Young children who visit mental health clinics for comprehensive psychiatric evaluation do so for a range of reasons. In order to develop a diagnostic formulation along with a relevant intervention plan, it is important for the clinician to plan an assessment process with a variety of components. These components comprise the following: a school consultation or observation, a structured developmental assessment, observation of the parent-child interaction, a family interview, and a diagnostic play interview.
The 1909 report of Little Sans by Sigmund Freud kickstarted the modern child psychotherapy. Hans was a little boy and had a phobia of horses. He was treated by his father, who examined his play, subsequently consulting with Freud so that he can relate the play to the underlying fears of Hans. This led to a recognition that plays permits children to reveal their inner world, comprising their perceptions of vital relationships, their wishes and anxieties, their feelings, and their conflicts. Since that instance, our knowledge of the developing aspects of children’s play has substantially amplified. It has allowed us to witness the diagnostic play interview as a vital part of any evaluation of young children. In certain instances, the information collected in a diagnostic play interview enables us to make a differential diagnosis.
A diagnosis play session enables a clinician to observe a great deal about personality functioning and social development of a child. By observing a child at play, a clinician may be able to learn about the specific relationships, defences, controls, and fantasies of a child, along with his level of anxiety and areas of conflict. The best time for a child to be seen in a diagnostic play session is after the general assessment of a child’s cognitive, language, and gross and fine motor skills. Besides offering information regarding socio-emotional development and personality, a child’s play may offer the clinician more information about the language, cognitive, and motor aspects of a child’s development. It is ideal to use two diagnostic play sessions during a comprehensive psychiatric evaluation. If the number of sessions is limited by insurance and time, a single comprehensive psychiatric evaluation session can offer the clinician with important information when combined with information from parents, home observations, classroom, and the results of formal testing to play intervention strategies after making a diagnosis.
However, before the role of comprehensive psychiatric evaluation, is fully explored, it is important to equip oneself with certain developmental concepts regarding play along with many roles that play fills in the young children’s lives.