Child development is an incessant and complicated process that takes various forms in different children. The process of child development is directly influenced by the surroundings of the child. A child’s environment, coupled with other important factors, is responsible for the behavior that one exhibits in adolescence and even adulthood. Therefore, child development and factors that affect it are significant to the physical and psychological development of each child.
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Psychological complications are bound to develop in any child irrespective of the social, cultural or economic background. These complications are caused by innate aspects as well as other features derived from the child’s experiences in life. This case study examines the case of a child who finds it hard to concentrate on a single activity. The case study will discuss the background of the client. The author will further present and diagnose his problem, recommend treatment measures, specify the goals of the client and finally, draft the questions to be submitted to the supervisor regarding his assessment, treatment and goal issues.
Background Of Client
Spencer is an eight year old boy who seems to be as conventional as any other boy of his age. He is in third grade at Washington School. Having been brought up by parents who loved and cared for him, Spencer has had the prerogative of getting anything he wanted. His mother, Shirley, claims that she cannot remember a single moment when Spencer lacked anything he had set his heart on. Unlike most children at his age, he never had to cry to get anything because his dear parents were always willing to make him comfortable.
A conspicuous feature about Spencer is his short stature. His height is rather small for an eight year old. Although his parents are comfortable with his shortness, Spencer personally execrates the fact that he is not as tall as it is expected of him. He goes ahead to admit that he often feels inferior to other taller boys of his age. Spencer tends to blame other bigger children of his age for his shortness and feels justified to despise them and even play some mischief on them.
In addition to that, Spencer is highly alert and quick to notice slight changes in his surroundings. He is in a position to perceive and discern the slightest sounds made around him. For instance, Spencer would hear an alarm siren at a distance and even make frantic efforts to go to the scene to witness the happenings. Because of this reason, he is likely to go missing for long durations of time only to be found in crowded places where there are frenzied activities going on.
Presenting Spencer’s Problem
A short period of time spent with Spencer will divulge his hyperactive nature. Spencer is indeed very hyperactive and rarely concentrates fully on one thing. Spencer’s problem can be traced right back to his very first day on earth. According to his mother, Spencer was an outwardly hyperactive baby just minutes after he was born. Spencer’s hyperactivity manifested in him through activities such as early walking and extreme curiosity. At the mere age of three, Spencer had managed to turn his mother’s full attention to him as she tried to keep him from destroying things around the house. Although the middle-aged mother of two hoped that this trait would sooner or later disappear, the reverse happened.
Spencer’s hyperactivity increased from one stage to another. Efforts by the parents to suppress it only worsened the situation. At one point, the parents were obliged to believe that Spencer was hyperactive by nature and nothing could change that fact. This was after all efforts to remodel his behavior had proved futile. The only option left for the parents was to take Spencer to a school with the hope that the new environment would deal with his hyperactive character.
However, Spencer’s condition at school worsened with time. In fact, one would think that the school environment served as an impetus in propelling his hyperactivity. He was regularly subjected to punishments because he rarely did what he was directed to do. He did things by impulse and at his own pleasure as opposed to what was expected of him at the preschool. Spencer also had a hard time socializing with other pupils because he was often aggressive to others.
Changing schools was the only thing that Spencer’s mother considered as her only alternative to reform her son’s character. However, not even this effected the desired change. When Spencer moved to the kindergarten, his condition deteriorated at an alarming rate. The condition worsened steadily as he progressed to first grade and then second grade. His teachers indicated that the boy never paid attention and had a problem following everything he was told to do. In fact, he could not focus on one thing for a few minutes. He was always impulsive and fidgety.
Assessment/Diagnosis Of The Problem And Justification Of The Assessment
Spencer probably suffers from the Attention Deficit/ Hyperactivity Disorder (ADHD). This is because he possesses most of the signs and symptoms associated with the disorder. First and foremost, he never concentrates on doing any task unless he finds personal interest in doing it. While Spencer can spend hours doing other activities that appeals to him such as skating, he is unable to spend a few minutes focused on his classwork. This is the main symptom of the Attention Deficit/ Hyperactivity Disorder (Cohen and Leo, 2003).
ADHD is a possible diagnosis for Spencer’s condition because it is not by his own will or pleasure that he is unable to pay attention. However much he tries, he finds himself totally unable to keep still even for just a few minutes. Although he seems disobedient, it is not his fault. In fact, Spencer has been trying to pay attention to classwork but drifts away into his world after every few minutes. He hates it that he always has to be reminded to pay attention in class.
