Behavioral history taking (Proceedings)

The initial inquiry

This is a complaint, not a diagnosis.  The initial inquiry could be directed to anyone affiliated with the hospital – Receptionist, Kennel Personnel, Veterinary Medical Staff, Family Members, Visiting Students. 

• Be sure everyone knows the hospital policies regarding behavioral inquiries and appointments.

• Can be helpful to have major differentials on a list that is kept nearby.

• Generally not a good idea to give specific advice unless the owner makes an appointment

• Be prepared to make an appointment or refer.

• Tell owner what they can do while waiting for an appointment.

• Keep a daily log of the problem, Complete a questionnaire, Sharpen observational skills, Video-tape or Audio-tape the behavior, take precautions not to let the problem occur – board if necessary.

 The appointment: Usually includes all of the following

• Physical exam

• History taking

• Observations

• Medical diagnostic tests

• Behavioral diagnostic tests

• Diagnosis

• Prognosis

Treatment plan

• Explanation and practice

Follow-up

• Postcards, Telephone, Appointment

• If you never hear from the client again that does not mean everything worked out well

History taking

• Goal is to Identify the problem(s); the etiology and what is maintaining them.

• Basic information needed, much of which can be captured on a questionnaire

• Signalment

• Medical History

• Description of the behaviors

Circumstances in which behavior occurs

Environment – composition of household (people and pets), yard, daily activities (eat, drink, play, exercise, eliminate, etc. )              

Important to shape how the owners respond to your questions. Get them to describe the actual behaviors, not give a subjective interpretation of the behavior. E.g., “He was angry with me” vs “He put his head down and walked away”.  “He greets people aggressively” vs “He jumps on people and licks their faces”

A very valuable technique is to ask the owner to describe 24 hours in a typical day in the life of the pet – starting where s/he sleeps at night. This allows the clinician to ask specific questions that may be relevant to the problem presented and help develop a treatment and management plan. For example, the clinician may discover that the dog only urinates in the house in the morning – between the time the owner gets up and takes the dog out or only in the afternoon.

Obtain several detailed descriptions of the problem behavior. Often the most recent, most dramatic and first incidents are remembered in greatest detail. Find out what happened just before and just after the event.

Don't forget to ask what has been tried and what were the results.

Common, specific types of problems require detailed information unique to the problem. For example, separation anxiety, aggression.

Initially, it may be difficult to formulate a treatment plan. The owner may not have been able to provide enough information, the clinician may not yet figured out how to formulate a treatment and management plan, or laboratory and ancillary medical information is not available. Whatever the reason, just ask the client to return for a second appointment, generally in about a week. Be prepared to give the client some interim procedures and management advice, such as teach the dog to sit-stay, don't let the hair-pulling 3-year old play with the dog in an unsupervised situation, perhaps board the pet until the next appointment.  During the interim, the owners usually more carefully observe the pet and sharpen their observational skills. They may also be able to collect some baseline data pertaining to the behavior.

Boiler-plate outlines are available with behavioral advice.  Generally, these suggestions have to be adjusted for individual cases. Written information must accompany your verbal instructions. Clients cannot remember all the information you may have told them. They may not have even heard all of the verbal instructions.

Most chapters on behavior in major medical books as well as text books devoted to animal behavioral therapy have examples of questionnaires, question formats, and history taking techniques. These are a good starting point for developing your own style.