Case study

Case Study: Marcus

Background Information Marcus is a 25-year-old biracial individual (of Black and Hispanic descent) who was recently released from prison. His story embodies the consequences of systemic failures at multiple levels of society, particularly within the educational and judicial systems. Diagnosed early in life with attention- deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder, Marcus was placed in restrictive educational settings under an Individualized Education Program (IEP) that, rather than providing the support he needed, isolated him and exacerbated his challenges. His misdiagnosis and inappropriate medication led to side effects that made him appear lethargic, aggressive, and combative, contributing to a cycle of disciplinary actions and eventual expulsion from mainstream schooling. The lack of proper diagnosis, where he should have been identified as having mild autism and pathological demand avoidance, meant that Marcus did not receive the necessary interventions, such as Applied Behavior Analysis (ABA) therapy and inclusive educational settings. Instead, his school environment became increasingly restrictive, culminating in an alternative school setup where he was left to work alone on a computer, lacking necessary teacher support and appropriate peer interaction. Marcus has a supportive family unit, but they are economically disadvantaged and live in rent-controlled government housing that does not allow individuals with felony convictions to reside on the premises. His family is loving and supportive, but they do not have the housing or employment connections to provide some of the resources he needs. The School-to-Prison Pipeline Marcus's journey is a stark illustration of the school-to-prison pipeline, where punitive disciplinary actions replace supportive educational environments, particularly for students of color with undiagnosed or misunderstood conditions. His escalating behavioral issues, compounded by the lack of appropriate support, led to involvement with the juvenile justice system and eventual incarceration. Inside the juvenile detention center, Marcus faced new challenges: his fear and trauma led to substance abuse and increased violence. However, he did manage to receive his GED and some job training. Reentry Challenges Upon release at 18, Marcus faced significant challenges in reintegration. With limited family resources or positive community ties and carrying the stigma of incarceration, employment opportunities were virtually nonexistent. His attempts to adapt were further complicated by his misunderstood autistic traits, such as stimming, which often provoked fear or aggression from law enforcement and others unfamiliar with such behaviors. Interaction With Social Workers Throughout his tumultuous journey, Marcus encountered various social workers, from the school system to the prison, and upon reentry. Initially, social workers associated with the school may have contributed to the restrictive environment due to a lack of understanding of his actual needs. Later, in the juvenile detention and adult prison system, social workers focused on GED completion and job training but failed to address the root causes of his behavioral issues or his complex mental health needs.

Development Across the Lifespan Prenatal Stage Marcus’s mother was on Medicaid. Few providers in the community accepted Medicaid patients. She could not secure appointments with an obstetrician, so she relied on the expertise of primary care providers at a community health center. She often saw different providers and found the experience

