Assessment
Demographics of the Patient
- Patient’s name is Edwin.
- He is 14 years old.
- He lives with his father and stepmother but sees his biological mother on weekends.
- Edwin is in the 9th grade.
Identifying Features/Complaints
- Edwin has just been arrested for shoplifting.
- The patient has exhibited explosive behavior at home, where he punches holes in his bedroom walls.
- He drinks at his age and has been brought home intoxicated five times in the past month.
- The patient also suffers from mood swings.
- Edwin is failing his classes and most of his grades are Ds.
- The patient states that he does not understand his teachers.
- On more than one occasion, he has left the house at night to go and party with his friends.
- He talks back to his father and constantly swears at him.
- He cannot maintain eye contact and stares at the floor during conversations.
Past history shows that the patient has been a truant child and has also had multiple problems in his studies. However, he does not have any family members that have had the same symptoms that he is exuding. Additionally, there is no history of psychiatric illnesses in the family. Because he has tested negative for any medical conditions through tests conducted by his PCP, there is no evidence of any medical treatment that has been administered to the patient to alleviate his situation.
Edwin has a history of drug abuse, which in this case is evidenced by the number of times he has gone home intoxicated. The patient has also had some attachment issues as he does not live with his biological mother. His relationship with his father is strained and he constantly curses and talks back at him. His explosive behavior at home also points to the fact that he does not have a close relationship with his stepmother. The separation of his parents can be identified as one of the main contextual life stressors for the patient. The fact that he is also on probation creates a current situational life crisis. He, unfortunately, does not have any strategies for self-care activities at the moment.
Being only 14 years old and already using drugs, Edwin poses a risk to his classmates, friends, and even his parents. His violent fits can be elevated by the rush and poor judgments that can be caused by alcohol. If a child has some truant tendencies, alcohol may make the situation worse (Reed & Shearer, 2012).
Diagnosis
Diagnosis of Edwin’s condition could not have been possible without a thorough analysis of his behavior both at school and at home. Questions about his early development needed to be asked to determine when exactly the symptoms began. However, Edwin had not had any early developmental problems such as talking and walking.
The symptoms that Edwin had, all point towards conduct disorder, which is a very common psychiatric condition amongst teens. Scientifically, conduct disorder would suggest that the primary symptoms (theft, aggression, rule violation, lack of interest in school) must be experienced for more than six months. Also, a persistent pattern of behavior has to be clearly drawn out. In the case of Edwin, both premises suffice. According to Scott (2012), a questionnaire is normally used to diagnose a conduct disorder. The patient was, thus, asked some questions as deemed fit according to Scott (2012). Some of the questions revolved around the police run-ins he had experienced so far, physical fights he had engaged in, his poor school performance, sneaking away from home, and his alcohol abuse. Edwin responded well to all the questions.
Conduct disorder can be caused by two main factors namely genetic disorders and environmental factors. Genetic disorders are a result of frontal lobe damage but Edwin had been cleared of any medical condition. This means that his condition can be associated with environmental factors such as a dysfunctional family, which in his case is true. Scott, Briskman, Woolgar, Humayun, and O’Connor (2011) note that men are more likely to be at risk of conduct disorder compared to women due to the complexities of both genders in dealing with different emotional factors.
It can be argued that Edwin feels neglected by his biological mother. His parent’s separation did not make much sense to him. Interestingly, his parents did not play an active role in ensuring that the transition process, from one household to another, was smooth. This affected him negatively such that he developed the rebellious nature as a coping mechanism. He is, therefore, not in a position to act like other children. Additionally, his anger and extra-curricular activities, including drinking, are a distraction to his classwork, hence, his poor performance.
Planning and Treatment
According to Meleis (2011), conduct disorder results from the formation of a repetitive pattern that needs to be broken. However, these are behaviors that have been adopted over time. Thereby, treatment might take some time to be effective. In Edwin’s case, the first step is to assess his living condition and the impact the identified living conditions have on the patient. Edwin has a problem with his father and it is for this reason that he keeps talking back and cursing at him. It can be argued that Edwin blames his father for the separation. It is, therefore, recommended that Edwin spend some time with his biological mother.
The suggestion is pegged on the fact that Edwin already visits his mother on the weekend. A possibility of him spending the weekend at his mother’s place should be considered. It is believed that a change of scenery can help Edwin calm down and also reduce the triggers to his unruly behavior.
