CASE STUDYASSIGNEMNT 1
Case Study Theo
Samantha Deenihan
School of Clinical Mental Health Counseling Liberty University
Client Concerns
Symptoms Behaviors Stressors
Distracted Not completing his work in
school,
School setting, car accident
Restless Grades going down in
school, cannot sit still
School setting, car accident
Nightmares Waking up in the middle of
the night, difficult to fall
back to sleep
Memory of the car
accident
Withdrawn Is not participating in
activates he used to enjoy,
not doing well in school,
leaving service for 3 hours
at a time
Car accident, being
stressed and scared
Lost interest in activates Not playing video game
mom got him, not talking
to friends,
Parents yelling at him
about playing video games
then got in the car accident
Scared Not participating in fun Fear something bad is
CASE STUDYASSIGNEMNT 2
activities, helping mom
and dad see for cars
going to happen, scared he
was going to die
Fidgeting Distracted in school Thinking something bad is
going to happen, school,
Paranoid/ Worry Sitting in the middle of the
back seat to help mom and
dad look for cars
Car accident, parents
driving in 2 lane roads
Assessment
Theo is a 6-year-old boy who has been having some behavioral and emotional difficulties
that have been due to a car accident with his parents six months ago. It has been noted that he
is having sudden changes in mood, frequent nightmares, very low involvement in activities that
he likes, fidgeting, and being distracted in the classroom. A traumatic experience I would want
to evaluate him for PTSD. But I would be specific with the tool and use the one that is signed for
helping diagnose PTSD in children. The Child PTSD Symptoms Scale (CPSS-5) Is a 27 item
measure for evaluating PTSD symptoms in children (Gillihan et al,. 2013).
Diagnostic Impression
Theo is presenting with symptoms that correlate with Posttraumatic Stress Disorder,
(F43.10). Feel has been showing symptoms since this traumatic event of the car accident with
his parents six months ago.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: disorder name
and code number
Client’s Signs/Reported Symptoms:
Criterion A: In children six years and younger,
exposure to actual or threatened death,
serious injury, or sexual violence in one or
more of the following ways
1. directly experiencing the traumatic
event or events
2. witnessing in person the event or
events as it occurred to others,
Theo was in the car with his parents when
they were in the car accident six months ago.
The car was flipped over and his parents
broke ribs and had concussions while he just
had bruises no serious injuries.
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especially primary caregivers
3. learning that the traumatic event or
events occurred to a parent or a
caregiving figure
Criterion B: Presence of one or more of the
following intrusion symptoms associated with
the traumatic event or events, beginning after
the traumatic event or events occurred
1. recurrent, involuntary, and intrusive
distressing memories of the traumatic
events
2. recurrent distressing dreams in which
the content and or effect of the dream
are related to the traumatic events
3. dissociative reactions in which the
child feels or acts as if the traumatic
event was reoccurring such trauma
specific reenactment may occur in
play
4. intent or prolonged psychological
distress at exposure to internal or
external cues that symbolize or
Theo is having reoccurring memories and
dreams about the car accident. Theo is also
acting out the car accident while using toy
cars. He is also sitting in the middle seat so he
can help his parents see cars coming so they
don't get into another accident. It has also
been reported that he is displaying
restlessness fidgeting in difficulty sitting still.
He is also not wanting to engage in video
games he has mentioned that he thinks that
something bad would happen if he engages in
video games.
resemble an aspect of the traumatic
events
5. marked psychological reactions to
reminders of the traumatic events
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Criterion C: One or more of the following
symptoms representing either persistent
avoidance of stimuli associated with the
traumatic event or negative alterations in
cognitions and mood associated with the
traumatic event, must be present, beginning
after the events or worsen after the events
Persistent avoidance of stimuli
1. avoidance of or efforts to avoid
activities, places, or physical
reminders that aroused relocations of
the traumatic event
2. avoidance of or efforts to avoid
people, conversations, or
interpersonal situations that arouse
recollections of
the traumatic events
Negative alterations in cognitions
3. substantially increased frequency of
negative emotional states
4. marked diminished interest or
participation in significant activities,
including constriction of play
5. socially withdrawn behavior
6. persistent reduction in expression of
positive emotions
Theo is no longer playing or singing with his
friends at church, does not engage in any
activities that involve cars he tries to avoid
riding in cars. He is also no longer playing
video games because he was playing video
games while he got into the car accident. He's
withdrawing himself from individuals at
school as well and not showing positive
emotions.
