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Case conceptualization of a child and an adolescent

Case conceptualization of a child and an adolescent

Assignment

 

Write  a well thought out case conceptualization of a child and an adolescent. You will select a case of a child and a case of an adolescent. Case Scenarios are below:

Product: A 8-10-page (total for both cases) APA formatted paper referencing course material.

 

Child Case: QUESTION Tatiana

  • Describe the symptoms.
  • What diagnosis would you give this child and why? Substantiate with DSM-5 criteria.
  • Suggest and describe an anticipated treatment plan and interventions. Explain your choice.
  • Explain who would be included in the treatment planning and interventions.
  • Describe any expected obstacles that might impede effectively intervening with this child.
  • Give suggestions, thoughts or ideas regarding other family members.

 

Adolescent Case QUESTION /JACKSON

  • Describe the symptoms.
  • What diagnosis would you give this adolescent and why? Substantiate with DSM-5 criteria.
  • Suggest and describe an anticipated treatment plan and interventions. Explain your choice.
  • Explain who would be included in the treatment planning and interventions.
  • Describe any expected obstacles that might impede effectively intervening with this adolescent.
  • Give suggestions, thoughts or ideas regarding other family members.

 

ADOLESCENT CASE SCENARIO

 

Case Conceptualization: Jackson

 

Presenting Problems

Jackson is a 14-yesar-old European American boy who came to therapy carrying a diagnosis of Asperger syndrome and attention-deficit hyperactivity disorder (ADHD). He was prescribed Concerta and Sertaline. Jackson is often targeted at school by his peers for teasing. He evidences poor social skills, idiosyncratic routines and rules, and eccentric behavior. He feels lonely and wishes for more friends. Jackson’s motor skills are quite well developed, but he is reluctant to join teams due to his fears of negative evaluation. He has various sensory sensitivities and becomes agitated when these sensory sensitivities are aroused.

 

Cultural-Context Variables

Jackson’s family is European American and middle class. The family is not very religious, stating, “We are two-day-a-year Catholics. We go to church on Christmas and Easter.” Jackson’s father holds is software engineer. His mother graduated from a local community college, works as a legal secretary, and regrets not continuing further in her education. Both parents value education.

 

History and Developmental Milestones

Jackson’s developmental milestones were within normal limits. His language development is unremarkable other than some eccentric and quirky word use.

Jackson lives at home with his mother, father, and a younger sister. His father drinks regularly, battles bouts of depression, and is seen by his mother as “an introvert who hates to socialize.” Mother is seen by Jackson as very nurturing and helpful, whereas he sees his father as kind of aloof: “He seems to be in his own world.” Jackson’s relationship with his younger sister is described as “good” but her blithe attitude “bugs” him. He finds her singing and various voices during doll plat to be “annoying.”

Jackson’s father sees his behavior as due to his “arrogance.” His mother is somewhat more accepting, and Jackson tends to confide in his mother about his school and peer problems.

Jackson is in the eighth grade in a large suburban school. He is an outstanding student academically. However, his behavior is often disruptive in class and his poor social skills make the school environment quite anxiety-producing for him. Jackson is often reprimanded for his behavior at school and ridiculed by his peers (who call him an “Ass-Troll”). He desperately wants to fit in with his peers and this sense of desperation prompts eccentric showing-off behavior. For instance, he walked up the stairs balancing only on the handrails during classroom changes (quite a feat!). Additionally, Jackson also is quick to point out any mistakes by teachers. He explained this by saying, “Everybody says I am a know-it-all. But I don’t think it is a problem because I am always right. I want to make sure the teacher is doing a good job.” Finally, Jackson acts as a self-appointed class monitor, point out peers’ misbehavior and failures to complete assignments.

Jackson generally engages in solitary activities such as riding his bike around the neighborhood, kicking a soccer ball in his backyard, playing with a pitch-back machine, watching TV, and playing video games. He is an avid reader particularly in his areas of interest (e.g., history of basketball, astronomy). He avoids group activities and is reluctant to join in with his peers in his neighborhood.

 

Cognitive Variables

He holds various beliefs such as “Rules are meant to be followed,” “My way is always right,” “People must always do their best,” “Feelings are strange,” “ I cannot allow myself to feel bad,” “I can’t stand feeling uncomfortable,” “I am in charge,” “Change is bad,” “Other kids will never like me,” and “I can’t fit in.”