In Edwin’s situation, both group and individual therapy modalities are suitable. Individual therapy will aim at identifying the source of the problem and what actually triggers Edwin to want to be rebellious. Individual therapy should be conducted before group therapy to enable the therapist to know how to approach different issues. Group therapy will then be conducted in two stages. The first stage will consist of the primary family.
During these sessions, the root cause of the problem will be addressed and Edwin will be able to ask questions, get to know the situation he is in, and let out the anger he is harboring. Edwin must understand that it is the anger he has that is causing the destructive behavior he exudes. The second stage of group therapy will involve the whole family (including the stepmother). This will help create a conducive living environment for Edwin when he is both in his father’s and biological mother’s houses.
According to Kraemer (2012), conduct disorder is a form of retaliation towards unresolved problems in a patient. Through therapy, it is possible to slow the progression of the disorder. Long treatment is recommended to ensure that progress is monitored and the destructive patterns are broken. Since the family was open to this treatment plan, Edwin will be required to come in for therapy twice a week, whereas, the family can come once every two weeks for treatment. The schedule will give ample time for progress analysis. However, it is important to note that for confidentiality purposes, the therapist will not be at liberty to disclose any information that Edwin offers, to his family unless he consents. This will help the patient feel safe and respected.
Implementation and Coordination
Since therapy is considered one of the most personal modes of treatment, the only partnerships that will be formed will be between the parents of the patient and their physician. However, it is equally important that a relationship is formed with Edwin’s teachers to enable a comprehensive report on his progress in school to be made. As treatment progresses, it is expected that Edwin will begin breaking his pattern of destructive behaviors giving him more time to concentrate on his schoolwork, thus, record better and improved grades. If the treatment is not enough, then very little change will be seen.
Health Teaching and Health Promotion
The parents must be well informed about Edwin’s condition so that they are in a better position to identify his triggers. It can be argued that the parents do not know how to handle their son at the moment. The father and biological mother must start the process with Edwin before the stepmother is included. This allows the biological parents to bond with their son and address his fears about their separation. According to Hobson, Scott, and Rubia (2011), it was best that parents with children suffering from conduct disorder not act with haste, or abruptly, as such actions can lead to a build-up of anger, consequently, worsening the situation.
Outcomes
Since the treatment plan is long term, it is pertinent that the physician and parents come up with a concrete payment plan that ensures the patient does not miss any of his therapy sessions. The only way the client will be satisfied with the services delivered is if his confidentiality rights are upheld. Scotts (2012) states that most teenagers who are recommended for therapy are usually skeptical as they believe their peers will eventually get to know their problems and they will be bullied.
Some of the expected outcomes include:
- Improved performance in school.
- Rehabilitation from alcohol use.
- Being more respectful to his father.
- Abstinence from illegal activities.
- Better communication between the different family members, leading to a reduction of destructive behavior.
Client goals include:
- A healthy relationship between Edwin and his family.
- Reduction in the number of dramatic episodes in the home environment.
Assessment tools to be used in monitoring Edwin include:
- A self-report which encourages Edwin and his parents to document the changes they have realized since the beginning of treatment.
- Provider administered reports which will include note-taking to document weekly progress that can be used to draw a graph on the patient’s therapy progress.
Taking the discussion into account, it is expected that the number of rebellious incidents reported by the parents will reduce over time. As for the care provider, it should be expected that the patient will be able to open up more throughout the treatment until he is comfortable using his words rather than as opposed to destructive actions.
References
Hobson C. W., Scott S., & Rubia, K. (2011). Cool and hot executive function deficits are associated with ODD/CD symptoms independently of ADHD in adolescents with early onset conduct problems. Journal of Child Psychology and Psychiatry, 52, 1035-1043.
Kraemer, H. (2012). Current concepts of risk in psychiatric disorders. Current Opinion in Psychiatry, 16, 421-430.
Meleis, A. (2011). Theoretical nursing: Development and progress. Philadelphia, PA: Lippincott Williams & Wilkins.
Reed, P., & Shearer, N. (2012). Perspectives on nursing theory. Philadelphia, PA: Wolters Kluwer.
Scott, S. (2012). Externalizing disorders: Conduct disorders. Geneva, Switzerland: IACAPAP.
Scott S., Briskman, J., Woolgar M., Humayun, S., & O’Connor, T. G. (2011). Attachment in adolescence: Overlap with parenting and unique prediction of behavioral adjustment. Journal of Child Psychology and Psychiatry, 52, 1052-1070.