Case Study: Marcus

challenging. She usually waited for hours for her scheduled appointment and would have to leave before seeing a provider to avoid missing work. She did not receive adequate health care services while pregnant with Marcus. Infancy Stage Access to quality healthcare remained an ongoing issue throughout Marcus’s infancy. He missed several immunizations. Concerns his mother had about some of his behaviors went unaddressed as a result. Toddlerhood Stage Marcus did not meet developmental milestones on time. He did not crawl until he was almost a year old and did not walk until he was nearly two. At three years old, Marcus could say only a few words and often threw tantrums because he could not communicate his needs. His family could not afford to send him to daycare, but they made a strong effort to expose him to as many other children as possible through parks and free library events. These outings often resulted in major tantrums and severe dysregulation. Sometimes dysregulation occurred during the event they attended. During one of these outings, the librarian witnessed Marcus in a severely dysregulated state and suggested that he no longer participate because it was disruptive to the others. Early School Age Marcus was removed from a general classroom and placed in a self-contained classroom, which was the most restrictive setting his school offered. His outbursts and aggression got worse, but his teachers were too caught up in the negative label placed on him before his diagnosis. Instead of empowering him with strategies for self-regulation, they sent him to the principal’s office or called his family to pick him up. Many of his teachers and school counselors thought he was acting out because he was not getting his way, when he was actually dysregulated. After all, the routine changed without notice. Middle Childhood Marcus learned that he could not go to his teachers or counselors for help. They seemed to only work with him when he was in trouble or too dysregulated to be in class. It also appeared they did not have time or patience for him when he asked to speak with them. Their notes were not accurate representations of Marcus, either. Rather than highlight his successes, they were focused on his indiscretion. The counselors seemed more concerned with collecting data to remove him from the school than with empowering him with skills. By the time Marcus was in middle school, he was placed in an out-of-district alternative educational setting. Doing so removed him from his community and the few peers he interacted with. The school was almost 40 minutes from his home, resulting in inconsistent, untimely specialized transportation. If his regular driver was out without notice, Marcus became dysregulated and would refuse to attend school. His family was unable to drive him, so he missed the entire day. He missed enough school that truancy got involved. Rather than viewing it through a restorative lens, the school punitively punished the family with a fine, and they incurred another fine for not being able to attend court due to a lack of transportation. At that point, Marcus no longer trusted anyone at the school, which led to significant challenges academically, socially, and emotionally. Early Adolescence By the time Marcus was a teenager, he was much taller and stronger than many of his peers. School staff were quick to blame him for negative peer interactions, even if he was trying to avoid them. His

Case Study: Marcus

stature, combined with his history of behavioral escalations, led to disciplinary referrals, suspensions, and poor academic performance. Marcus began to feel that the staff had given up on him. His family did not have the proper support at home to support his increasing behavioral outbursts, and they were unaware that free educational advocacy was available to them. The social workers at the school assumed that he was a student who did not want to work, was lazy, and unmotivated, and the teachers treaded lightly so as not to cause an outburst. No one recognized that he was not making eye contact, was rigidly stuck in routines, and stimmed when overstimulated. Instead, his behaviors were misconstrued as rude and disrespectful. Marcus also had several interactions with law enforcement that escalated extremely fast. Rather than recognizing that Marcus was neurodivergent and adjusting their approach, they encroached on his personal space as he was stimming out of fear. On one occasion, he injured an officer when the officer attempted to take Marcus’s backpack off his person after police were called to the school for him. Unable to see the officer behind him and not expecting to have someone in his personal space, Marcus became explosive and violent. Later adolescence Marcus was sentenced to a juvenile detention center after injuring the officer who attempted to remove his backpack. While there, he was restrained multiple times, witnessed violent attacks, and had been attacked himself. The environment triggered a trauma response, and Marcus always remained on high alert. To cope with the stress, he began self-medicating with drugs that were illegally brought into the detention center. They only made him more violent and explosive, as his inhibition was severely hindered. Staff at the facility labeled him as violent and explosive without recognizing the hallmark traits of Autism. Again, another systemic failure that perpetuated Marcus’ label. Marcus entered a job training program and eventually earned his GED. The facility offered smaller classes and individualized instruction that effectively supported his learning preferences. He excelled in the program thanks to his high IQ, but was observed to stim and appear very anxious with new and unexpected changes in the routines. On more than one occasion, Marcus refused to attend class because a substitute was present. Rather than see this as rigid, linear thinking, the facility claimed he was non-compliant and threatened to remove him from the GED program. Early Adulthood Marcus earned his GED and had job training, but his criminal history barred him from obtaining a job upon his release. His family was in government-subsidized housing, and his criminal history barred him from living there, too. His family did not have the proper support available to help transition him, either. Marcus did not know where he would live or how he would pay for it. The thought of going to a shelter reminded him of being at the facility and evoked panic and fear every time it was discussed.

