What is your approach when the child refuses to separate from parents during psychiatric evaluation?

Children sometimes refuse to separate from parents during a psychiatric evaluation. The simple answer to how I respond when this occurs is that I complete the interview with the parent(s) in the room. For preschoolers and many school-age children, a refusal to separate is not necessarily something that needs to be addressed directly. For older school-aged children and adolescents, it might well interfere with the evaluation and mental status exam, but should not be the sort of event that signifi...

Some of this depends on the age of the child and presenting concerns. In general, if a child refuses to separate at the initial visit, I don't push things too much, as this isn't all that unreasonable, especially with younger kids. For younger kids (preschool age and early elementary), sometimes a little "benign neglect" helps them get comfortable. If the child reacts with avoidance during my introduction, I shift to talking with parents while allowing the child to play, while I appear to "ignor...

It depends upon the age of the child. For younger children (and those whose presentations suggest more fragility), I always meet initially with caregivers to obtain a full history and let them know that the child is not to be present. This is to minimize the “triggering” of the child and to assure that I’m able to get a complete history.

If the child insists on a parent being present for their part of the evaluation, I never dispute this. Rather, I work with the child directly with the parent pr...