Conflict During Physical Examination with Family Present
Yes, it is not uncommon for conflict to emerge between a child and their relative during a physical examination, particularly when the child is an adolescent or when there are underlying family interactional problems. 1
Expected Dynamics During Family-Present Examinations
Conflict emergence is a recognized phenomenon during clinical assessments. The American Academy of Child and Adolescent Psychiatry explicitly notes that "it is not uncommon for conflict to emerge in the session while the clinician gathers history," and at such points, behavioral problems are not merely reported but actively demonstrated. 1
Age-Related Considerations
Adolescents are particularly likely to argue or express disagreement with parents during examinations, as they may have conflicts they cannot easily divulge with parents present. 1
Younger children may exhibit behavioral disruption rather than verbal argument, which is why the American Academy of Child and Adolescent Psychiatry recommends having games or activities present to decrease the likelihood of behavioral disruption during family interviews. 1
Clinical Context Matters
The likelihood of argument increases when:
Interactional problems exist in the family history, such as oppositional behavior, running away from home, or family arguments preceding the visit. 1
There is hostile family communication, which the American Academy of Child and Adolescent Psychiatry identifies as a familial risk factor for psychiatric disorder. 1
Discrepant views exist between family members about the child's clinical problems, which often emerge more sharply during joint interviews. 1
Clinical Utility of Observed Conflict
Rather than being problematic, conflict during examination provides valuable diagnostic information. The American Academy of Child and Adolescent Psychiatry emphasizes that when conflict emerges, "the antecedents and consequences of behavioral problems are not merely reported but demonstrated," allowing clinicians to understand the meaning and function of behaviors in relationship to the child's family. 1
What Clinicians Should Observe
The reciprocal nature of family influences: family interaction may be associated with symptoms in the child, but the child's symptoms may also provoke family responses. 1
Patterns of problem resolution (or lack thereof) become evident through real-time observation. 1
Common Pitfall to Avoid
Do not suppress or prevent conflict from emerging during the examination. The American Academy of Child and Adolescent Psychiatry recommends that clinicians "manage flexibly the simultaneous tasks of history taking and observing family interaction," recognizing that acute disagreements, while potentially preventing systematic data gathering, provide "powerful experiential process data." 1