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Case Study: Theo 1
Case Study: Theo
School of Behavioral Sciences, Liberty University
COUC 546
2025
Author Note
Case Study: Theo 2
Client Concerns
Symptoms Behaviors Stressors
Nightmares Dreaming about the car
accident, unable to fall back
to sleep
Due to the car accident
Restless Fidgeting, unable to sit still in
and out of school
Stress from the accident
Withdrawn Has stopped playing video
games and is with friends at
school
“
Stressed and scared The client begins to scream
and covers his head when
driving on specific roads
Feels terrified to drive down a
two-way lane, which is where
the accident occurred, but
feels okay when driving on
the interstate
Distracted The client has gone from an
honor roll student to having
difficulties completing
classwork, following
instructions, and going to the
bathroom often
“
Assessment
An assessment that can create a bridge for Theo’s symptoms and his diagnosis is by using the
Child Post Traumatic Stress Disorder Symptoms Scale (CPSS-5). Memarzia et al. (2024) uses
the Child Post Traumatic Stress Disorder Symptoms Scale to asses children who have suffered
from a single-event trauma such as motor vehicle collisons or assault. The CPSS-5 consists of
twenty-seven items that are a semi-structured interview. Seven of the twenty-seven items asses
the effects that the traumatic even is having on the daily functioning of a child and the remainder
twenty items assess DSM-5 PTSD symptoms (Memarzia et al., 2024).
Case Study: Theo 3
Diagnostic Impression
The symptoms that Theo has been presenting for the last six months meet the criteria for
the diagnosis of Post Traumatic Stress Disorder, corresponding ICD-10 code F43.10. Theo meets
several criteria listed for children aged six or younger.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Post
Traumatic Stress Disorder, F43.10
Client’s Signs/Reported Symptoms:
Criterion A: Exposure to or threatened death,
serious injury, or sexual violence, one or more
The client directly experienced the motor
vehicle collision (traumatic event)
Criterion B: Intrusion symptoms associated
with the traumatic event, one or more
Recurrent and involuntary memories of the
traumatic event are visibly seen through
Theo’s action of playing with the cars,
reenacting the accident, recurring distressing
dreams about the event, and intense
psychological distress when on a two-way
road, which resembles where the accident
occurred
Criterion C: Persistent avoidance of stimuli
relevant to the event or negative alterations in
cognitions and mood that are associated with
the event, one or more
Theo’s parents avoid two-way roads due to
the excessive screaming and covering his
head. Theo has not played his new video game
because he feels as if it was his fault, has
feelings of guilt about why the accident
occurred, has no interest in playing with other
children, and is withdrawn
Criterion D: Altercations in arousal and
reactivity that are associated with the event,
these symptoms began or worsened once the
event occurred, two or more symptoms
Hypervigilance when in the car to ensure
another accident doesn’t happen, having issues
concentrating at school or church, difficulty
staying asleep due to nightmares
Criterion E: The duration of the disturbance is
more than a month
The client has been having these symptoms
for the last six months
Criterion F: The disturbance is causing
distress or impairment in relationships or
school behavior
The client went from an honor roll student to
struggling to complete classwork, distracted,
and hard to sit still, with no desire to see or
play with friends
Criterion G: The disturbance isn’t caused by The client’s symptoms didn’t exist until the
the use of substances or another medical
condition
car accident
Case Study: Theo 4
Other DSM-5-TR Conditions Considered
Another diagnosis was considered for Theo, which closely aligned with and met multiple
criteria of the diagnosis—Acute Stress Disorder, Corresponding ICD-10 code F43.0. Many of the
symptoms required to meet the criteria for Post Traumatic Stress Disorder are similar to those of
Acute Stress Disorder, such as how the traumatic event occurred, intrusion symptoms, negative
mood, avoidance symptoms, and arousal symptoms. However, Theo’s symptoms do not meet
criteria C, which states that the disturbance has to be at least three days but only up to a month.
Theo has been having symptoms since the car accident, six months ago, with new symptoms
appearing a month ago.
Developmental Theories and/or Systemic Factors
Using Piaget’s Cognitive Development Theory helps to understand where Theo is in his
developmental stage. Piaget states that young infants process new information by balancing what
they already know within the existing mental schemes and accommodating that new information
into new mental schemes (Malik & Marwaha, 2023). Piaget divided child development into four
stages: Sensorimotor ages zero to two, Pre-operational ages two to seven, Concrete Operational
stage ages seven to eleven, and Formal Operational stage ages twelve and older (Malik &
Marwaha, 2023). Theo is currently in the Pre-operational stage. In this stage, he can use
symbolic thought and language and has learned to imitate and pretend to play (Malik &
Marwaha, 2023). While in this stage, Theo deals with egocentrism; he is unable to see that others
can think differently from them, and everything that occurs around them, whether good or bad, is
directly linked to them (Malik & Marwaha, 2023). This is seen by Theo thinking that it is his
fault that his father crashed, when in reality it was caused by a drunk driver who was driving
recklessly.
Multicultural and/or Social Justice Considerations
Since discussing that Theo is in the Pre-Operational stage of Piaget's Cognitive
Case Study: Theo 5
Development Theory, it creates an understanding that there are other areas of his life that he still
doesn’t understand or hasn’t developed, such as his religious beliefs, finances, family
background and history, and potentially even his ethnicity or racial identity. However, there is an
understanding that he is being impacted by the recent traumatic experience that put his well-
being in danger. When exposed to a traumatic event at such an early age, it creates the possibility
of affecting the neurobiological development that is used to identify threats and respond to them
(McLaughlin & Lambert, 2017). This can be seen in Theo’s sudden change in behavior when
being in the car after the accident; he is hypervigilant and becomes overstressed when on specific
roads similar to where the accident occurred. Although the hypervigilance could technically be
seen as a positive symptom, like being hypervigilant and safe whenever he begins to drive, it can
also lead to mental health disorders, such as his PTSD (McLaughlin & Lambert, 2017). If his
PTSD is consistent and isn’t resolved, as he grows older, it can create specific thinking that
provokes him to be terrified to drive at all or to drive on roads that resemble the traumatic event.
