Physical Examination of Children

Physical Examination

• A physical examination may be necessary to complete the assessment, focusing on evidence of conditions that might affect the brain.
• The examination involves observing the child's appearance, coordination, and gait, at rest and during play.
• A basic physical examination may follow, with emphasis on the nervous system.
• If abnormalities are found or suspected, the opinion of a pediatrician or pediatric neurologist may be needed.

Ending the Assessment

• The psychiatrist should explain the assessment results to the parents and child, in terms appropriate to the child's age.
• The psychiatrist should explain how they propose to inform and work with the general practitioner, and seek consent to contact other people involved with the child.
• The psychiatrist should encourage questions and discussion throughout the process.

Formulation

• A formulation can help summarize key issues, starting with a brief statement of the current problem.
• The diagnosis and differential diagnosis are discussed, and recorded using the ICD-10 within a multiaxial framework.
• Aetiology is considered, including predisposing, precipitating, and perpetuating factors.
• The formulation should note the child's developmental stages, strengths, and achievements, as well as the family's problems and strengths.
• Any further assessments, treatment plans, and expected outcomes should be specified.

Court Reports

• Psychiatrists may be asked to prepare court reports about children, which should include:
  • Qualifications of the writer and who commissioned the report
  • Written information available and who was interviewed
  • A summary of the findings from the interview
  • The writer's interpretation of the information
  • Comments on the options before the court

Principles for Obtaining Evidence from a Child

• Allow the child to talk freely, asking as few questions as possible.
• Obtain evidence as soon as possible after the event, and before any counseling has taken place.
• Try to complete the account on the first occasion, as subsequent accounts are likely to be less accurate.
• Be aware that the greater the pressure to remember, the less accurate the account is likely to be.

Understanding Children's Memory

• Memory varies with age, as do verbal skills required to describe what has been remembered.
• Children below 3 years seldom have the cognitive and other capacities to produce a reliable account for a court of law.
• Children above 3 years can produce detailed and accurate memories, but may not be able to describe them clearly without some prompting.
• Children above 6 years can use straightforward grammar and syntax adequately, but may be confused by complicated questions.
• Children may agree with leading questions or make up an answer in the hope that it will be correct.
• Children do not have an accurate sense of the sequencing and timing of events, and memories of frightening events are often incomplete.