Family assessment and family interventions — OSCE

Candidate information (2 minutes reading, 12 minutes station)

You are the general paediatric registrar in an outpatient clinic. Tariq, aged 8, with ADHD on an optimised stimulant, is brought by his mother Aisha, who is raising him alone after a recent separation. His aggression at home has been escalating for four months. Read the presentation, then conduct the assessment and counselling. The examiner will role-play Aisha. [6] [12]

Candidate tasks

1. Take a non-blaming family assessment — establish the caregiving and recent-separation context, map the behaviour across home and school, and assess family functioning without locating the problem in Aisha. [10]
2. Name the likely family-level mechanism maintaining the behaviour and explain it to Aisha in plain language. [6]
3. Recommend and justify the first-line family intervention, explaining why parent training precedes a medication increase or family therapy. [4] [7]
4. Respond to the disclosure of family violence with the correct safety conversion and disposition. [9]

Marking anchors

Distinction (PASS)

• Performs a non-blaming family assessment and explicitly states that the behaviour is not Aisha's fault — naming the coercive cycle in plain language as the mechanism that maintains the aggression. [6]
• Recommends behavioural parent training (PMT, Triple P, Incredible Years or PCIT) as first-line and cites that it targets the coercive cycle, while continuing the ADHD treatment on its own merits; declines to escalate the medication or admit purely for behaviour. [4] [7]
• Converts the plan to a safeguarding and safety pathway when the violence is disclosed — screens Aisha alone, makes a same-day safety plan, involves child-protection and domestic-violence services, and states that joint family sessions are contraindicated while violence is active. [9]

Borderline

• Names parent training but cannot articulate the coercive-cycle mechanism or justify why it precedes family therapy, or recommends the safety pathway without a clear same-day plan. [6]

Fail

• Blames Aisha for the behaviour, agrees to increase the medication or admit purely to manage behaviour, or proceeds to "refer for family therapy and review in clinic" despite the disclosed ongoing violence. [9] [12]

Examiner prompt sequence

1. Opening (the mother): "Doctor, can you increase his medication or admit him? I can't parent him, and someone said it's my fault." — Candidate must reject the parent-blaming frame and name the coercive cycle. [6]
2. The mechanism probe: "So why does it keep getting worse when I try so hard?" — Candidate explains negative reinforcement in plain language. [6]
3. The intervention probe: "Shouldn't he have family therapy?" — Candidate defends parent training as first-line and explains the stepped ladder. [4] [7]
4. The disclosure: "His dad shoved me against the wall last week while Tariq watched." — Candidate must convert to the safeguarding pathway. [9]