Criterion D: Alterations in arousal and
reactivity associated with the traumatic
event, beginning or worsening after the
traumatic event occurred, as evidenced by
two or more of the following
1. irritable behavior and angry outbursts
typically expressed as verbal or
physical aggression towards people or
objects
2. hypervigilance
3. exaggerated startle response
4. problems with concentration
5. sleep disturbance
Theo is showing us irritable behavior
throughout the day and playing aggressively
with his choice. He is also showing
hypervigilance in the car, and having trouble
concentrating in school. He is also having a lot
of nightmares where he is wanting a caregiver
to stay with him until he falls back to sleep.
Criterion E: The duration of the disturbance is The car accident happened six months ago,
CASE STUDYASSIGNEMNT 5
more than 1 month then Theo started showing these symptoms
after.
Criterion F: The disturbance causes clinically
significant distress or impairment in
relationships with parents, siblings, peers, or
other caregivers, or with school behavior
Theo has somewhat of a strained relationship
with his parents no well they are in cars. He's
also not doing the best in school his grades
are slipping
Criterion G: The disturbance is not attributed
to the physiological effects of a substance or
another medical condition
It was noted that Theo is not taking any
medications and does not have any other
medical conditions
Other DSM-5-TR Conditions Considered
F43.0 Acute Stress Disorder
While I was reading Theo’s intake, I also was considering acute stress disorder.
Many of the symptoms that Theo has described or have been described
correlate with acute stress disorder like experiencing the traumatic event,
witnessing the event happened to others, having those distressing memories,
reoccurring dreams, hypervigilance etc. But the duration of the symptoms is
what was different at the moment of the diagnosis.
F41.1 Generalized Anxiety Disorder
I also considered generalized anxiety disorder for Theo’s diagnosis. He was
showing a lot of the symptoms like difficulty sleeping, excessive worry and not
being able to control the worry, having anxiety about going in cars. But
generalized anxiety disorder would not fit all of his symptoms.
Developmental Theories and/or Systemic Factors
Theo would be in Eric Erickson’s theory of psychological development in the fourth
stage. This stage is industry versus inferiority. During this stage it's when children are developing
CASE STUDYASSIGNEMNT 6
a sense of competence and being able to identify by comparing themselves to other peers
(Cherry, 2024). According to Maree (2021), the more the children are encouraged and praised
by others the higher chances of getting a sense of self belief and proficiency. In terms of Theo, it
seems that he has focused primarily all of his attention in helping his parents when they're
driving in the car to avoid another accident and that is when he's also developing these skills to
help his parents drive. So, they're rooted from a traumatic experience.
Multicultural and/or Social Justice Considerations
Theo is still too young to know how to cope with these feelings alone. He is also too
young to fully understand what he is going through. He is not seeking that connection with
other kids or anyone or talking through his emotions and thoughts to help heal himself from
this trauma event (Bogdan et al., 2022). Since he is still a child he needs help with these tasks.
Theo is also a 6-year-old African American boy whose parents are a part of the Jehovah
Witnesses religion. Theo is not baptized yet; his mother would like him to make that decision
when he is old enough. But this religion could play a part in how he copes and sees the world.
Treatment Recommendations Key
Issues for Treatment
•Mood Changes
•Reliving Trauma
•Fear/scared
Recommendations for Individual Counseling
For Theo one of my first recommendations would be Eye Movement Desensitization and
Reprocessing (EMDR). This therapy can help children like Theo with PTSD. During this process a
child recalls the traumatic event while being tapped on the sides of their body or making eye
CASE STUDYASSIGNEMNT 7
movements (Karadag et al., 2020). This bilateral stimulation is t to distract from the memory's
intensity and replace it with a less overwhelming memory. This therapy can help Theo improve
his behavior, get better sleep and have less nightmares, improve his academic performance etc.
My concern with this is that his mother noted that insurance will be covering only 6 sessions so
this may not be enough. EDMR can show improvement in as little as one session but can need 8
or more sessions to provide the best results (Guerriero, 2023).
Another recommendation that I have is Cognitive Behavioral Therapy (CBT).
