Preparing for the Interview


 

Traumatic brain injury refers to an acquired injury to the brain results from external physical force causing functional disability and/or psychosocial impairment. Traumatic brain injuries often cause difficulties in more than one domain. The following types of impairments may be present: cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem‐solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech.

 


Physical impairments 



Prior to the interview



To adequately accommodate a child with a physical disability, information about how the child is affected by the disability and what physical accommodations are necessary should be gathered beforehand. Attention must be paid to:



• Arranging transportation and parking

• Physical access to the building and interview room

• Waiting area and bathroom accessibility

• Timing of the appointment (morning vs. afternoon)

 


Strategies for specific diagnoses



Deaf or hearing impaired

Many people who are deaf or hearing impaired do not see themselves as having a disability; they see themselves as part of a culture with different means of communication. This method of communication depends on when the person acquired hearing loss and the means communication at home and in school. When interviewing a child who is deaf or hearing impaired, gather this information beforehand, so you know what type of communication is preferred. Do not assume that the child has no usable hearing.



Children with hearing impairments will communicate in a variety of ways. Sign language may be the preferred choice, or speaking, or writing. Writing is a useful accommodation when clarification is needed.



American Sign Language and English Sign Language differ, and other countries have their own sign language versions. When using an interpreter during an interview, look directly at the child you are conversing with, not at the interpreter. Be sure you have the child’s attention before beginning, and speak slowly and clearly. Do not rely on writing or lip reading. Ask where he or she would like to sit in the room and position the interpreter in a spot where neither you nor the deaf person will have to move to see the interpretation. As with foreign language interpreters, sign language interpreters are valuable in providing a cultural context for words and meanings, as well as accepted communication practices.



Additional strategies:

• Always explain interruptions or odd noises (such as a door slamming or a cell phone)

• Touching the child’s arm or shoulder to get his attention is culturally appropriate and acceptable

• Eye contact is essential, as is pantomime and gestures, when appropriate

• Speak in a normal voice; yelling may distort words and interfere with lip reading

• Sit close enough that the child can see you and the interpreter

 


Visually impaired

Do not assume that the child has no usable vision; many people who are “legally blind” can see shapes, colors, and light. To accommodate for children with visual impairments:



• Ask where he or she would like to sit in the room.

• Do not sit the child directly in front of a light or window; have the primary light source behind the child so he can see you well.

• Use natural or lamp lighting; fluorescent lights can be particularly distressing.

• Announce yourself when you enter or leave the room.

• Always ask before petting a service animal, remember that the animal is not a pet, it is working.

• To guide a child who is blind, let him or her take your arm, not the other way around. Say where you are going and what is in front of you before you get there.

• If possible, have written materials available in other formats, such as Braille, large print, audiotape, or picture.

• Instead of drawing or coloring, Play‐Doh can be used for a calming activity for the child.

• When assessing knowledge of prepositions, ask the child to hold an object, such as a pen, to show where the object is (i.e. up, down, in, on, under, or behind)

 

 


Cognitive impairments



 When a child has an intellectual disability, you may observe some of the following:

• Conversational style that seems immature for the child’s age

• Social behaviors that seem immature for the child’s age

• Slower mastery of speech compared with age mates

• Ability to converse about concrete topics but difficulty with abstraction

• Literal interpretation of words and gestures

• Later development of problem solving skills, which are less sophisticated compared with age mates

• Difficulties integrating knowledge (new or stored information) into problem solving or established behavioral patterns

• Impulsivity in decision making due to the impaired thought processes related to intelligence (unlike ADHD, which is unrelated to intelligence)

• Inability to perceive danger when danger presents as an abstraction

• Limited thinking and reasoning abilities but normal sexual development

 


Prior to the interview



As with other disabilities, the interview strategies when working with children with intellectual disabilities will depend on the extent of the disability. If possible, gather this information beforehand. If the interviewer has time and access to the child’s Individualized Education Plan (IEP), review this for tips on how to best communicate with the child. If you can discuss the child’s abilities with caregivers or therapists beforehand, do so, and ask for the child’s most current medical diagnoses and psychological records. If you cannot get such information beforehand, proceed with your interview as you would with any child. It is important not to “talk down” to the child but to be respectful while adapting the interview to the child’s abilities and level of functioning.



If you do have historical documents on the child’s functioning, use them as a guide for planning the structure of your interview and for setting realistic expectations for the child’s abilities to communicate. However, be aware that your experience with the child may differ, sometimes dramatically, from what you might have expected upon reading past reports of school and/or developmental testing. As we know, children’s development can vary across the developmental domains. For example, you may have records indicating that a 12‐year‐old girl who has been referred for an interview “functions at the level of a five year old.” When in the interview, it is clear that her language skills are much better than those of a typically developing five year old. However, she cannot read. Therefore, you may not need to make as many accommodations when interviewing this girl as you had anticipated.

 


The interview



Introduction

In the beginning, spend time on your introduction.

• Introduce yourself and explain what will happen during the interview.

• Tell the child where you will be taking him or her, and how long you expect to be there.

• Explain your interview room.