Furthermore, Spencer has not shown signs of dropping his hyperactive character as he progresses into adulthood. Instead, his hyperactivity has exacerbated with age. This is a normal sign of ADHD in children. It is possible that Spencer may have to live with his condition throughout his life. Although his hyperactivity may reduce with the onset of old age, his disorder is likely to keep him from paying attention to one single activity for a long time.
In addition to that, Spencer is inattentive to details such as directives from teachers and parents. Instead of following instructions, he is often caught up in doing his own exploits. He also tries to follow the instructions given but get stultified with the task before it is completed. This is another sign of the Attention Deficit/Hyperactivity Disorder. Another sign that is close to this one is the ease with which Spencer makes mistakes. He is erroneous in practically everything he lays his hands on. Unlike other children of his age, he never learns from his past mistakes. Instead, he can do the same mistake just minutes after being admonished for the same.
Spencer’s difficulty in remembering things is another symptom that makes him a possible victim of ADHD. He has a problem keeping track of small details around him. For instance, he rarely remembers where he leaves his toys. He also does not remember to do his homework till he goes back to school the following day. Initially, his parents used to blame him for his negligence. Later on, they came to understand that it was a condition that he had become accustomed to.
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Another symptom of ADHD possessed by Spencer is his constant squirming and fidgeting. It is typical of Spencer to leave his seat when he is expected to remain in it and maintain silence. He is ever distracted and seems unaware of the fact that he is supposed to pay attention. In addition, Spencer often has a problem playing quietly. Instead, he shouts and makes noises even when constantly told to be quiet. He also tends to blurt out everything that comes into his head without thinking of its repercussions. He talks excessively and seems to have an idea about everything being discussed. This is also another symptom of the ADHD.
There are a variety of options that can be used to administer treatment or control Spencer’s hyperactive character. These methods of treatment make use of a number of techniques such as therapy, healthy eating, exercising and behavioral modifications. Though not encouraged in most cases, drugs can also be used to the treatment of ADHD. The most recommended method is a gradual modification of the child’s behavior. Though this process may not get rid of the hyperactivity and impulsivity, it is likely to restore some level of attentiveness in him.
Behavioral treatments are the most common remedies for the Attention Deficit/Hyperactivity Disorder. The treatments are administered through a strategized plan that works effectively if keenly followed. There are several types of behavioral treatments for ADHD which include combined pharmacological and behavioral treatments, direct contingency management, clinical behavior therapy, intensive behavioral treatments and cognitive-behavioral interventions.
Cognitive-behavioral interventions (CBI) emphasize on the importance of self-control in allaying the impulsivity and hyperactivity of an ADHD victim. This method can be used to treat the client through cognitive modeling, verbal instructions and problem-solving techniques. This technique of treatment will give Spencer an opportunity to reinforce, evaluate and monitor himself. He will have to watch his words and actions and meditate on their impacts before saying or doing them.
Cognitive-behavioral interventions are conducted by a therapist. In this case, such a therapist would meet Spencer at least once a week and take him through the process that will improve his situation. Spencer will be taught to have self-control through activities such as role playing, modeling and practicing cognitive strategies. These are instrumental tools to stop Spencer’s impetuous behavior and reduce his inattentiveness.
Unlike the CBI, the Clinical Behavior Therapy (CBT) focuses on what can be done by individuals taking care of ADHD victims to reduce their hyperactivity, hastiness and absent-mindedness (Cohen, Gwynedd and Stead, 2005). These include teachers, parents and caregivers. These people attend a series of training programs that educate them on the ways of restoring the children’s character back to normal. Such a training program would be of much help to Spencer. It can be attended by either or both his teachers and parents. The teachers can then work in close coordination with the parents to monitor Spencer’s behavior.
At the training program, the teachers or parents will be given standard behavioral techniques and a model comprising of instructions to be followed by Spencer. His progress can then be recorded in a weekly report card. He can also be given tokens or points every time he meets the stipulated behavioral standards at school and at home.
Contingency management (CM) is a program that is conducted intensively in a sort of specialized classroom. Under this program, the child is made to understand that each action he does has its own consequences. Such a consequence could be either positive or negative. Spencer can be made to discern this by rewarding his good deeds and penalizing him for every bad deed or word. For instance, the teacher can praise him for good conduct and berate him for misconduct.
The Intensive Behavioral Treatment (IBT) combines the Clinical Behavior Therapy (CBT) and the Contingency Management (CM) to build on the self-control and socialization skills of children affected by ADHD. The IBT takes place in the form of a program where children are grouped and taught standard behavioral characteristics. Such a program could help Spencer to convalesce from ADHD and start living a normal life. At the same time, his parents can keep track of his progress at home and reward him for the same.
