Psychological testing without family interviews?

July 6, 2010 7:55 PM

How are psychological/psychiatric assessments conducted when there is no family available for history interviews?

I'm considering having a full psychological/psychiatric assessment done, specifically for a possible ADHD/impulse control issue, and I know that a significant part of such assessments includes family history interviews to create a snapshot of the patient in childhood (or before age 6, my PNP said).

That makes sense. But I'm wondering what assessors do when there is no family to ask. I have no immediate family members left who spent time with me as a child, and I moved away from home so long ago I have no ties at all to anyone who taught me or cared for me when I was young. There's no one I can dig up. Really. I promise.

In that situation, what would an assessor do? How would that part of the testing be completed? Would it mean that the assessment couldn't be done, or what? And yes, of course I'd ask the practitioner, but I'd like some informal information before I proceed.

posted by anonymous to health & fitness (11 answers total)

I was assessed for ADD a few years back, and no one talked to any of my friends or relatives. They never asked whether they could, so apparently, there are assessments that don't require outside interviews.
posted by decathecting at 8:17 PM on July 6, 2010

When I was assessed for ADD at a psychiatric clinic, there were no interviews of family members. Their diagnosis depended entirely on (1) what I said and (2) how I did on their tests (IQ test, ADD-specific tests, depression test etc.). The impression I got was that ADD, if present, would be observable from the patient's responses and could not be some kind of latent condition.
posted by mnemonic at 8:18 PM on July 6, 2010

I interview teens and adults about ADHD in my lab. They are not that reliable in self report so we sometimes interview parents but more often we just ask about their interactions with adults to the extent they remember. Did their mom yell at them about being disorganized more than siblings or friends got reprimanded? Was the teacher calling on them for not paying attention more than anyone else in class? Comparing your symptoms to your peer group is a common and powerful tool in assesment and can be less biased than family.
posted by slow graffiti at 8:50 PM on July 6, 2010

My mom had a neuropsych eval that I sat in on, and while they asked about family members they didn't ask to talk to any of them. They didn't even seem that interested to talk to me in private.
posted by radioamy at 8:50 PM on July 6, 2010

Yeah, no family assessment, here, either, but there were a lot of questions about how family viewed me, to which I drew a blank. It didn't seem to be problem as I think they are used to not having that element present.
posted by dual_action at 8:58 PM on July 6, 2010

I did a psychological assessment for depression/panic disorder at John Hopkins in 2003, and while they did ask about my family history they never actually interviewed any of my family.
posted by divabat at 9:06 PM on July 6, 2010

Most of the time, adult assessment doesn't require family interviews, because the measures used are designed to target the specific issue (rather than the retrospective view of childhood behavior as an indicator of AD/HD or whatever). For kids, it's standard to interview parents, but definitely not for adults.
posted by so_gracefully at 9:38 PM on July 6, 2010

For ADHD I might ask to speak to a college student's parents but any older and I'd probably not bother, unless the client seems like a really unreliable source. Questions like "did you get to the prinicpal, were you a class clown, did your teachers say you were hyper etc." are usually enough to establish some history as well as any academic problems you may have had as a result of inattention. Its harder to establish ADHD as an adult but your situation shouldn't be a deal-breaker.
posted by gilsonal at 1:24 AM on July 7, 2010

I do a different kind of evaluation - autism, and for research purposes rather than clinical - but we do include parent interviews. In our case we would first try to see if there's anyone else who knew you as a kid (sounds like no) and if you have or could get any documentation from when you were little - school reports, doctor's evaluations, anything that might give us a hint into any developmental or behavioral issues you might have had then.

If there's absolutely nothing to be dug up, then we'd just do only the parts of the assessment battery that you can self-report, and leave it at that. At least for autism, although we'd really like to have the parent history to be more sure of our diagnosis, current behavior and clinician's impression is usually good enough for our purposes to make the diagnosis.

The exception could be if someone has had years and years of really spectacularly good therapy, and/or has managed to teach him/herself really great ways of coping, and was pretty mild in the first place, we might in the end wind up a little uncertain as to whether they have autism, and that's where the parent interview would have been extremely helpful. If you think you might be a person who's so mild/borderline that it will be very hard to diagnose you without earlier history, I'd spend some time beforehand trying very hard to remember and write down as many examples from childhood as you can of situations where an ADHD or impulse control problem may have caused problems for you.
posted by Stacey at 4:00 AM on July 7, 2010

I have sat in on psychiatric evaluations with my clients a number of times and have never heard a psychiatrist ask to speak with family members, nor could they without a signed consent form from the client for each specific member of the family. I think your PNP either gave you misinformation or there may have been a miscommunication, or maybe they were referencing a specific program that engages in this practice with a specific population, but as you can see from all the responses here it's not a standard practice for adult evaluations and you shouldn't worry about not having family members the doctor can speak to.
posted by The Straightener at 5:06 AM on July 7, 2010

They ask you about a family history. in fact I would imagine that speaking with family would be abnormal, given the privacy most patients want regarding possible mental health issues.
posted by Phalene at 7:48 AM on July 7, 2010