• Review who is observing and that you are videotaping, if applicable.

• Tell the child where the restroom is and that he or she can take a break if needed.

• Advise the child of answer options, including

o Correcting the interviewer’s mistakes

o Importance of not guessing; it is okay to say “I don’t know”

o Talk about real things, no pretending

o Option of not talking about a particular topic

o Let interviewer know you do not understand the question

 


Rapport building

Spend extra time establishing rapport to become familiar with the child’s abilities and language. As the interviewer, it is your responsibility to understand what the child is saying, not the child’s responsibility to understand what you are saying.



During rapport building, assess the child’s ability to respond to abstract questions. For example, if asked “What brings you here today?” the abstract response would be, “I’m here because someone hurt me.” For the child without this ability to abstract, the concrete response would be, “Bus number 7.” Again, it is important to tailor your questions to the language and intellectual abilities of the child.

 


Comfort

Once in the room, ask if the child is comfortable. The offer of a beverage or snack often will help put a child at ease. By beginning with a familiar activity, snacking, the child may more easily transition from a familiar social situation to one that is not so familiar, an interview.

 


Language

Spend time familiarizing yourself with the child’s language, vocabulary, syntax, and grammar. This will greatly increase your ability to pose appropriate questions and understand the answers. Do not spend too much time on this, as some children may become fatigued.



• Use plain language, not “baby talk”

• Ask one question at a time.

• Use “when” questions in the context of the child’s daily or weekly activities.

• Match the child’s language.

• Avoid compound questions and sentences. Use one idea per sentence.

• Avoid using “why” questions.

• Do not rush; allow the child to speak at his or her own pace.

• Use open‐ended questions and invitational prompts to initiate narrative.

 


The interviewer may have to resort to beginning the discussion with direct, yes/no, or multiple choice questions if the child is unable or unwilling to provide a running narrative. The interviewer can use phrases such as, “And then what happened?” OR “Tell me more about that” OR “What was that like?”



Children with intellectual disabilities may not tell you when they do not comprehend your questions. The interviewer should remain cognizant of this and continue posing neutral questions as well as clarifying answers. Frequently, ask the child if she or he understands the question. If you cannot understand the child’s speech or statement, ask for clarification. Sometimes saying, “I didn’t understand that part; please say it again” is the best way to clarify a statement. Other times, the interviewer may need to pose the question again, allowing the child time to process and answer the question. Allow a pause before posing questions in order to avoid confusion. As well, remember to avoid the use of “why” questions, especially with children with intellectual disabilities. The child likely does not know the answer, and may feel badly about not being able to provide an answer to you.



Breaks

During the interview, watch the child for signs of stress, fatigue, or discomfort. If the child demonstrates any signs of stress, it may be time for a break. In many cases, the child may not ask for a break when needed, even if you have given him or her permission to do so. Therefore, pay attention to the child’s body language as well as the following:

• Withdrawal

• Distraction (looking around)

• Fidgeting, hand wringing

• Humming, groaning

• Not answering the questions

 


When these characteristics are present, there are two options: (1) take a break from the topic by introducing another topic or (2) take a break from the interview. Rather than asking the child if he or she needs a break, say, “I’d like a quick break. Would you also like one?” This will give the child a chance to relax, use the bathroom, take a drink, and/or take respite from the intensity of the interview. During the child’s break, the interviewer should remain on camera, if videotaping. When the child re‐enters the room, assess his or her level of comfort before continuing.

 


Multiple interviews



For children with intellectual disabilities, several short interviews may be more productive and less stressful than one long interview. Use your judgment in deciding whether or not to schedule multiple interviews. If you do bring the child back for additional interviews, take care to discuss contamination with the caregiver and other community partners

 


Communication/speech impairment

 


Prior to the interview



The main question before beginning an interview is “What type of communication does this child use?” When children have complex communication problems and you have the luxury of time, it is important to gather information from schools, speech and language professionals, and family members to learn how the child communicates and how best to converse with the child. If the child uses anything other than verbal communication, such as an augmentative communication device, the interviewer should spend time becoming familiar with the device the child uses prior to meeting the child.



Augmentation refers to the use of a communication tool or aid. There are various augmentative communication devices. Examples include:



• Computer keyboard

• A to Z spelling board

• Picture board 

 


During the interview



Children with communication difficulties may simply need more time to receive, process, and respond to questions, so allow for long silences. If the child has difficulty in articulation and phonology, the interviewer will need to listen carefully and stop to ascertain what the word means. As with all interviews, the interviewer should take care to speak clearly and distinctly.



It is sometimes helpful to acknowledge communication challenges in the beginning of the interview, perhaps as part of rapport building. This will give both the child and the interviewer permission to correct themselves or each other and more comfort in communicating. For example, the interviewer can say, “You are new to me. Sometimes it’s hard for me to understand new people. I may have to ask you to repeat some things.” Or, “I will have to learn what words you use for things. Probably I’ll ask you to make drawings to help me understand what happened.” During the interview, do not be reluctant to say, “I didn’t understand what you said, please repeat it.”



