PARENT INTERVIEW

Child: Harlea M.
Date of Birth: March 7, 2006
Age: 8

Parent/Guardian: Christi and Steve M.

School: Canmore Elementary School
Grade: 4

Interviewer: Melissa Martin

Reason for Referral: troubles

focusing, paying attention, gets
frustrated easily, and difficulties
with math and English Language
Arts (ELA)

CONFIDENTIALITY AND PURPOSE OF INTERVIEW

Thank you for taking the time to meet with me today and for completing
the various questionnaires that you received before our meeting. I have
reviewed the information you provided on the forms, and I would like to hear
more about your concerns about [childs name]. Your perspective as a
parent is very important for me in understanding [childs name]. I want to
let you know that the interview may touch on a lot of feelings, but were
here for the purpose of helping your daughter. Usually your first
response to a question can be the right observation, but if you want to go
back and explore the answer further or change an answer we can do that.
And if you dont know the answer to a question thats ok. If you need to
take a break at any time, just let me know.
This interview is part of my evaluation and will be summarized in my
written report. I want you to know that I only include information that is
relevant for understanding [childs name] functioning and planning
appropriate interventions. We can discuss what information will or will not
be included at the end of the interview if you like.
Please let me know if you have any questions at any time.
Lets take a few minutes to review your consent for me to complete the
psychoeducational assessment by going through this checklist.
Its important for you to know and understand the purpose & nature of the
assessment, the benefits & risks, mutual responsibilities, the alternatives to
assessment & consequences of not consenting to the assessment, your
ongoing right to refuse or rescind consent, the time limits, and the multiple
uses of the assessment.

PARENT INTERVIEW
Purpose & Nature of Assessment
Investigation into strengths & weaknesses
Cognitive ability, academic achievement, language & behaviour
Involves intelligence tests & other testing, rating scales, interviews,

observations, history taking, & measuring responses to intervention

Assessment occurs one-on-one but within school hours
Written report will be shared with parents & school personnel
concerned about the student, & will become a part of the students

school record
Parents have opportunity to ask questions & make suggestions about

the report
Goal is to gather specific & new information to better understand
your child and improve their current functioning or learning.

Benefits
May help develop insights into needed changes or develop new
strategies, accommodations & adaptations that may be necessary

to improve your childs learning

May help school personnel gain a better understanding of your

childs strengths and challenges

May help school based team develop educational programs to

improve success in school

May lead to a child being diagnosed as having special educational
needs. Diagnosis can make it easier to access some additional
services that might benefit your child.

Risks
Not all assessments lead to the possible benefits we discussed
May lead to diagnosis of learning or language disabilities,
developmental disorders, and/or behavioural/emotional disorders that
will require follow up treatment or interventions outside the

PARENT INTERVIEW
classroom, which can be upsetting
Assessment results may contribute to a re-evaluation of school or life
plans for your child
If diagnosis leads to your child being identified as a special needs
student, it may limit their enrollment in some classrooms or programs
To minimize unexpected problems its important that any concerns or
questions that develop over the assessment period be mentioned as
soon as possible.
Mutual Responsibilities
I will ensure that a written copy of the assessment is given to the
school in a timely manner
The school is responsible for setting up a meeting to discuss the report
with the you, myself, and your childs teachers
Together we will collaborate to ensure your child is prepared for
any changes in routine and is made to feel as comfortable as possible
regarding the assessment
Alternatives to Assessment
Students may receive a limited level of help in school without any
additional assessment information
The decision to assess can be postponed to another time
The current educational program or placement can be maintained
If you choose a private assessment can be completed by individuals or
agencies not connected to the school
Consequences of Non-Action
A wait-and-see strategy can be a reasonable choice as other
alternatives to a full assessment are implemented & evaluated which
may provide new & useful information
Decisions about educational programs should be made with adequate
information
The absence of psychoeducational information may limit the

PARENT INTERVIEW
effectiveness of other actions or delay the implementation of
appropriate interventions
Non-action can delay the goal of understanding and improving your
childs current functioning and learning
Ongoing Right to Refuse or Rescind Consent
You have the right to refuse consent at any time during the
assessment
Just contact myself or the school principal & ask that the assessment be
stopped
I will inform you of any changes in the assessment process and get
your consent before implementing any changes
Time Limits
Your consent for the assessment is time limited & lasts only for the
duration of the school year
Limits of Confidentiality
All documents & the written report are the property of the school
board
The information within the reports is considered private, confidential,
& protected by law
They may not be disclosed to any person or agency without your
specific & written consent
I am required by law to contact the appropriate agencies if there is a
clear risk of harm such as suspected child abuse or if your child poses
a danger to themselves or others, or if a court orders the disclosure of
the records
Multiple Uses
Information from the assessment may be used to identify a child as
having special educational needs

