Case Study Psychology

COU 680 Week Three Case Study: Deena Deena is a three-year-old Caucasian female who was brought into therapy by her foster mother, Jamie, as a result of extreme emotional outbursts and a struggle to connect. Deena was removed from her birth mother’s care at 18 months of age as a result of extreme abuse and neglect, and has now moved into her sixth foster home since entering foster care. She now lives with her foster mother, Jamie; foster father, Jesse; and their biological son, Max, age seven. Deena is presenting with an array of developmental, systemic, and relational deficits related to many of her unmet needs. Of particular concern are the delays related to language acquisition.

History Deena was born in rural Alabama. Her single, 18-year-old Caucasian mother raised Deena alone after her boyfriend Lewis “hit the road” when he learned of the pregnancy. We know little about Deena’s first year of life, but do know that the Department of Human Services (DHS) initiated an investigation just after Deena’s first birthday. Although initial complaints of suspected abuse and neglect went unsubstantiated, a trip to the emergency room (ER) ultimately resulted in a DHS decision to remove Deena from her birth mother’s care. In the report it was disclosed that Deena’s birth mother had been routinely using sedatives in place of babysitters. Whenever Deena’s birth mother wanted to go out with friends, she administered sedatives to Deena, who would fall into a deep sleep while her mother “was out partying.” One morning, however, Deena did not wake. Terrified, her mother rushed Deena to the ER and revealed her strategy for “childcare.” In accordance with state child protection laws, the physicians immediately notified DHS. This incident, coupled with prior unsubstantiated abuse complaints, resulted in DHS immediately removing Deena from the home and placing her into foster care. Rather than fighting this action, Deena’s birth mother seemed relieved and did not contest the decision. Within six months, she voluntarily surrendered her parental rights. Deena arrived in her first foster home at 18 months of age and stayed less than a month. The first set of foster parents described Deena as inconsolable, highly emotional, and so “out of control” that they felt unequipped to provide adequate care for her. Over the course of the next 15 months, Deena would be placed in—and soon removed from—four additional foster homes. It was not until she lived with Jamie and Jesse that Deena experienced any consistency of care. Deena has now been with them for three months.

Developmental Considerations From a developmental perspective, Deena manifested some delays, which were unsurprising given her life history. For example, in the context of psychosocial development, Deena struggled with the development of trust in herself and others, and she also exhibited low tolerance for frustration. Additionally, Deena displayed some cognitive delays, most clearly evident with regard to language acquisition.

Relational Considerations From a relational perspective, Deena’s early relationship with her primary caretaker had been insufficient at best. Rather than offering the consistent and loving care and attention needed to build strong attachments, Deena’s mother remained inconsistent, often inattentive, neglectful, and

sometimes abusive. When removed from her birth mother’s care, Deena was already at risk for attachment-related difficulties.

Multicultural Considerations Although they all identified as Caucasian, differences related to socioeconomic status may have contributed to the difficulties early foster parents had in relating to Deena. The foster families benefitted from the privilege afforded by a middle-class lifestyle and had no real understanding of the impact of poverty on Deena’s birth mother. They had no real understanding of how poverty, both in terms of financial and social capital, might contribute to a mother’s decision to choose inexpensive sedatives purchased on the street over a human babysitter. This may have resulted in them villainizing Deena’s birth mother and having great difficulty in responding to Deena’s emotional distress over her separation from her mother. Ultimately, Deena experienced foster care as a series of changes in caregivers that prevented her from forming healthy or stable relationships.

Diagnosis Diagnostically, Deena is displaying symptoms consistent with reactive attachment disorder (RAD; American Psychiatric Association [APA], 2013), which is etiologically related to the lack of consistency and care in her early relationships (RAD Criterion D). Deena is also presenting with symptoms consistent with a diagnosis of post-traumatic stress disorder (PTSD; APA, 2013).

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Washington, DC: Author.