When children in preschool or the early elementary years are referred for an assessment of behavioral challenges it is standard practice for clinicians to conduct developmental, family and social histories with the family, observe the child at play in a clinical office interview, to have parents and school personnel complete behavioral questionnaires and to sometimes carry out diagnostic testing.  What is not standard is to observe the child in the classroom.  I suggest that an observation should be an essential component of a diagnostic work up.

Behavior is communication.  Behavior does not occur randomly or without reason.  Behavior is a reaction to events and experiences in the classroom.  It is important to know what triggers the behavior. School visits allow the clinician to learn firsthand about the culture and the structure of the classroom, the teaching style of the instructor, the demands being placed on the student and the nature of  the other students in the room.  A school visit, for instance, confirms whether the children have opportunities to play, how often they have activity breaks and how academics are structured throughout the day. 

When developing a school-based treatment plan, the clinician must decide where change ought to occur to help regulate the student’s behavior.  What behaviors and attitudes does the student need to modify, how might the teacher alter his/her teaching style to better accommodate the learning propensities of the student and how might the learning environment (the classroom) be changed or modified for the student to feel more at ease or appropriately challenged. For example, if the child is acting out because the classroom requirements are either too difficult or too easy, those requirements will need to be altered.  These decisions can be facilitated with findings obtained in a school visit.

It is important that a school visit be made prior to first contact between the clinician and the student.  Any visit can alter the normal routine of the classroom, but if the student knows that he/she is the object of the observation, his/her behavior is less likely to be typical of what normally happens in the classroom.

Visits should last at least an hour and should include the following components: 1) observation of the child in a structured learning situation, 2) observation of the child in an informal situation such as group work or recess and 3) a conversation with the teacher about the students and the culture of the classroom.  Such information needs to be a vital component of the diagnostic process.

School visits are a regular component of the diagnostic process at Keller Clinic for young children referred for an assessment of aggressive, inappropriate, impulsive and distractive behavior.

 

For further information about our assessments, please contact Dr. Mitch Parker at mparker@kellerclinicpc.com.