Treatment Considerations
Key Issues for Treatment
●Fear of death due to the traumatic event
●Withdrawn from social activities and academic
●Aggressive playing, simulating the event
Recommendations for Individual Counseling
Based on Theo’s extensive symptoms that have manifested after having the motor vehicle
collision six months ago, and the newer symptoms that have formed over the last month. It is
evident that he is struggling to move past the traumatic event and instead is being negatively
impacted by it. There is a Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) that focuses
on treating trauma and traumatic grief in children and adolescents (de Arellano et al., 2014).
Based on Theo’s development, he didn’t have any previous reported symptoms, behaviors, or
stressors up until the traumatic event occurred. Before the event, he socialized well at his church
Case Study: Theo 6
and school, had no nightmares, would play video games, and had no fear of being on a two-lane
road. TF-CBT is used to reduce the post-traumatic stress disorder symptoms that Theo is having
by considering the role of his caregiver and the impact on development, and the child’s ability to
regulate emotions and coping capabilities (de Arellano et al., 2014). The length of administering
the TF-CBT consists of twelve to sixteen sessions (de Arellano et al., 2014). Theo’s mother has
expressed some hesitancy about continuing services once the six sessions that her insurance
covers are over. Being able to sit and discuss Theo’s potential progress can create a timeline of
how many sessions are needed and the necessity of following through with the treatment plan.
Another recommendation of a form of counseling that can help Theo is Play therapy.
According to Gupta et al. (2023), play therapy is a form of psychotherapy that consists of using
play and other creative activities to help small children effectively express thoughts, emotions,
and work through challenges. Play therapy can address various issues such as behavioral issues,
anxiety, depression, relationships with others, and trauma (Gupta et al., 2023). After Theo began
withdrawing and having no desire to play with other classmates, he began to play by himself
often. At school, he was seen playing with cars, mimicking a car collision, and throwing a car
around, exactly what he went through with the collision. He could benefit from play therapy due
to his young age and potentially limited ability to express and understand the situation and why it
occurred. Through small bits of exposure and creating understanding through play therapy, Theo
can understand that he wasn’t at fault for the accident but instead the drunk driver.
Based on Theo’s age, I would not recommend medication. Although he can be given
medication to reduce stress or anxiety resulting from the traumatic event, because of how young
he is and the level of severity of his symptoms, it would be important to prioritize individual
counseling and then see if more support is needed.
Specific Considerations
As mentioned earlier, using Trauma-Focused Cognitive Behavioral Therapy consists of
twelve to sixteen sessions. These sessions consist of working closely with the caregiver and
Case Study: Theo 7
using some cognitive behavioral principles and exposure techniques to address post-traumatic
stress due to the traumatic event, other symptoms such as anxiety, depression, and any difficulties
that the caregiver may be having with the child (de Arellano et al., 2014). The treatment plan
would consist of implementing psychoeducation, coping skills, gradual exposure, cognitive
processing of the traumatic event, behavior modeling, and body safety skills (de Arellano et al.,
2014). The biggest barrier when formulating a treatment plan is that the mother is hesitant to
keep bringing Theo to therapy after the six covered sessions are over. Considering that the theory
requires more sessions, and Theo’s symptoms reflect the same, if no more than six
sessions occur, the effectiveness of the session can be reduced.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental
Disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Press, Inc. de
Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S.,
Ghose, S. S., Huang, L., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral
therapy for children and adolescents: assessing the evidence.
Psychiatric services (Washington, D.C.), 65(5), 591–602.
https://doi.org/10.1176/appi.ps.201300255
Gupta, N., Chaudhary, R., Gupta, M., Ikehara, L. H., Zubiar, F., & Madabushi, J. S. (2023). Play
Therapy As Effective Options for School-Age Children With Emotional and Behavioral
Problems: A Case Series. Cureus, 15(6), e40093. https://doi.org/10.7759/cureus.40093
La Greca, Annette M., and others, 'Traumatic Stress Disorders in Children and Adolescents', in J.
Gayle Beck, and Denise M. Sloan (eds), The Oxford Handbook of Traumatic Stress
Disorders, 2nd edn, Oxford Library of Psychology (2022; online edn, Oxford Academic,
7 May 2020), https://doi.org/10.1093/oxfordhb/9780190088224.013.8, accessed 2 June
2025.
Liberty University. Theo Case Study. [Case Study Assignment: Theo]. School of Behavioral
Case Study: Theo 8
Sciences, Liberty University, Canvas. https://canvas.liberty.edu/
Malik F, Marwaha R. Cognitive Development. [Updated 2023 Apr 23]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK537095/
McLaughlin, K. A., & Lambert, H. K. (2017). Child Trauma Exposure and Psychopathology:
Mechanisms of Risk and Resilience. Current opinion in psychology, 14, 29–34.
https://doi.org/10.1016/j.copsyc.2016.10.004
Memarzia, J., Lofthouse, K., Dalgleish, T., Boyle, A., McKinnon, A., Dixon, C., Smith, P., &
Meiser-Stedman, R. (2024). Predictive models of post-traumatic stress disorder, complex
post-traumatic stress disorder, depression, and anxiety in children and adolescents
following a single-event trauma. Psychological Medicine, 54(12), 3407-3416.
https://doi.org/10.1017/S0033291724001648