Strengths Marcus has a very supportive, loving family who is willing to do whatever it takes to offer a roof over his head. He himself has a very high IQ and grasps concepts quickly. Marcus earned a GED and has job training. Housing Instability and Reentry Barriers Marcus is currently experiencing housing insecurity due to policies that prohibit individuals with felony convictions from residing in government-subsidized housing. His family, though loving and supportive,

Case Study: Marcus

lives in rent-controlled housing and cannot legally accommodate him. This has left Marcus without a stable place to live, and the prospect of entering a shelter evokes panic and fear due to past traumatic experiences in detention facilities. Marcus’s reentry into society has been complicated by his criminal record, which severely limits his access to employment and housing. Despite earning his GED and completing job training, Marcus has been unable to secure work. His high IQ and ability to focus intensely on tasks are strengths that remain untapped due to systemic barriers and a lack of inclusive employment opportunities for formerly incarcerated individuals. Mental Health and Misdiagnosis Marcus continues to take medication for a diagnosis that does not accurately reflect his needs. Initially diagnosed with ADHD and oppositional defiant disorder, Marcus was later understood to have mild autism and pathological demand avoidance, conditions that were overlooked throughout his childhood and adolescence. The misdiagnosis led to inappropriate treatment and disciplinary actions that exacerbated his behavioral challenges. His neurodivergent traits, such as stimming and rigid adherence to routines, are frequently misinterpreted as aggression or defiance, particularly due to his physical stature. These misunderstandings have led to escalated interactions with law enforcement and institutional staff, further traumatizing Marcus and reinforcing negative labels. Marcus has not received consistent or trauma-informed mental health care. His experiences in juvenile detention, including exposure to violence and restraint, have left lasting psychological scars. Without access to appropriate therapeutic support, Marcus struggles to manage anxiety, fear, and dysregulation, especially in unfamiliar or unpredictable environments. Social Isolation and Systemic Disconnection Throughout his life, Marcus has experienced social isolation, beginning with his removal from general education classrooms and placement in restrictive educational settings. These environments lacked peer interaction and teacher support, contributing to Marcus’s sense of alienation and mistrust of institutional systems. His interactions with social workers have been inconsistent and often focused on compliance rather than empowerment. In school, social workers contributed to punitive measures rather than advocating for inclusive support. In detention, the focus shifted to GED completion and job training, but his mental health needs remained unaddressed. Marcus’s family has remained a consistent source of emotional support, but they lack the resources and connections to help him navigate reentry. He has no extended community ties and limited access to advocacy or mentorship, leaving him vulnerable to further marginalization. Healthcare Access and Developmental Neglect From prenatal care through early childhood, Marcus experienced significant gaps in healthcare access. His mother, reliant on Medicaid, faced long wait times and inconsistent care, resulting in missed appointments and delayed developmental assessments. Marcus did not meet early milestones and exhibited behaviors that went unaddressed due to systemic neglect.

Case Study: Marcus

These early challenges set the stage for a lifetime of misdiagnosis and misunderstanding. Marcus’s neurodevelopmental needs were never correctly identified, and his behaviors were consistently pathologized rather than supported. He continues to face barriers in accessing healthcare that is culturally competent, trauma-informed, and responsive to his neurodivergence. Preferences, Priorities, and Goals for the Future Preferences Marcus wants to live independently and to secure competitive employment. Priorities Now a returning citizen, Marcus remains hopeful about his future. His high IQ and ability to focus intensely on tasks could be significant assets in the right environment. However, he continues to require support to navigate his reentry effectively, including finding employment and managing his mental health. Goals for the Future Marcus’s goal is to work full-time and live in his own apartment.

Conclusion Marcus's story is a poignant reminder of the gaps within our educational, judicial, and social systems, particularly for biracial individuals, individuals with disabilities, and those who come from marginalized communities. As he navigates his reentry journey, a holistic, supportive approach from social workers and community programs can lay the foundation for a more hopeful, stable future, aligning with principles of restorative justice and mental health support. The complex nature of Marcus’s experiences requires a nuanced and integrated approach across all levels of social work practice. By providing individualized support, fostering family and community connections, and advocating for systemic changes, social workers can offer Marcus the comprehensive support needed to navigate his reentry and work towards a positive, self-directed future.