Cognitivebehavioral therapy is a form of psychotherapy where the techniques are used to help
by modifying distorted or negative thinking, reactions and behaviors. With Theo CBT- will help
with the cognitive and emotional managing of the accident. CBT will also help Theo by reducing
the symptoms he is displaying such as fear, stress, poor social interaction, restlessness, among
others.
Medication could be a consideration for Theo. According to Donnlly (2023) SSRIs may be
effective in treating children’s PTSD, but they could experience poor sleep, irritability and
inattention. Some medications that could be taken are Sertraline, Citalopram, and Fluoxetine.
Because there’s almost no evidence for other antidepressants in childhood PTSD, we rarely
prescribe SNRIs, MAOIs, TCAs, trazodone, nefazodone, or mirtazapine (Tein, 2015).
Specific Considerations
Theo experienced trauma in his life. In Theo’s case, he is presenting feelings of guilt and
symptoms of fear, anxiety and poor social interaction. In a trauma- informed approach with a
client like Theo you want to create a safe and supportive environment, actively listening to their
experiences, validating their feelings, allowing them to set the pace of disclosure, using
ageappropriate language, etc. You want to make them feel safe and heard while they are
CASE STUDYASSIGNEMNT 8
disclosing to you. Collaborating with a child client during treatment planning is extremely
important. It allows for a more personalized and effective treatment plan by incorporating the
child's perspective, needs, and understanding of their situation. It gives the child a bit of control,
so they feel as though they are also in charge of what they can do with their life. Some barriers
that I may face when working with Theo are, developmental. Theo may not have language or
cognitive skills to share with me all that he needs too. That ties into the communication
difficulties because he may not be able to verbally communicate how he is feeling, which then
we can use visual aids
etc.
CASE STUDYASSIGNEMNT 9
References
Bogdan, E. A., McDonald Harker, C., Bassi, E. M., & Haney, T. J. (2022). Holding together after ‐
disaster: The role of social skills in strengthening family cohesion and resilience.
Family Relations, 72(4), 2194-2214
Cherry, K. (2024). Industry versus. Inferiority in Psychosocial Development.
Donnelly CL. (2023). Pharmacologic treatment approaches for children and adolescents with
posttraumatic stress disorder. Child Adolesc Psychiatr Clin N Am. 2003 Apr;12(2):251-
69. doi: 10.1016/s1056-4993(02)00102-5. PMID: 12725011.
Gillihan, S. J., Aderka, I. M., Conklin, P. H., Capaldi, S., & Foa, E. B. (2013). The Child PTSD
Symptom Scale: psychometric properties in female adolescent sexual assault survivors.
Psychological assessment, 25(1), 23–31. https://doi.org/10.1037/a0029553
11
Case Study Assignment:
Theo
References
American Psychiatric
Association.
(2022).GDSM-5-TR".
CASE STUDYASSIGNEMNT 10
American Psychiatric
Association. Cherry, K.
(2022, December 29).
Industry vs. Inferiority
Is Stage Four of Psychosocial
Development. Verywell
Mind. https://www.verywell
mind.com/industryversusinf
eriority-2795736#:
~:text=Industry%20v ersus
%20inferiority%
20is
%20the
CASE STUDYASSIGNEMNT 11
Child PTSD Symptoms
| CPSS-5 | Greenspace (US).
(2020, November 17).
https://
greenspacehealth.com /en-
us/child-ptsdsymptoms-
cpss-5/ #:~:text=Th e
%20Child%20PTSD%
20Symptom%20Scale EMDR
for children – PTSD UK.
(2023).
https://www.ptsduk.or
g/emdr-for-children/
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Guerriero, C (2023, January
27). How long does EDMR
Treatment Take to Work?
Therapy Evolved.
Guerriero, C. (2023). How long does EDMR Treatment Take to Work? Therapy Evolved
Karadag M, Gokcen C, Sarp AS. (2020). EMDR therapy in children and adolescents who have
post-traumatic stress disorder: a six-week follow-up study. Int J Psychiatry Clin Pract.
2020 Mar;24(1):77-82. doi: 10.1080/13651501.2019.1682171. Epub 2019 Oct 30. PMID:
31663396.
Maree, J. G. (2021). The psychosocial development theory of Erik Erikson: Critical overview.
The Influence of Theorists and Pioneers on Early Childhood Education, 191(7-8), 119-
133
Tien, E. (2015). Medications for Childhood PTSD: It’s All Off-Label. Carlat Publishing.
