case study

Case Study

The case study that I have chosen is titled Psychotic Student? found on page 159 of our text by Cipani and Schock (2010), which references a male adolescent who is enrolled in both a residential and day treatment program for emotionally disturbed children. He has been demonstrating a variety of undesired and disturbing behaviors as well as a decrease in his work production through avoidance tendencies which were simply ignored therefore leading to his disengagement in academic tasks. In an attempt to increase this individual’s task completion he was restricted from leaving his seat to engage in free time or preferred activities until a specific amount of his work was completed. This strategy was also carried over into his home environment and eventually began to show a gradual improvement in the amount of non preferred tasks being completed.

Diagnosis and Suggested Intervention

Due to the disruptive and avoidant behaviors being exhibited by this particular adolescent I would diagnosis him with a disruptive behavior disorder, precisely oppositional defiant disorder (ODD) (Burnette, 2013). It could still be difficult to make this definitive diagnosis without further assessing his history with regards to development, familial and environmental background experiences, potential trauma and patterns of behaviors. There could also be the possibility of co-occurring diagnoses such as depression or anxiety for this individual which would need to be assessed through further assessment techniques such as interviews, behavioral observations and self report scales. It is mentioned that the residential and day treatment programs that he is enrolled in are for severely emotionally disturbed children indicative of the fact that he may have experienced some level of trauma in the past contributing to some of the disruptive and noncompliant actions he displays (Burke, Rowe & Boylan, 2014). Individuals with ODD are typically diagnosed prior to the age of 8 and are known to demonstrate a pattern of defiant, disruptive and hostile behavior and can also be associated with antisocial behavior as well as an increase in risk for multiple forms of psychopathology (Burnette, 2013). This particular adolescent has become increasingly incompliant with completing tasks, whereas his behaviors are now effectively aiding in his escape and avoidance of tasks (Cipani & Schock, 2010).

A proposed treatment plan for this individual would consist of cognitive behavioral intervention and behavioral parent training, which can also be implemented by the staff or teachers within his residential and day treatment programs (Matthys, Vanderschuren, Schutter & Lochman, 2014). The combination of these two intervention methods have been found to be successful in the treatment of ODD in younger aged children through adolescence with improvements in attention, social reinforcement, emotional regulation, monitoring and supervision of behavior, social skills and social problem solving skills (Matthys, Vanderschuren, Schutter & Lochman, 2014).

Potential Barriers to Treatment

An evident factor that could impede the effectiveness of his treatment is his current environment and the potential lack of daily interaction and support from family members (Karver & Caporino, 2010). The inability for this adolescent to be attending a typical school placement within society because of his behaviors could also influence therapy in a negative manner. He is living in a residential setting with peers whom are possibly exhibiting some of the same if not more severe behaviors due to the primary focus of clientele being those that are severely emotionally disturbed. It is not referenced whether this particular adolescent’s behaviors or avoidance of task completion is evoked by specific situations or peers, which could impact his intervention strategies.

The individual’s cultural background could also present as a potential barrier to the efficiency of treatment. There isn’t any information provided on this adolescent’s cultural background but his and his family’s beliefs and traditions could be of significance in the outcome of therapy (Burke, Rowe & Boylan, 2014). To most efficiently treat this adolescent, his therapist and staff of providers within his programs would need to be culturally component when interacting with him, which would come from further exploration of his familial history prior to the creation and implementation of treatment. His treatment method and strategies would certainly require modifications in order to adhere to and respect his and his family’s cultural background.

References

Burke, J. D., Rowe, R., & Boylan, K. (2014). Functional outcomes of child and adolescent oppositional defiant disorder symptoms in young adult men. Journal of Child Psychology and Psychiatry, 55(3), 264-272. doi:10.1111/jcpp.12150

Burnette, M. L. (2013). Gender and the development of oppositional defiant disorder: Contributions of physical abuse and early family environment. Child Maltreatment, 18(3), 195-204. doi:10.1177/1077559513478144

Cipani, E., & Schock, K. M. (2010). Functional behavioral assessment, diagnosis, and treatment. [electronic resource]: a complete system for education and mental health settings. New York: Springer, 2010.

Imbach, D., Aebi, M., Metzke, C.W., Bessler, C. & Steinhausen, H. C. (2013). Internalizing and externalizing problems, depression, and self-esteem in non-detained male juvenile offenders. Child and Adolescent Psychiatry and Mental Health, 7(7), 1-8.

Karver, M. S., & Caporino, N. (2010). The use of empirically supported strategies for building a therapeutic relationship with an adolescent with oppositional-defiant disorder. Cognitive and Behavioral Practice, 17(2), 222-232. doi:10.1016/j.cbpra.2009.09.004

Matthys, W., Vanderschuren, L. J., Schutter, D. G., & Lochman, J. E. (2012). Impaired neurocognitive functions affect social learning processes in oppositional defiant disorder and conduct disorder: Implications for interventions. Clinical Child and Family Psychology Review, 15(3), 234-246. doi:10.1007/s10567-012-0118-7

World Health Organization (2003). Caring for children and adolescents with mental disorders. Retrieved from http://www.who.int/mental_health/media/en/785.pdf