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marycartezc545p2Case Study of Behavioral Disorders
Case Study of Behavioral Disorders
Carter, M
psy 308
June 28, 2016
Argosy University Online
Behavior disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), are something that many children are diagnosed with on a daily basis. Thapar, van den Bree, Fowler, Langley, & Whittinger (2006) suggest that, “Early occurring ADHD, particularly when severe symptoms of hyperactivity-impulsivity are present, is one of the most reliable predictors of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Longitudinal studies have found that ADHD leads to ODD and CD rather than vice versa. (Marsh & Wolfe, 2013, p. 136). According to Beauchaine, Hinshaw, & Pang (2010), “Children with ODD overreact by lashing out at adults and other kids. They are stubborn, short-tempered, argumentative, and defiant. Children with CD violate societal rules and are at high risk for getting into serious trouble at school or with the police. They may fight, cheat, steal, set fires, or destroy property (Marsh et al, 2013, p. 136).
“A study by Kutcher (2004) found that approximately fifty percent of all children with ADHD also meet the criteria for ODD” (Argosy University Online, 2014). Although ODD and CD are similar in their characteristics, there are also some differences. They are both associated with symptoms of ADHD. If the ODD and CD are not treated properly or on time, there is a greater risk for behaviors of ADHD tomanifest. “ADHD occurs seven times more often in children with ODD or CD, and major depression occurs ten times more often” (Harstad & Barbaresi, 2011). For conduct order to be diagnosed, “A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the twelve criteria related to CD in the past twelve months, with at least one criterion present in the past 6 months.” Merikangas also noted that, “ODD is more prevalent than CD during childhood, but by adolescence the prevalence is about equal. Lifetime prevalence estimates are 12% for ODD (13% for males, and 11% for females), and 8% for CD (9% for males and 6% for females)” (Marsh et al, 2013, pp. 166-167). With ODD the behaviors only need to be present for six months showing four or more of the eight behaviors associated with the disorder. According to Nock (2007), “Symptoms of ODD typically emerge two to three years before CD symptoms, at about age six years for ODD versus age nine years for CD” (Marsh et al, 2013, p. 167).
When diagnosing anyone with a disorder there are certain criteria the individual must meet. In regards to ODD the individual must have experienced at least six months of, “A pattern of negativistic, hostile, and defiant behavior during which four (or more) of the following are present” (Marsh & Wolfe, 2013, p. 165):
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive
Although it is natural for most children to go through a normal phase of oppositional behavior at some point in their life, it becomes a problem when their “openly uncooperative and hostile behaviors become so frequent and consistent that it stands out when compared to other children of the same age and developmental level and when it affects the child’s social, family, and academic life” (AACAP, 2013).
The following is a case about an adolescent named Joe. He is a thirteen year old Asian-American boy who has just begun his first year in high school. The two possible diagnoses that Joe might meet the criteria for in his diagnoses are Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Behavior disorders begin with ODD then progresses into CD therefore this author would see it necessary to concentrate more on treating Joe for ODD. Based on the information provided in the vignette, the behaviors he displays that are associated with ODD are the fact that throughout his educational career, starting from kindergarten, his teachers have all reported experiencing problems with his behavior. Some accounts of his behavior have been noted as, “In elementary school, he was described by his teachers as immature and argumentative with authority figures. In middle school, his behavior escalated to include verbal and physical aggression toward classmates” (Argosy University Online, 2014). Now that he is in high school his behaviors continue to escalate and classroom time is interrupted by his extreme talking and being noisy. When his teachers ask him to do something he begins to argue with them and does not obey school rules. During free time outside of the classroom he has been seen associating with a group of kids whose behaviors tend to be along the same lines. Since he acquaints himself with others whose behaviors are not respectful of others he is now becoming influenced by his cultural surroundings. In addition to his negative behaviors he also seems to become easily angered and confrontational with others. Some students have even reported that they have been threatened by him. These behaviors demonstrate those associated with CD. “CD is characterized by antisocial behavior, including “aggression to people or animals..., destruction of property..., deceitfulness, or theft", and "serious violations of rules” (Argosy University Online, 2014). During the times Joe has been involved in fights and threatening his peers he shows no signs of remorse or regret. Even though some of his behaviors fit the criteria for CD, there are still more obvious behaviors associated with ODD.
