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Compendium December 2008 (Vol 30, No 12)

Understanding Behavior — Behavior Assessment: History Forms and Interviews

by Sharon L. Crowell-Davis, DVM, PhD, DACVB

    When a pet has a behavior problem, most owners want to know two things: what is making their pet "misbehave," and how to stop it. However, before the veterinarian can arrive at a diagnosis and develop a treatment plan, he or she must collect specific information about the pet and its behavior. There are two primary modalities for collecting the necessary information: (1) communicating with people familiar with the animal and (2) observing the animal, either directly or on videotape. Both assessment modalities take time and patience. This article focuses on how to obtain a thorough, clinically relevant behavioral history from the client through the use of history forms, interviews, and the proper terminology.

    History Forms

    Gathering information from people who are familiar with the animal can be accomplished via direct interview, a written history form, or both. Having clients fill out a written history form in advance is much more time efficient for the practitioner than collecting all the information by interview. Another advantage to the history form is that clients have time to think about their answers and recall information that might not immediately come to mind when asked a verbal question. However, a disadvantage of the written history form is that clients may misinterpret the question being asked and give a less useful answer. Another disadvantage is that opportunities to pursue discussion of details that the veterinarian identifies as being relevant to the case are missed.

    Two major categories of history forms are necessary. The first is a general history form that includes questions on information that needs to be obtained regardless of the behavioral complaint. There should be a separate general form for each species seen in the practice, with questions appropriate to that species. Although there will be some overlap between forms, each should be species specific. For example, while questions about litterbox management are relevant for clients with cats, rabbits, or ferrets, these clients should not be given the same form because other topics (e.g., outdoor hutch maintenance) do not pertain to all three species. Also, it may be useful to adapt the general forms based on the location of the practice. Litterbox questions are usually not relevant for clients with dogs. However, some people—often those who live in apartments in high-rise buildings—do train their dogs to use litterboxes. Therefore, a practice in a large city may find it worthwhile to include questions about litterboxes on the form for dog owners, while practices in rural and suburban areas likely will not.

    The second type of history form asks questions that are specific not only to the species but also to the behavior problem. If a cat is eliminating outside the litterbox, extensive and detailed information about litterbox management, such as the size, shape, age, and material of each litterbox, is needed. However, if the cat's behavior problem is that it is attacking one of its owners, basic information about litterbox management (enough to ensure that litterbox management is reasonable and not likely to trigger a future elimination behavior problem), such as the number of litterboxes in the house and how often they are cleaned, is sufficient.

    Direct Interviews

    When an appointment for a behavior problem is made, it is beneficial if it can be arranged so that everyone who has significant involvement with the pet can be present. Sometimes this is not possible (e.g., one member of a couple cannot leave work). In such cases, arrangements for the individual who is not present to be accessible by phone can be helpful.

    The advantages of a direct interview include the willingness of many people to provide information that is of a sensitive but important nature in a verbal interview when they would not be willing to write the same information down. Another advantage of the direct interview is that the veterinarian has the opportunity to explain and clarify questions if the client does not seem to understand what is being asked. Also, areas of critical information can be pursued in detail as they are identified. The disadvantage to the direct interview is that it is time consuming. This fact can be exacerbated if the client has a tendency to digress at length on topics that are not really relevant or helpful in arriving at a diagnosis and treatment plan.

    When conducting an interview, it is usually best to begin with a detailed review of the behavior or behaviors that the client perceives to be a problem. While detailed information on other topics, such as the pet's daily routines, is necessary, clients are more focused on the main problem and are generally eager to write and talk about that first. Also, a clear understanding of the problem may affect decisions about what other information about the pet's environment is needed. For a recurring behavior, it is best to focus on one incident at a time. Clients generally recall the most recent incident best, so this is usually a good place to start. The interview can then lead back to earlier incidents—all the way back to the first incident if possible, although it is not uncommon for the details of the first incident to be unclear in the client's memory.

    Using a Combination Approach

    The advantages of the written history and direct interview can be used, and the disadvantages mostly avoided, by combining the two techniques. The client can be provided with history forms to complete at home and instructed to return the forms to the veterinarian before the interview appointment. The veterinarian can then review the written history at a convenient time and develop a set of questions to ask on topics that need clarification and elaboration during the direct interview, which can also be when the client brings the pet in for its behavioral appointment.

    The combination approach can help fit behavior appointments into a general practice. Except for simple, minor problems, behavior appointments, much like surgery, are time consuming and must be scheduled and charged for accordingly. If a client brings up a behavior issue during a pet's routine wellness examination or a visit for a minor illness or injury, a brief interview can quickly identify whether the problem has a simple answer or can be addressed with a client handout or whether it is a complex or serious problem that requires more time than has already been scheduled for that particular visit. If the behavior problem falls into the latter category, the client can be assured that the pet's problem is probably treatable but requires further information and time for an appropriate treatment plan to be devised. The client can then be given a copy of the history form and asked to schedule a behavior appointment at checkout. Alternatively, if the history form is available in one or more word-processing programs and the client prefers to fill it out electronically, the form can be sent to the client via email to be completed and sent back to the practice.

