Special Education Pt.2: Assignment 2-Case Study (OSR)

This is the government navigational page through the heading of OSR/IEP

http://edu.gov.on.ca/eng/document/curricul/osr/osr.html

http://www.edugains.ca/newsite/SpecialEducation/transitions.html

Case Studies are often used in social work, psychology, psychiatry, and special education to give other professionals a detailed report on one particular patient, student, or child.  Special education teachers are sometimes asked to prepare case studies for IPRC’s or an ISRC (in school review committee).  Your task is to write a case study on an actual student in your school. The case is based on:

• The student’s OSR and all of information in the OSR – past report cards, psychological testing, psychiatric reports, medical records, CAS reports, school reports such as suspension letters, transition plans, etc.
• Teacher interviews and comments
• Observations of the student
• Samples of student work

This assignment requires that you have access to a student’s OSR. As well, you will be expected to interview teachers and give your professional observations on the student.
Your case study should be double spaced and approximately 5-6 pages long. Please do not use the student’s real name, name of school, location of school, names of social workers, psychiatrists, etc. Complete anonymity MUST be maintained for all parties pertaining to the case study throughout your work.
Your case study needs to be based on a student who is already diagnosed with the label you chose for your presentation in assignment one.
On the next page is a guideline of the sort of information that is required, and a template to help organize your case study.
CASE STUDY GUIDELINE
1. Case History
An introduction is necessary to establish the focus of your case and provide orientation to your reader. It should consist of clear and concise opening statements, which typically include information on:

•   Name (pseudonym)
•   Age
•   Observations
•   Central need(s)

1.2 History of Presenting Issues & Observations
This should be a detailed account of the student’s issues that you have already identified in your opening statement. Include details about the student’s needs and related symptoms in a chronological order, as this will help with the clarity of your writing.
1.3 Past Psychiatric/Psychological/Academic History
This section needs to detail the student’s psychiatric, psychological, medical and/or academic history when needs where first identified. The student’s OSR will help inform this section.  You need to review all past report cards and teachers’ comments and look for common themes and issues.
Include details of previous diagnosis, education and psychological testing, their results, and past treatment plans. Note any medication and include information on who administered management (when and where), what the treatment was (and preferably the dose and duration of treatment), and the student’s responses to treatment. Make sure to include details from any outside agencies, hospitals, or other professionals.
1.4 Past Medical History
In this section, include any medical history that is relevant.  If the student has had long episodes of hospital care, note the dates. Make sure to include all medications and therapies (speech, physical, etc.) and demonstrate an understanding of their significance.
If this does not apply to your student, then simply state the student did not have any medical issues.
1.5 Family History
Include details of parents and siblings, nature of the relationships between family members, any family tensions and stresses and family models of coping.  State if there is a family history of psychiatric illness (incl. drug/alcohol abuse, suicide attempts).
1.6 Current Treatment Plans, IEP’s and Issues
This last section needs to briefly outline current treatment plans such as crisis intervention, behavior plans, and IEP’s.  The very last comments should question if these plans are effective, need to be reassessed, or appear to be working. This is your own professional opinion.
DO NOT post this Assignment in the Discussion Area

Submit Assignment #2 using the corresponding Course ASSIGNMENTS Folder

Instructor Notes:

***If you are currently in a position where you do not have access to OSRs ->  For Assignment #2 - I am going to suggest you base your case study on a sample student(You can find them under "Resources" > "IEP Sample Case Studies") or base it on a student that you know from your teaching experience or a student you remember from supply teaching(if you did/do any supply teaching).  Use the information you know (or that is provided in the sample case study and add additional pertinent facts as you see fit (add additional fake information that you think could be possible for said student - facts about medical history, family history, possible paraprofessional involvement etc). For example, if you are working with a student with Depression, you may know he or she is an only child, parents are separated, etc.   You may not know what their psych assessment says or when the student was diagnosed. In that case, use your academic and professional judgement and research skills to create a "composite" of the student. You can also reach out to a local Psychiatrist or Psychologist to see if they can provide you with any additional resources or information that may help you with your assignments.  Accessing resources within your community is encouraged and would be beneficial to your learning.  