PARENT INTERVIEW
Teachers, administrators, or the school based team may use the
information to make school placements, educational programs, or
provincial funding decisions for your child
Includes decisions about class composition, provincial examination
conditions, & special education support staff hiring
Do you have any questions? NO
Okay, now Id like to continue by hearing more about your concerns for
[childs name].

CONCERNS
What concerns you most?

RESPONSES/COMMENTS
-having trouble paying attention in
class, difficulties in math and ELA,
gets angry and frustrated about her
struggles in school

When did you first become

concerned? How long has it been a

- Its been ongoing. More noticeable

problem?

when she started school, about 3

years.

Can you describe these concerns a

little more?

-Has trouble focusing on tasks and

gets distracted in group settings.
Cant read out loud very well and has
troubles spelling. Has troubles with
math operations and cant do word

Is there anything else you are

problems very well.

PARENT INTERVIEW
concerned about?
-Gets really frustrated because she
cant focus and follow instructions.
What do you think [child] has

Has trouble completing her

[problem]?

assignments.

How does [childs name] deal with

- Not sure

[problem]?
- Not sure how she deals with them,
Do any other children in your family

usually gets angry and can shut

also have [problem]?

down.

Has [child] been evaluated or

- Shes an only child

received any help for [problem]? If

so, query: type, progress, etc.
-Not yet
What are [child]s strengths?

What do you want to see happen for

-Very active, energetic, outgoing,

[child]?

friendly, creative, sociable, athletic,

intelligent

PARENT INTERVIEW
-To see her do better in class, be able
to focus and complete tasks, handle
her frustration better
Now lets discuss how [childs name] is doing in school.
SCHOOL FUNCTIONING
How is [child] getting along in

RESPONSES/COMMENTS
-Not as good as we thought. She

school?

struggles in math and ELA, does well

in her other subjects, troubles
retaining info, cant follow directions

What does [child] like best about

school?

Seeing her friends, riding the bus.

She likes her teacher, recess, phys
ed, and art
-Doesnt like having to sit still in

What does [child] like least about

class and listen, homework, and not

school?

getting enough time to finish tasks.

-Phys Ed, Art, Music

What are [child]s best subjects?

-Math, ELA (especially reading and

writing)

What are [child]s worst subjects?

-well-coordinated (kinaesthetic
How well does [child] learn things?

learner), can catch on to sports and

PARENT INTERVIEW
games really quick. Has difficulty
learning more complex, multi-step
tasks where theres lots of
instructions (cant follow too many
instructions)
Does [child] seem to understand
things that are said to him/her?

-Sometimes. If shes not paying

attention, she needs it repeated at
least once.

Is [child] quick or slow to catch on to

things?
-Sometimes, depends on the task
and if shes interested. Is usually lost
Does [child] stick with tasks that

on multiple step instructions and

he/she is trying to learn?

needs them repeated.

-Not if she thinks its too difficult for

How does [child] feel about his/her

her. She will usually give up and

schoolwork? His/her homework?

move on to something else.

How much homework does she/he

have?

-Doesnt like homework, not

When & where does [child] usually

interested in completing it. Gives up

do homework?

after about half an hour and get

PARENT INTERVIEW
Does she/he have any trouble with

frustrated and refuses to finish.

homework?

Usually 30 minutes of homework a

How long does homework typically

night.

take?
Does she/he get help with

-Yes, she struggles with math and ELA

homework? If yes, how does that

homework. I try and help her but she

work out?

usually gives up and wont finish it.

How does your child get along with

his/her teacher(s)? Is there anyone
at school who is important to

-She likes her teacher but doesnt like

him/her?

it when she gets in trouble from her.

Are you generally satisfied with

She has two good friends that are in

[child]s achievement in school? If

her class.

no, tell me what youre not satisfied

-I think she needs to be doing better

with

in math and ELA. Im concerned that

shes getting too distracted and isnt

Does [child] have any learning

remembering the information from

problems? If yes, what kind of

the lessons.

learning problems?

