clinician observes whether the child’s speech is coherent, whether it is rapid and difficult to follow, or whether the child abruptly stops speaking in mid-conversation.

Other aspects of cognition include the child’s overall intelligence, attention and memory, and orientation. Orientation refers to the child’s awareness of himself, his surroundings, and current events. For example, a child involved in a car accident might become disoriented. Lack of orientation to person, place, and time can indicate serious cognitive impairment.

The final components of the child’s cognition are his insight and judgment. Insight refers to the degree to which the child recognizes that he might have a social, emotional, or behavioral problem. Youths with eating disorders and conduct problems often show poor insight; they often deny having problems. Judgment refers to the child’s understanding of the seriousness of his behavior problem and its impact on himself and others. Judgment also refers to the child’s ability to consider the consequences of his behavior before acting. ADHD and conduct problems are usually characterized by poor judgment (Sommers-Flanagan, 2018).

Let’s imagine that we interview Sara and her mother during her first session. Sara presents as an emotionally withdrawn girl who participated in the session only with reassurance from her mother. She lives with her mother, a dental hygienist, and her father, a cook who has been unable to work because of a stroke several months ago. Sara’s developmental history was unremarkable, although her mother described her as a “shy” and “needy” child who has always been reluctant to try new things. Sara’s physical health had been excellent until the beginning of this school year, when she began to experience physical symptoms. Academically, Sara has always lagged behind her classmates. However, she has never been tested for a learning disability. Sara admitted that she feels “uncomfortable” going to school but would not elaborate. However, she was able to identify several friends at school and described her teacher as “okay.” Sara was a member of her school’s soccer team but has been ineligible to play because of her absences. She has never been referred for therapy or prescribed medication.

We might administer the Kiddie-SADS to systematically assess Sara’s school refusal:

Was there ever a time when you had to be forced to go to school? Do you have worries about going to school? Tell me those feelings.

Do you ever worry that something bad might happen to you when you are away from home?

Do you ever worry that something bad might happen to your parents when you are at school?

Sara’s responses to these questions revealed frequent school refusal and worries that something bad might befall her parents while she is away. Her responses suggest that she might have an anxiety disorder associated with separating from loved ones.

Review

 The diagnostic interview is the cornerstone of psychological assessment. The clinician establishes rapport with the family and gathers information about the family’s presenting problem, history, and current social–cultural context.

 Many clinicians conduct a cultural formulation interview to understand the family’s concerns in light of their social and cultural background and values.

 A mental status exam provides a quick snapshot of the child’s (1) appearance and actions, (2) emotions, and (3) cognitions.