When diagnosing a child with any disorder it is important to understand what the root cause of their behaviors are so that you understand where they are coming from and how to address them. “There are often genetic vulnerabilities combined with significant environmental and individual characteristics that can put a child at risk for ODD” (AACAP, 2013). Being that Joe is of Asian descent it is possible that his parents migrated to the United States. If they had problems acclimating to American culture their behaviors might have influenced the way he behaves. “Some studies have identified a coercive pattern of parent-child interaction associated with ODD. Coercive parent-child interactions reinforce or reward (unintentionally) the oppositional behavior” (Argosy University Online, 2014). If he was influenced by an inconsistent parenting lifestyle he may have learned that it is not important to follow rules and that there are not any consequences for bad behavior. If these behaviors were never addressed or corrected then he just formed a pattern of oppositional behavior that he has not been held accountable for. Multicultural factors also contribute to ODD as “association with a peer group of children with disruptive behavior increases a child’s risk of developing ODD or CD, as does living in a low socioeconomic neighborhood, a neighborhood with a high crime rate, or in a home fraught with domestic violence (Harstad et al, 2011). Children who come from families on the lower spectrum of socioeconomic status are more prone to developing these behaviors due to parents not being able to provide the necessary guidance or lack access to resources that are required to promote healthy development. When proper development is not fostered it could lead to behavior disorders. “Typically, children with ODD will have a history of difficult temperaments as infants, toddlers, and preschoolers. Difficult temperament is characterized by an inability to soothe easily, oversensitivity, frequent crying or irritability, and difficulty achieving a smooth sleeping and eating routine (Thomas, Chess, & Birch, 1968).
Through much research there has been multiple treatment options made possible to help those who suffer from ODD. One of the treatments is through the administration of prescription stimulant drugs. This is usually only done in the event that ADHD is comorbid with ODD. “Psychostimulants such as methylphenidate and dexamfetamine, together with their sustained-release versions, have been the standard and most common drug therapies used in the treatment of ADHD for many years. These medications appear to be quite effective in improving symptoms of inattention, hyperactivity, impulsitivity and oppositional behavior” (Turgay, 2009). Parents play a significant role in a child’s behavior. It is important for them to be included in treatments for their child so that they can learn ways to help them manage their behavior. A way to treatment includes parents in through Parent-child interaction therapy (PCIT). This allows the health care professional to assist parents with interacting with their child. “In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through strategies that reinforce their children's positive behavior. As a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves and problem behaviors decrease” (Mayo Clinic, 2014). A third option is cognitive problem-solving training. “This type of therapy is aimed at helping the child identify and change through patterns that are leading to behavior problems. Collaborative problem-solving in which the parent and child work together to come up with solutions that work for both of them can help improve ODD-related problems” (Mayo Clinic, 2014). This treatment is beneficial because it teaches the child how to recognize their behavior and it helps them open up to new strategies that will help them cope with their disorder. It also helps the parent by getting them involved in what the child is going through and they can help reinforce the treatment so that they can increase the probability of displaying more positive behaviors.
Not every treatment is right for every child and there are precautions to take when administering treatment. One strategy that has been proven to be non-effective are those that require the child to be placed in a treatment facility or being instructed to attend behavior instruction courses such as child behavior boot camps. Henggeler & Santos , ( 1997) suggested that, “Restrictive approaches such as residential treatment, inpatient psychiatric hospitalization, and incarceration also show little effectiveness and have the additional disadvantage of being extremely expensive. Incarceration may not even serve a community protection function, since youths who are incarcerated and then released often commit more crimes than youths kept at home and given treatment” (Marsh et al, 2013, p. 192). The reason for this may be that when children are incarcerated they may feel that they are being punished for their behaviors. Instead of being shown that they are cared for they feel as if their family and community are ashamed of them and would rather hide them away where they do not have to be bothered by them. Also, in these types of environments they are kept from the public and they are not being taught strategies that will assist them in learning how to properly socialize. The sooner treatment is administered the better outcome the child will have with being successful in coping with and managing their disorder.