-She finds math, reading, writing, and

Why do you think he/she is having

spelling difficult. The multiple steps

learning problems?

required in these subjects seem to be

What has been done to address

too complex for her and she doesnt

PARENT INTERVIEW
these problems?

like practicing these skills. She has

gotten extra help from her teacher at

Has [child] ever received special

lunch to finish late assignments.

help at school? If yes, tell me more

about that: what kind of help? How

-She was in a pull out reading

often? Do you think this is enough?.

program twice a week in grade one

to work on pronounciation and

Has [child] ever been retained or

reading out loud.

held back a grade? If yes, when? For

what reason? How did they feel?
How did you feel?

-No

Do you have any other school

concerns?
-No
What else would you like to have
happen for [child] at school?

-More one-on-one help and extra

practice like she had with the reading
program in grade one. More time to
complete assignments.

Lets move on to talking about [child]s behaviour and emotions.

BEHAVIOURAL/EMOTIONAL
PROBLEMS

RESPONSES/COMMENTS

PARENT INTERVIEW
Does [child] have trouble paying

Yes

attention?
Yes
Does [child] have trouble staying
with one activity?
Its limited. She can get openly
What kind of self-control does [child]

frustrated when things get difficult

have?

for her and will talk to others when

she should be listening.

Not very well. She usually misses

How well does [child] follow

them and needs them repeated.

directions?
Yes, she gets angry and refuses to
work.
Does [child] get frustrated easily?
Yes, especially if shes doing
Does [child] get upset by abrupt

something she likes.

changes?

Sometimes, it depends if shes

feeling vulnerable or picked on. She

Are [child]s emotional responses

doesnt like being singled out or

unpredictable?

feeling stupid.

PARENT INTERVIEW
No, shes very sociable.
Does it take [child] a long time to
warm up to new situations or new
people?

-Hyperactive. Shes very energetic

and cant sit still very long. She

Tell me about [child]s activity level.

loves moving around.

Yes, sometimes. If shes bored, she

Is [child] impulsive? If yes, tell me

can start acting up (visiting, moving

about this impulsiveness.

around, talking too much)

-She feels good about herself in some

How does [child] feel about

ways but she feels stupid when it

himself/herself?

comes to reading and math. She can

get frustrated and down on herself.

-She will whine, get frustrated, and

sometimes shut down.
How does [child] behave when faced
with a difficult problem?

-Yes, gets worried about math and

ELA class. She gets worried about

Does your child seem unusually

getting into trouble and losing

anxious or worried about things? If

friends.

PARENT INTERVIEW
yes, tell me more about that.
-She can get sad during school
Has [child] ever seemed very sad or

sometimes when shes struggling or

depressed for a long period of time?

if she feels the kids are picking on

If yes, tell me more about that.

her. But she seems happy to be

around her friends.

Does [child] have any behaviour or

-Low frustration tolerance, can react

emotional problems at school? If

poorly to change and can get mad at

yes, what kind? Where? When? For

herself when she cant do as well as

how long? How often? What usually

her classmates in math and ELA.

happens at school? What has been

done to address these problems?
Her difficulties with math and ELA
What do you think is most important

and not being able to pay attention.

to address now?
Now Id like you to tell me about [child]s social relationships.
SOCIAL FUNCTIONING
How many close friends does [child]

RESPONSES/COMMENTS
2 in her class and another friend

have?

across the street.

I think so, she seems happy with

Do you think that is enough?

that.

PARENT INTERVIEW

How do you feel about his/her

Theyre nice kids. But she can be

choice of friends?

demanding towards them.

How does [child] get along with

-She often likes to do what she wants

his/her friends?

to and can get mad when they want

her to do something that she doesnt

Do other kids come to your house to

want to

play?

-Yes

Does [child] go to other kids

-Yes

houses?
-She gets along with most kids but
Does [child] have any problems

she has mentioned a few kids in class

getting along with other kids? If yes,

that she doesnt get along with.

tell me more about that.

Now Id like to talk about [child]s medical and developmental history.
MEDICAL, DEVELOPMENTAL, &

RESPONSES/COMMENTS

FAMILY HISTORY
Does [child] take any medications?