    Understanding Client Answers

    Pet owners are often inclined to interpret their pet's behavior in human terms and provide subjective information, such as statements that their pet's problem is that it is spiteful or jealous. Even terms such as aggressive and afraid can be highly subjective. In my own practice, the complaint of "aggression" has been applied to a wide range of specific behaviors. Sometimes a dog that is presented for aggression has a problem with jumping up on people and repeatedly soliciting petting and attention by barking and shoving its head under people's hands. If the dog has been engaging in these behaviors without growling, snapping, or biting and instead often exhibits play bows, the problem is not aggression. Instead, people with whom the dog interacts have unintentionally operantly conditioned these behaviors by giving the dog social attention when it behaves in this manner.

    Another example derives from the phrase gets mad. Following are three examples of detailed descriptions that were obtained from clients who complained that their dog "got mad" at them when they were near its food. They also interpreted the dog's behavior as meaning that the dog thought they were going to try to take its food away from it.

    1. If I pet him while he's eating, he'll crouch down, kind of cringe away, lower his tail, and growl at me.

    2. If I come anywhere near him while he's eating, he'll just walk away. He usually won't eat if anyone's near his bowl, and he definitely won't eat if you're standing right near him.

    3. Once I put the food bowl down, I leave the kitchen. If I don't, my dog will run at me, growling and barking, sometimes snapping. He's bitten me twice when I didn't leave fast enough.

    These three dogs obviously have three very different behavior problems and require three very different treatments.

    When clients use subjective terms in discussing their pet's behavior problem, I ask them to clarify, using wording such as, "Can you tell me what your pet actually does that makes you think it is afraid [mad, spiteful, angry, jealous, timid, etc]?" Most clients then answer with as clear a description of what the pet does as they can recall. At this point, the veterinarian may be able to identify areas in which the client needs to be educated about what to observe about the pet. For example, the client may have no recollection of the pet's ear position during any situation and be unaware that this is important information. A few clients persist in using subjective terms. In these cases, further clarification of the question may be necessary, such as, "Imagine that the incident in which Rex was spiteful is on TV. Can you describe exactly what Rex and everyone else in the scene is doing?" Regardless of how questions need to be worded to obtain empirical descriptions of the physical movements and vocalizations of all parties involved, it is critical that such descriptions be obtained if an accurate diagnosis is to be accomplished.

    Even terms that seem empirical to veterinarians because we have been taught a specific definition are not necessarily understood in the same way by the client. Spraying is the term used for the behavior in which a cat positions its hindquarters, specifically its anus and perineal region, close to a vertical surface, sticks its tail up in the air at a 90° angle to the surface on which it is standing or arches the tail to the side in a hook shape, and ejects a small amount of urine onto the vertical surface. While this is the standard term in behavioral and veterinary nomenclature, I have had clients who use the term to refer to any excretion of urine by a cat. Thus, they may say that their cat sprays all over the house, but when they are asked where the urine spray is found; in what quantities it is found; and, if they ever see the cat spraying, what position the animal is in, it is clear that the cat is in a squatting position whenever the client observes it "spraying," large volumes of urine are passed, and the urine is usually on the carpet or another horizontal surface. This cat is clearly eliminating outside the litterbox, but it is not spraying. Conversely, some people are not familiar with the term spraying. They will state that their cat urinates outside the litterbox, but questions about exactly what their cat does, where it urinates, and how much urine it produces reveal that the cat backs up to a wall, sticks its tail up in the air, and sends a small jet of urine onto the wall.

    It is also important for veterinarians to be clear in the terms they use. Just as vomiting, diarrhea, and coughing are clinical signs, not diagnoses, biting, urinating outside the litterbox, and destroying household items are complaints, not diagnoses. It is the cause of the undesirable behavior that is the diagnosis.

    Conclusion

    Clear, specific information about the pet's behavior is only the first step toward arriving at an accurate diagnosis and understanding how to best help the owner implement a treatment plan. Equally specific information about the owner's interaction with the pet is also necessary. For example, if a dog has separation anxiety, the details of treatment and management will be different if the person to whom the dog is attached is a flight attendant who is home for several consecutive days, then gone for several consecutive days; an office worker who is gone Monday through Friday from 7:30 am to 5:30 pm; or someone who is home most of the day. The different categories of information that need to be obtained in each case and their relevance to developing treatment plans will be discussed in the next article.

    This article is the first in a series about evaluating patients for behavior problems. Future articles will discuss more detailed aspects of taking the patient history, evaluating the patient's environment, and observing the patient.

    Dr. Crowell-Davis discloses that she has received financial support from CEVA Animal Health and from Merial.

    NEXT: Year-End Index (December 2008)

    didyouknow

    Did you know... 61% of dog owners in the US heed the recommendation from the Humane Society of the United States to keep a radio or television on in the house, to give their dog the opportunity to have visual and auditory stimulation.Read More

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