Lastly, combined pharmacological and behavioral interventions make use of both medication and behavior shaping as remedies for children with ADHD. The use of this method on Spencer would achieve what could not be achieved by medication or behavioral modification. The two methods can also be used interchangeably to achieve the desired effect.
The use of medication to treat ADHD in children has risen in the recent past with the inventions of different types of drugs. Some of these drugs include Vyvanse, Daytrana and Concerta (Safer, 2000). These drugs serve the purpose of stimulating the children and enabling them to be attentive and less impulsive. Spencer can use these drugs to get the same effect. The drugs are effective in reducing distractibility, and decreasing impulsivity. It further enhances neat handwriting, increase accuracy, achieve better self-control and reduce aggression towards others (Sleator and Ullmann, 1981).
However, children with ADHD do not respond to the medication in the same manner. While it may work for some, it may not work for others. In other cases, the side effects of using the medication may be more than the benefits. The use of the drugs in such cases will lead to little or no relief. It is advisable to use other methods of treatment in such circumstances.
However, it should be noted that the use of medication on children with ADHD is not a cure to the disorder (Erkulwater and Mayes, 2009). The medication only axes the hyperactivity, impulsivity and inattentiveness for certain duration of time. This is why it is advisable to use a combination of medication and other methods of treatment. This will ensure that Spencer not only gets a slight assuagement but also a lifetime solution to his problem.
Specific Client Goals
Spencer does not like being seen as any different from his colleagues. It is his wish to behave like any of them. His ADHD is therefore a hindrance to the realization of this desire. He feels powerless against this disorder and wishes that he could do things in the manner in which they ought to be done. His main goal is to get the better of his problem and do activities in the right manner.
Spencer would also like to win the approval of his teachers and parents as a humble, mature and obedient boy. Sadly for him, this is currently not the case. Instead, he is seen as a nuisance by many people. At school, he is known even by the senior graders as an impudent and aggressive boy. Although he admits that this could be true, he is quick to point out that all this happens because of something that is beyond his control.
Spencer’s main goal is to improve in class work. Because he rarely concentrates in class due to his ADHD, he performs poorly and is ranked among the lowest performers in class. His forgetfulness is also a limitation to his better performance in school work. He is not in a position to remember a large percentage of what is taught at school. It is hoped that undergoing the forms of treatment elucidated above will help him improve substantially in his class work.
Questions To Supervisor
Considering Spencer’s rapidly deteriorating condition, one wonders if his condition will ever be brought under control. Although it has been made clear by the writer in the preceding paragraphs that ADHD can be treated, it is not a guarantee. This is the first question that the writer asks the supervisor: Is there a possibility for such a case as Spencer’s to be totally brought under control?
Spencer’s behavior is largely influenced by his disorder. He rarely decides anything on his own without the impulse caused by the disorder. There is therefore a possibility that his real character has been incorporated into his impulsivity and hyperactivity. It may not be possible to separate his disorder from his true identity. The second question is whether Spencer’s character will change for the better once he has gone through all the treatments aimed at getting rid of his disorder.
Even though Spencer’ s impulsive behavior may change after overcoming his disorder, there may be a possibility that he may go back to his former character after a certain period of time. The third question to the supervisor is whether Spencer may go back to his usual behavior even after overcoming the disorder after some time.
In conclusion, it is evident from the above discussion that Spencer is suffering from the Attention Deficit/Hyperactivity Disorder. It is also clear that this disorder has a negative effect on Spencer’s school work and his relationship with other people. His impulsivity and hyperactivity are the two conspicuous signs of this disorder. Furthermore, it can be seen from the discussion that there are a variety of treatments that Spencer can be subjected to. These treatments will help him to achieve his outlined goals once the disorder is gone. However, a number of uncertainties surround his recovery as presented in the previous three paragraphs.
Cohen, D. and Leo, J. (2003). Broken brains or flawed studies? A critical review of ADHD neuroimaging studies. The Journal of Mind and Behavior, 24, 29–56.
Cohen, D., Gwynedd L. and Stead J. (2005). Critical new perspectives on AD/HD. New York: Routledge.
Erkulwater, J. and Mayes, R. (2009). Medicating children: ADHD and pediatric mental health. Cambridge: Harvard University Press.
Safer, D. J. (2000). Are stimulants overprescribed for youths with ADHD? Ann Clin Psychiatry Journal, 12(1), 55–62.
Sleator E. and Ullmann R. (1981). Can the physician diagnose hyperactivity in the office? Journal of Pediatrics, 6(1), 13–7.