If the child uses an augmentative communication device, the interviewer and child should demonstrate use of the device during the rapport building section of a videotaped interview to also acquaint the observer of the videotape with the equipment.



General strategies for many types of communication difficulties



If receptive communication is a concern, the interviewer can



• Minimize distractions in the interview room

• Pay attention to eye contact, body language, and other cues the child provides to indicate that he does not understand (such as squirming, grimacing, or long pauses)

• Stop periodically to ask the child if he understands or has any questions

 If expressive language is a concern, the interviewer can

• Use tools to enhance communication (such as drawings, anatomically detailed dolls, mapping)

• Reflect back to the child what you understood, to assure accurate understanding

• Clarify pronouns and use identifiers whenever possible (e.g., “your uncle,” “John,” “the man with the yellow hat”; rather than “he,” “she,” “him”)

• Resist the temptation to fill in the blanks, but be aware that not all children will speak in full sentences

 


 

Emotional impairments 



Behaviors that suggest difficulties in social and emotional domains include



• Persistent sad or unhappy mood

• Wide mood swings

• Withdrawal or avoidance

• Argumentative

• Angry outbursts

• Atypical behavior for age (acting much older or younger than age)

• Failure to make and maintain eye contact

• Impulsive

• Fidgety and unable to be still

 


Prior to the interview



Prior to beginning the interview, gather as much information as possible regarding the child’s baseline behaviors and whether there have been any changes in his or her behaviors. Ask and consider how the child will react when feeling anxious, as the interview questions may provoke stress and anxiety. Ask about the dosage and timing of medications in order to schedule the interview at the best possible time. Find a location where environmental stimuli are limited. As well, this location should allow enough space for the child to move about the room, yet be secure, so the child cannot run off. Ask the caregiver if the child has had the appropriate medication today.



As a way to anticipate how the child will present during the interview and how you can best make accommodations, ask about his or her behavioral challenges. Do they include?



• Verbal perseverations

• Compulsive behaviors

• Self‐abusive behaviors

• Assaultive behaviors (to people or objects)

• Pica behavior (eating nonnutritive substances)

• Sexualized behavior

• Hyperactive behavior

• Oppositional behavior

• Withdrawal

• Sensitivity to environmental stimuli (noises, mirrors, crowded rooms, number of people in one location)

 


Any of the above‐mentioned behaviors require accommodations prior to the interview. For example:



• Schedule the interview at a time of day that is least stressful for the child.

• Anticipate and allow for possible behavioral change when asking questions that may be stressful for the child.

• Consult with the child’s mental health provider about what type of supports the child may need, and to what extent he or she will be able to engage in the interview.

• Remove environmental stimuli from the waiting and interview rooms.

 

 

 

During the interview



During an interview, children may exhibit behavioral difficulties for a myriad of reasons other than pathology or diagnosis, such as



 Fears

• Defiance

• Medication mismanagement

• Drug use

• Anxiety about the interview process



The behaviors present as acting out, challenging, or withdrawing, or all simultaneously. Sometimes the source of the behavior is important, such as if the child is over or under medicated, as this can be corrected and the interview can proceed at a later date. Sometimes the source of the behavior can be addressed up front and neutralized, so the interview can proceed as planned. For example, for a child with Reactive Attachment Disorder, it may be difficult to separate from his or her caregiver. If separation is stressful for the child, spend more time with the care provider and child together, or invite the caregiver to transition the child to the evaluation. This may help ease the child’s anxieties (and/or the caregiver’s anxieties) and reduce stress. A careful review of the rules and structure of the interview process might also calm an anxious child.



In the beginning, spend time on your introduction. Introduce yourself, explain your role, and explain the interview room including what will happen during the interview.



When feeling anxious during the interview, the child may react either by becoming agitated or by withdrawing. Allow space for him or her move about, as kinetic activity may be a way for the child to calm him or herself. Likewise, if he is withdrawing, allow periods of silence to give him space to process his reactions. Take breaks as needed. If the child seems to dissociate, try engaging him in a non‐threatening activity like drawing or Play‐Doh, and then re‐engage him in the discussion. Another approach would be to acknowledge the difficulty for the child in discussing the topic at hand. “It seems like this is hard to talk about.”



Allowing space for the child to move, crawl, wiggle, or fidget may be helpful. However, if the behaviors become disruptive, either for the interviewer or the child, setting limits for the child and re‐directing those disruptive behaviors may be necessary. For example, the child may be moving under the table, sitting on the floor, climbing on the couch, but remains engaged in the interview process. This behavior needs no redirection. However, if the child then begins dangerously jumping off the furniture, you might redirect him or her by saying “I’m worried you are going to hurt yourself. Come back to the chair so we can talk and be safe.” For children whose behaviors are too disruptive, the interviewer may need to use clinical judgment in determining when to suspend or end an interview. Pick your battles; set clear and reasonable boundaries.



 Shelton, K., Bridenbaugh, H., Farrenkopf, M., & Kroeger, K. (2010). Project Ability: Demystifying disability in child abuse interviewing. Oregon:  CARES Northwest. Retrieved from: http://www.oregon.gov/DHS/children/committees/cja/proj-abil.pdf