Clinical Child/Adolescent Interview
Child/Adolescent’s Name: Tristan Dolan Person Completing Interview: Samantha Guy
Evaluation Date: 12/11/2025 Grade: 11
Date of Birth: 1/13/2009 Gender: Male
Introduction:
What did you parents tell you about your visit today?
Tell me why you think you’re here today?
What do you like about yourself? /What do you do well?
What would you like to change about yourself? About your family?
What makes you happy?
Sad?
Angry?
Scared?
Nervous?
Family:
Who lives with you? Can you tell me a little bit about each of them?
What is it like at your home? (Describe relationship with mother and father)
What do you like best about your mother?
Father?
What does your mother do that you don’t like?
Father?
What kinds of things do you get punished for? How do they punish you?
Are they fair?
Is one parent the primary disciplinarian?
(If have) How old are your siblings? How do you get along?
What activities do you enjoy doing with your family?
Other important people in life (extended family, close friends)?
School:
Let’s talk about school. What grade are you in? What’s your teacher’s name?
What’s your favorite subject?
What subject do you dislike?
How do you feel about school?
What do you like best about school?
Least?
What are your grades like?
How do you learn best (visual, verbal, hands on, no preference)?
Are there any ways that you have had difficulty learning?
How do you get along with your classmates?
Teachers?
Do you have or have you had any problems in school?
Goals for the future?
Social History:
Tell me about your friends. How many? Do you have a best friend?
What do you do with your friends?
Do you prefer kids older than you, younger than you, same age, mixed?
Do you feel as though your peers like you?
Do your parents know your friends? Do they approve of them?
Leisure activities/hobbies:
Extracurricular activities:
Medical History:
Any current medical problems?
Any difficulty with eating/recent weight loss or gain? History of eating disorder?
How is your sleep? How many hours? Nightmares or sleep walking? Co-sleep?
All of us have had pain at one time or another, such as minor injuries, headaches, or
toothaches. Have you had pain other than those everyday kinds of pain in the past
month? (If so, describe, where, rate pain, how long, affect daily living?)
Any problems seeing or hearing?
MSE:
Do you ever see things other people don’t see?
Do you ever hear things others don’t hear?
Have you ever been so upset that you wanted to hurt or kill yourself (or any risk-taking,
life-threatening behavior)? How recent? Plan? Intent? Means to carry it out?
Have you ever been so upset that you wanted to hurt someone else?
Has anyone ever touched you in a way that made you feel uncomfortable?
(Touched you in your private parts or had you touch theirs?)
Has anyone every hurt you (bruises, bleeding)?
Has anyone ever treated you in a way or said things that made you feel very bad about
yourself?
Not cared for you by not taking you to the doctor when you needed it, not feeding you,
not providing you with clothing or leaving you alone for long periods of time?
Do you:
Have trouble sitting still, trouble focusing on things, often feel restless, do thinks without
thinking first?
Ever feel stressed out for days or weeks at a time?
Anxious?
Have thoughts of death or dying?
Lack interest in activities?
Lack energy/feel fatigued?
Have feelings of worthlessness/excessive guilt?
Often feel sad? Irritable?
Ever experimented with drugs or alcohol? Smoking/Vaping?
Have you:
Hurt or tried to hurt an animal?
Set a fire?
What is your current mood?
If any previous mental health treatment, what for? Was it helpful?
Spirituality and Cultural Concerns:
Do you have any religious or spiritual beliefs that influence your daily life?
What cultural group or groups do you identify with?
Do you, or your family members involved in treatment. need the services of a translator?
Closing
If you could be anyone in the world, who would it be? Tell me about that.
If you could be any animal, what it would be? Tell me about that.
What animal do you least want to be? Tell me about that.
If you could have three wishes, what would they be?
Do you have anything else you would like to tell me about yourself?
Do you have any questions?
don’t get it.