-No

If yes, please describe (what for,

name, dose, purpose, effect, doctor)

Has [child] experienced any severe

illnesses, accidents, operations, or
medical problems? If yes, please

-No

PARENT INTERVIEW
describe (type, age, treatment,
doctor).
-None
Does [child] have any allergies? If
yes, describe.
-No
Are you concerned about any aspect
of [child]s health?
-Yes
Does [child] eat well? Sleep well?
-Financial difficulties in the last
Were there any problems or issues

month of pregnancy (Steve lost his

with the pregnancy? Birth? Newborn

job and Christi got migraines and had

period? Medications? Smoking or

trouble sleeping), head stuck in birth

drinking alcohol? Stress?

canal, needed an ambulance and a

vacuum was used for the birth

Have you noticed any problems in

-No, developed normally

[child]s development? If yes, please

describe.
-Met all these milestones on time
Were any of the following difficult or
slow to develop for [child]?

PARENT INTERVIEW

Walking
Speaking
Toilet training
Motor control? (scissors, etc.)
Motor coordination? (jump,

skip, run)
Reading
Writing

Have any members of your family

had a problem similar to [child]s?
Tell me about that.

Steve had trouble paying attention

and struggled in math and ELA in

Has any relative of [child] have any

school

of the following problems?

Chronic diseases (diabetes)

Mental illnesses
Neurological disease (seizures)
-Steves uncle and cousin had
Mental retardation
Learning problems
schizoprenia, Christis grandpa had
Behaviour problems
Other problems?
SAD, and her sister had epileptic
seizures from age 13-30

Now I would like to talk about [child]s family relations and home situation.
FAMILY RELATIONS & HOME

RESPONSES/COMMENTS

SITUATION
Tell me about your family.

-Harlea is an only child. Steve works

long hours on weekdays and Christi

PARENT INTERVIEW
Is there anything about your home

works weekends. Dont see each

or living situation that is a problem

other as much as wed like, can

for you or the family (work situation,

create difficulties getting along.

financial problems, etc.)?

Financial issues (have to work a lot to

make enough money for cost of
living)

How does [child] get along with

members of the family in your
home? (father, mother, siblings,

-Harlea generally gets along with

grandparents, stepparents, etc.)

parents. Closer to Christi since shes

with her more. Gets along with

Have there been any recent major

relatives well.

changes or stresses in your family?

-No
Has anything happened to [child]
that was very upsetting to him/her?
-No
What are the rules & expectations
about behaviour in your home?
-respect others, use your manners,
What kind of discipline procedures

finish your homework

are used in your home?

-revoke privileges

PARENT INTERVIEW
What happens when [child] does
something good or special?
-give a reward/treat, praise
Does [child] have any special chores
or jobs at home?
-feed the cat, clean her room
Tell me about [child]s daily
activities and routines.
-Gets up for school, works on
homework after school or after
supper, read or play video games,
get ready for bed.

Id like to hear a little about [child]s interests and hobbies.

CHILD INTERESTS & HOBBIES
What does [child] do in his/her spare

RESPONSES/COMMENTS
-yoga, soccer, play with friends, art,

time?

crafts

Is [child] involved in any sports or

-baseball, soccer

extracurricular activities? Tell me

about that.
-likes swimming and most sports.
What activities does [child] like the

Doesnt like chores, homework,

PARENT INTERVIEW
most? The least?

cleaning, listening, being told what to

do

I have just a few general questions left.

CONCLUDING QUESTIONS
Overall what do you see as [child]s

RESPONSES/COMMENTS
-friendly, outgoing, creative, athletic

strong points?

And overall, what do you see as

-Lack of focus and concentration,

[child]s weak points?

difficulties with math and ELA, not

able to follow instructions, gets
frustrated and down on herself

Is there any other information about

Even though she seems pretty tough

[child] you think I should know?

on the outside, shes pretty sensitive

and emotional

What do you want from the

assessment?

To help her pay attention and to learn

better and remember what she
learns

Do you have any questions at this

point?
SUMMARY

No

PARENT INTERVIEW
I just want to briefly review what we discussed

Current functioning
Major problem areas
Competencies & strengths
Relevant circumstances

Do you have any concerns about reporting any of the information we

discussed today?
You may go home and rethink some of your answers, if you want to change
anything or discuss anything further you can email or call me.
From here I will go ahead with the assessment, and either the school or I
will contact you for our meeting to discuss the results and
recommendations for Olivia.
Thank you for coming today and if you have any other questions please
call me.