Description of Child and Family
Joseph “Joe” Walter Tom was a 15-year old white Caucasian boy of American nationality and citizenship (My flesh and blood 2003). Joe was the adoptive son of Susan Tom, and lived with her and his 12 other blood unrelated siblings in Fairfield, California, with English being the preferred language in the family. Mother, Susan Tom, is divorced and unemployed, has a detached relationship with her mother, and denies possessing significant savings or having a retirement plan.
The family lives on funds provided by Adoption Assistance Program, which is a government initiative that supports adopted children with special needs. The maximum AAP payment is determined based on the families circumstances and the age and needs of the child, on average ranging between $480 to $859 per child.
Child’s Functioning
Cognitive/Intellectual Functioning
Joe Tom was suffering from the Attention Deficit Hyperactivity Disorder (ADHD), which was noted during his early participation in the Head Start program for low-income children and their families. The symptoms were difficulty focusing and uncontrolled attention shift, uncharacteristic for the boy’s age.
In the kindergarten, Joe was unable to draw, found it hard to learn the alphabet, had difficulty maintaining concentration and adhering to class discipline. The situation was amended to a degree by prescription of a central nervous system stimulant. However, at the time of observation, the patient still exhibited strong impulsiveness associated with ADHD.
Dangerous Behaviors & Immediate Threat to Personal Safety: The main threat to Joe Tom’s personal safety was his declining health as a result of cystic fibrosis.
Susan Tom expressed fears that the boy’s anger issues may lead to future abusiveness since he showed both an occasional inclination for physical violence and, disregard for authority and emotional lashing out. It is unclear if the issues would have progressed or receded when he got older.
Emotional/Psychiatric/Behavioral Functioning
As a result of his early abandonment, adoption history, problematic biological family and six years of untreated ADHD, the boy developed problems with emotional functioning, exhibiting severe impulsiveness and anger management issues. These resulted in frequent mood swings and verbally aggressive behavior towards his adoptive mother and siblings.
Joe also showed interest in explorative sexual play in the form of offering to “play doctor” with his mentally challenged adopted sister Katie, and Susan Tom was considering the possibility that he might make similar offers to other girls in the family.
Social Functioning
Susan Tom and other adoptive children noted Joe’s tendency to push away people on impulse, either by ignoring them or by being overtly offensive, insulting or threatening. Joe displayed many signs of antisocial behavior. In particular, he expressed racist opinions towards people of other nationalities, citing a difficulty in empathizing with those of his siblings who were originally foreign, and mentioned preference for Americans and American siblings in particular, for whom he showed a notable degree of appreciation and concern. Despite some remaining learning difficulties as the result of ADHD, he also expressed interest in school at least on a social level and mentioned having friends and acquaintances in it.
Cultural/Spiritual Functioning
Joe showed no visible signs of any spiritual and cultural engagement, beyond participation in holiday celebrations. He didn’t show any interest in religion, didn’t show any open interest in the American culture.
Community Involvement/Recreational Status
Joe showed interest in television and video games, with the latter mostly being violent games.
It is unclear if he had many other activities as he was not seen participating in outdoor or sports exercises, which can be explained with potential breathing and growth problems as a result of cystic fibrosis.
Special Circumstances in Childhood
Joe entered the adoption system at the age of four, as the result of his family entering a program to treat their drug addiction problems. It was noted that he went through several families before being taken by Susan Tom, which might have resulted in his tendency to distance himself from people surrounding him.
Susan took him in an open adoption and allowed Joe and his biological parents to stay in contact before they moved to Oregon. This resulted in a lot of emotional stress for Joe.
Significant Medical History
Along with three out of eight of his biological siblings, Joe was affected with cystic fibrosis, a genetic disorder which affects lungs, causing frequent lung infections and resultant difficulty with breathing and sputilization, which is the process of coughing up mucus from trachea and bronchi. The disorder also causes problems with the pancreas, kidneys, and intestine, and its main symptoms are poor growth and weight gain, salty-tasting skin, breathing difficulty and heavy cough.
Joe was frequently brought to the hospital with breathing problems and accumulated mucus. He was also prescribed a regular use of a vibrating vest and a breathing apparatus, to loosen the mucus collected in the lungs and aid in coughing it up, and to improve lung function.
List All Medication Currently Taken
Joe was prescribed Ritalin (methylphenidate) for oral consumption. The medicine is a central nervous system stimulant and was used to treat the patient’s the Attention Deficit Hyperactivity Disorder. It allowed him to focus more, follow directions and apply to tasks at hand.
As part of treatment for cystic fibrosis, he would have also taken antibiotics to prevent and take care of lung infections, mucus-thinning medication to help cough up mucus and bronchodilators to relax the muscles around the bronchi and maintain the airways open (Cystic fibrosis, 2015). There is no information about exercise training, breathing techniques or special nutrition prescribed.
Substance Abuse
Joe has no noted history of substance abuse.
Prenatal and Birth History
Since it is known that that Joe’s biological parents were drug users at some point before he was given up for adoption, it is possible that his mother was involved in substance abuse before or during pregnancy.
Delayed Developmental Milestones
As a result of ADHD, Joe Tom had a noted verbal comprehension, language and motor skill delay in kindergarten and the Head Start program.
Sensorimotor Functioning & Motor Development
Joe had difficulty drawing in the early kindergarten, as well as in some other areas of study. According to the statement by Susan Tom, a lot of the educational difficulties were resolved when he started ADHD treatment.
Last/Current Grade Completed and School Attended
While the name of school attended and Joe’s grade completed was not mentioned, at 15-16 years old it can be assumed that he was attending 10th-11th grade.
Strengths and Barriers
Strength-based focused treatment is crucial when addressing difficult issues. Thus, it is important to acknowledge the child’s strengths, and appreciate them as possible tools to deal with the issues he is facing. However, to efficiently address the child’s issues it is also to recognize the barriers the child is facing. Several principle strengths and barriers can be defined by evaluating Joe Tom’s character and situation.
In spite of his semi-frequent outbursts, in his calmer moments, Joe showed engagement with his adoptive relatives and compassion for them. He was worried about his sister Margaret when she had an emotional breakdown of her own, and, despite being distressed due to his biological parents leaving to a different state, expressed understanding of their ply. Also, despite his occasional clashes with his adoptive mother, on the other times, Joe displayed great rapport with her.
He also expressed optimism in the face of his sickness and remained composed and calm when overcome with the symptoms or when being brought to the hospital.
Finally, the boy showed a level of independence of thought, and the confidence to stand up to others.
If developed, these character features could help him become more adjusted, and help integrate him with the rest of the family and the society when he was older.
Unfortunately, to achieve that goal there were also several barriers he would have to overcome. Firstly, impulsiveness and mood swings negate the effect of his compassion, creating tensions and conflict. Secondly, his aloofness and trust issues, which came to be as a result of his biological family history, being transferred from one family to another, and the comprehension of his declining health, kept him distant from his family members and made them distrust and fear him in return. Lastly, his health issues were the main barrier impeding his development. The specifics of his disorder meant that he was limited in the types of activities he could participate in, and susceptible to a large range of mucus-producing sicknesses. Again, this meant that he would have been excluded from many bonding and connecting experiences both in his adoptive family and in the outside world.
References
Karsh, J. (Director). (2003). My flesh and blood [Online]. Fairfield, USA: Home Box Office.
Cystic fibrosis. (2015). Web.