 

Behavioral Antecedents and Consequences

Jackson experiences the urge to correct others when he believes they are providing misinformation. The urge is an aversive state and is reduced by correctio. Thus, his “correcting behavior” is negatively reinforced. Social interactions are unsettling and anxiety-producing. Avoidance relieves this unpleasant emotional state and so is also conditioned by negative reinforcement. His retreat into solitary, self-absorbed, narrow interests is pleasurable, giving Jackson a sense of control.

CHILD CASE SCENARIO /

Case Conceptualization: Tatiana

Presenting Problems

Tatiana is an 11-year-old European American female who lives with her mother and two younger sisters. At school, she is a model student. She is on the distinguished honor roll (GPA = 99.9) and takes several gifted classes. Tatiana is secretary of the student senate, and participates in soccer, gymnastics, chess club, choir, and orchestra. However, at home, her behavior is a different matter. Her mother describes extreme noncompliance and oppositional behavior, noting, “It is impossible to get Tatiana to do anything around the house. When you do, she explodes and goes off on me.” When she becomes angry at her mother, Tatiana is quite verbally abusive to her mother (e.g., “You dumb slut,” You miserable whore.”). Tatiana’s aggression is not limited to her mother. She is verbally and physically aggressive to her middle sister (e.g., breaking her toys, calling her stupid and retarded).

 

Cultural-Context Variables

Tatiana’s mother’s income placed her squarely in the middle class. Tatiana’s mother and her parents immigrated to the United States from Croatia 15 years earlier. Her mother speaks several languages and currently works as a paralegal. Tatiana’s grandparents are wealthy entrepreneurs and serve as emotional and financial supports.

 

History and Developmental Milestones

According to her mother’s report, Tatiana reached her developmental milestones within normal limits. Tatiana’s mother described her as “always being high-strung” and being “too spunky for her own good.” The family history was quite remarkable. Tatiana’s mother and father divorced when she was six years old. Her father currently lives in another state and suffers from bipolar disorder complicated by cocaine abuse. Prior to the separation and divorce, the marital relationship was marred by intense conflict and domestic violence. Tatiana witnessed several incidents where her father was hitting and physically intimidating her mother. Both Tatiana and her mother disclosed that Tatiana would try to get in between her mother and father to protect her mother (e.g., “I would try to push that big jackass out of the way, but I couldn’t.”). Mother responded to Tatiana’s rescuing behavior by telling her to stay out of the way and warned her to hide under her bed in her room. Tatiana interpreted this as her mother being bossy and dismissive (e.g., “She thinks she is the only one who can handle things. She’s so stupid. She’s the one who married the asshole. She is the one who has to be in control, but I can handle things. I am not a baby.”).

According to Tatiana’s mother, Tatiana is not “a good big sister.” She noted, “I think she resents them and competes for attention with them.” Tatiana finds her siblings “annoying” and admitted, “Mom thinks they are angels but they’re not. They don’t respect me, and they get away with everything.” Tatiana collects a variety of dolls, stamps, and coins. She also keeps old ribbons, wrapping paper, and still has papers and projects from kindergarten. Moreover, Tatiana orders her books and CD’s alphabetically. Her younger sister often “gets into” these things which angers Tatiana. Not surprisingly, Tatiana gets upset when her sisters “messes up” her arrangement.

Tatiana is an exceptional student. She earns straight A’s and is in gifted classes. She plays a variety of instruments. Tatiana is very popular with her peers. She also is on a travel soccer team and is a competitive gymnast.

This is Tatiana’s first experience with a clinical social worker. She was seen by a pediatrician due to her mother’s concern about her “explosive behavior.” The pediatrician deferred the recommendation to prescribe medication, preferring to wait until a six-month of trail of therapeutic treatment was initiated.

 

Cognitive Variables

Tatiana voiced automatic thoughts such as “I must be in charge,” “My best ability is the way I control others,” “Absolute perfectionism is my way to stay in control,” “I must be the best always,” “ I must have positive attention from everyone,” “Emotions are dangerous,” “Having feelings men you are out of control,” “Other people are unpredictable,” “Others are unjustly punishing,” “I have to strike out at others before they plan to attack me,” “I must never be a victim,” “Victims are weak and stupid,” “The world is frightening,” “I hate chaos,” and “The world should work according to my rules.”

 

Behavioral Antecedents and Consequences

Behavioral triggers for Tatiana included competitive situations, criticism, and perceived or actual coercion. Her aggressive behavior relieved an aversive internal experience of pressure. Tatiana’s emotional avoidance was quite satisfying to her because it protected her from uncomfortable emotional states. When she received negative consequences for her noncompliant, aggressive, or overcontrolling behavior, her sense that others are punishing was confirmed.