during the interview and psychosocial history. Some clinicians administer a structured diagnostic interview, which systematically reviews all of the major psychiatric diagnoses to determine whether the child meets criteria for any diagnosis (Kearney et al., 2020).
For example, the Schedule for Affective Disorders and Schizophrenia for School Aged Children (Kiddie-SADS) is the most widely used semistructured diagnostic interview for children and adolescents. After gathering information about the child’s presenting problem and psychosocial history, the clinician administers the Kiddie-SADS to parents and children. The interview consists of initial questions that screen children for the major DSM-5 diagnoses, such as anxiety disorders, depressive disorders, and conduct problems. If the parents or child endorse these screening questions, the clinician will systematically review symptoms to see if the child meets DSM-5 criteria for any specific disorder (Kaufman et al., 2016).
Cultural Formulation of Children’s Problems
Many clinicians conduct a cultural formulation interview to gather data about clients’ racial, ethnic, and cultural identities. Clinicians can use this information to understand the way these identities might influence their clients’ mental health problems, psychosocial stressors, and willingness to participate in treatment (American Psychiatric Association, 2013; Lewis-Fernandez, Aggarwal, Hinton, Kirmayer, & Hinton, 2016).
During the interview, the clinician asks open-ended questions to children and their caregivers to see the child’s problem from their point of view. The complete interview consists of four parts, as shown in the From Science to Practice section.
Table 4.1
Note: Adapted from Garcia-Barrera and Moore (2013) and Reynolds and Kamphaus (2015).
First, the clinician looks for a cultural definition of the child’s problem. How does the family understand the problem? How would family members describe the problem to others in their community, such as a relative or close friend? For example, we might learn that Sara’s family immigrated to the United States from El Salvador when she was little. They sought asylum in the United States because of violence at home. Sara has been living in the United States for 5 years and has generally been a good student. This academic year, however, she has been more irritable than usual. Her physician diagnosed her with depression, but her family members describe her problem as “spells” or “attacks of stubbornness.” Initially, we might use these same words with her family to show we are trying to see the problem from their perspective (Boehnlein, Westermeyer, & Scalco, 2016).
Second, the clinician assesses the family’s cultural perceptions of the problem’s cause and context. According to family members, how did the problem come about? What aspects of the family’s cultural identity might contribute to the problem or be a source of support? For example, we might discover that Sara’s parents are ashamed and disappointed by her behavior. They attribute her low grades to “laziness” and her tantrums to “disrespect for her family.” In contrast, Sara might feel “caught between her family and the school.” She knows that her parents are disappointed in her and have many other stressors in their lives—working multiple jobs, caring for her younger siblings, and trying to establish a new home in the United States. “They came to this country so we could have a better life and I have let them down,” she might say (Rousseau & Guzder, 2016).
Third, the clinician gathers information about cultural factors that affect coping and past help-seeking. How has the family responded to this problem? What has worked and what has been less effective? Although Sara’s parents lead busy lives, they might be willing to participate in therapy to help manage her school refusal. We might work with her parents to identify barriers to treatment such as their work schedules, access to childcare, or the cost of treatment.
From Science to Practice: The Cultural Formulation Interview
Psychologists try to understand children’s problems in the context of their culture and past experiences. One way to do this is to conduct a cultural formulation interview. Here are some sample questions from the interview that a clinician might ask:
I would like to understand the problems that bring your family here so that I can help you more effectively. I want to know about your experiences and ideas. I will ask some questions about what is going on and how your family is dealing with it. There are no right or wrong answers.
Cultural Definition of the Child’s Problem
People often understand problems in their own way, which may be similar or different from how doctors describe the problem. How would you describe your family’s problem?
Cultural Perceptions of the Problem’s Cause and Context
Sometimes, people’s background or identity can make problems better or worse. By “background or identity” I mean the communities you belong to, the languages you speak, where you and your family are from, your race or ethnicity, your gender or sexual orientation, and your faith or religion. Are there any aspects of your family’s background or identity that make a difference to this problem?
Cultural Factors Affecting Coping and Past Help-Seeking
Has anything prevented your family from getting the help it needs? For example, money, work or family commitments, stigma or discrimination, or people who do not understand your language or background?
Cultural Factors Affecting Current Help-Seeking
Sometimes, therapists and clients misunderstand each other because they come from different backgrounds and have different expectations. Have you been concerned about this and is there anything we can do to provide your family with the care you need?
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Note: Based on Lewis-Fernandez et al. (2016).
Fourth, the clinician assesses cultural factors affecting current help-seeking. Does the family feel comfortable working with the clinician? Is the treatment suggested by the clinician acceptable to the family? At first, Sara’s family was more willing to speak to a physician, rather than a mental health professional, about her problem. They might also prefer a professional who speaks Spanish. We might suggest meeting with the family for a few sessions, during convenient hours, to help Sara feel more comfortable at school. After a few sessions, the family can reappraise the situation and decide if it is useful for them (Aggarwal, Jimenez-Solomon, Lam, Hinton, & Lewis-Fernandez, 2016).
Mental Status Exam
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