Diagnosing a child with a disorder can be beneficial as it can help bring awareness to them, their family, and the community by educating everyone about their disability; people fear what they do not know. It is also necessary in order for a health care professional to determine eligibility. However, placing a label on a child can also bring a negative stigma upon them. Labeling a child might make them feel like they are not as good as everyone else. “Disability labels focus on what students cannot do, not on what they can do, and therefore can encourage children to think of themselves as incomplete or inadequate and to contribute to the development of low self-esteem” (Oswalt, 2010). The way this can affect them at home and at school is because the child’s teachers and/or parents might feel that they are not capable of doing the same things as other children and therefore they begin to lower their expectations of them. When this happens they are no longer encouraging the child to strive for higher goals but rather settle for less. It could also affect their social skills among their peers as they might treat them differently or they may start to distance themselves from them because they see them as being different. “A final criticism of disability labeling is that labels are inherently general, and fail to capture the unique strengths and limitations of each child, or the severity of their symptoms” All of these negative views of labeling could ultimately contribute to further behavior problems such as depressive disorders. It is important for the parents to understand what their child is going through so they know how to tend to their needs and advocate for them until they are able to advocate for themselves. “Parents, teachers, and other school professionals can work diligently to see each child as an individual with unique needs, strengths, and qualities. Parents, in their role as advocates for their children, play a particularly important role in helping to insure that negative expectations do not come to dominate a child's educational planning” (Oswalt et al, 2010).
Fortunately there are ways that children who are labeled with having a disability are protected. “The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education” (U.S. Department of Education, 2014). If Joe receives the necessary attention and treatment for his behavior disorder he will have a better chance at being successful once he transitions into adulthood. Despite the fact that he may never be cured of his disorder does not mean that he will never learn how to cope with ODD. There is still a good probability that he will overcome his bouts of anger and hostility and learn to redirect his anger in a more effective manner.
References
American Academy of Child and Adolescent Psychiatry, (2013). Children with oppositional defiant disorder. Retrieved from http://www.aacap.org
Argosy University Online, (2014). Behavioral disorder: Male vignette. Retrieved from http://www.myeclassonline.com
Argosy University Online, (2014). Oppositional defiant disorder. Retrieved from http://www.myeclassonline.com
Harstad, E. B., & Barbaresi, W. J. (2011). Disruptive behavior disorders. In R. G. Voigt, M. M. Macias, & S. M. Myers (Eds.), Developmental and behavioral pediatrics (pp. 349–358). Elk Grove Village, IL: American Academy of Pediatrics
Mash, E. & Wolfe, D., (2013). Abnormal child psychology. 5th Edition. Cengage Learning. Retrieved from https://digitalbookshelf.argosy.edu
Mayo Clinic, (2014). Oppositional defiant disorders: Treatments and dugs. Retrieved from http://www.mayoclinic.org
Oswalt, A. (2010). Childhood special education: Criticisms of disability labeling. Retrieved from http://www.mentalhelp.net
Thomas, A., Chess, S., & Birch, G. (1968). Temperament and behavior disorders in children. New York, NY: New York University Press. Retrieved from http://myeclassonline.com
Turgay, A. (2009). Psychopharmacological treatment of oppositional defiant disorder. CNS Drugs, 23(1), 1-17. Retrieved from http://search.proquest.com
U.S. Department of Education, (2014). Family educational rights and privacy act (FERPA). Retrieved from http://www2.ed.gov