Caregivers will often ask why a physician completing an assessment will often seem to stop the formal evaluation and begin what looks like play time.
This is a sharp observation and also relatable. For example, I know that in my practice, when there is critical information that I need to gather directly from a child, that is when the laptop and pad of paper are usually put away. I will make an intentional effort to migrate over to an area of my office that is dedicated to interactive education and having fun.
When caregivers see this, they often express a number of concerns, including:
Concern that playing with the patient is detracting from their formal medical evaluation.
Concern that medical appointments are sometimes complicated to coordinate and/or expensive. In that context, setting aside significant evaluation time to engage in play can seem very odd.
Often children do well during unstructured play time but struggle in other settings. Caregivers often would like to focus on those situations.
All of these are understandable concerns. Why, during an important appointment in a medical clinic, do child psychiatrists devote so much time to play?
When these concerns are expressed, I will encourage guardians to consider the act of playing as one of many various tools that a physician may use to complete a medical evaluation. Psychiatrists can learn an incredible amount about a child's history, average day, and past treatments by engaging in imaginative play with them or just providing pleasant distractions while they talk with us.
Just like physicians have other medical tools like physical exams, blood pressure machines, thermometers, and laboratory tests, child psychiatrists also have developed toy toolkits to maximize the value of the interview portion of their evaluation. Unlike adults, children are not as experienced in the concept of answering a series of questions to help determine how to construct a treatment plan. So just like apparent small talk is used with adults to keep an appointment pleasant and engaging, structured play can be used with children to keep them engaged and sharing during their appointments.
Play during evaluations and treatment is a common approach during child mental health appointments. Caregivers can expect to see those interactions even during psychoeducation or therapy appointments, even where there is no expectation that medications might be discussed. For example, Parent-Child Interaction Therapy (PCIT) or Trauma-Focused Behavioral Therapy (TF-CBT) or family therapy all provide treatment approaches that can feel very much like playing to the child.
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