Sample case studies

https://www.bced.gov.bc.ca/specialed/adhd/case.htm  (No longer available) 

Lakehead University has added 3 case studies to the course (You can find them under "Resources" > "IEP Sample Case Studies").  If you do not have access to a student OSR you use information from one of these sample case studies to form your own case study. 

You can also use the sample IEPs found on the EduGAINS website and be creative and create the family and medical history to match the student described in the IEP for the purpose of this assignment. 

http://www.edugains.ca/newsite/SpecialEducation/transitions.html

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Reddit:

"Interested in Learning about ODD"

In regards to Oppositional Defiant Disorder, how does a psychiatrist diagnose this in children. I was reading up online and the best information I could get was "self-testing" as created on the basis of symptoms as outlined in the DSM. I am completing studies in the field of education; specifically special education and I am hoping to provide expert level insight into the process that students/children are going through in regards to diagnosis and psychoanalysis.

Names of different tools and tests are good; but if you have actual documents I could use in my presentation, that would be much appreciated!

Thanks for taking the time to consider my request!
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  Child's overall health, behaviour, school and sports performances are noted down. A detail history of behaviour of child from both the parents, relatives and even teachers may be required. Complete medical, psychological and past history is also required.
  Physical exam is also done to ascertain any other possible cause behind child’s behaviour. 
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  In some cases, Neuro-imaging or blood tests may be required. 
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  For diagnosis, there is a criteria specified by American Psychiatric Association, according to which at least four criteria should be present-
  
• Behavioural problem in kid like anger, irritability, argumentative, defiant behaviour, vindictiveness causing significant problems at work, school & home.
  
• Should not be a part of any other mental problem
  
• Should last for at least six months
  
• Symptoms occurs during interaction with at least one individual who is not a sibling
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  Testing & Diagnosis for Disruptive Behavior Disorders in Children
  
  Tests
  
  
  The first step in treating your child's disruptive behavior disorder is forming an accurate and complete diagnosis.
  
  
  Diagnosing oppositional defiant disorder
  
  At Children’s Hospital Boston, a mental health clinician (typically a child and adolescent psychiatrist, child psychologist or psychiatric social worker) makes the diagnosis of oppositional defiant disorder after doing a comprehensive psychiatric assessment with you and your child. During this assessment, you will be asked to talk about your child’s behavioral problems and to give an overview of your child’s family history, medical history, school life and social interactions. Learn more about how Children’s diagnoses ODD.
  
  
  Diagnosing conduct disorder
  
  Conduct disorder is typically diagnosed if a child has done three or more of the following within a 12-month period:
  showed aggression toward animals or people
  destroyed or stolen property
  lied and been deceitful
  seriously violated parental or school rules
  
  
  A child with conduct disorder experiences noticeably dysfunctional relationships at home, at school and with peers as a result of these behaviors.
  
  
  If my child is diagnosed with a disruptive behavior disorder, what happens next?
  
  Your child’s mental health clinician will help explain the disorder and answer any questions you or your child may have. The next step is developing a mutually agreed-upon treatment plan that works for you, your child and your family.
  
  
  http://www.childrenshospital.org/conditions-and-treatments/conditions/d/disruptive-behavior-disorders/testing-and-diagnosis
  
  
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  http://labs.uno.edu/developmental-psychopathology/articles/PPRP%202013%20Assessment%20of%20Conduct%20Disorder.pdf
  
  
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  Diagnosis
  
  In general, a child shouldn't receive a diagnosis of attention-deficit/hyperactivity disorder unless the core symptoms of ADHD start early in life — before age 12 — and create significant problems at home and at school on an ongoing basis.
  
  There's no specific test for ADHD, but making a diagnosis will likely include:
  Medical exam, to help rule out other possible causes of symptoms
  Information gathering, such as any current medical issues, personal and family medical history, and school records
  Interviews or questionnaires for family members, your child's teachers or other people who know your child well, such as caregivers, babysitters and coaches
  ADHD criteria from the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association
  ADHD rating scales to help collect and evaluate information about your child
  Diagnosing ADHD in young children
  
  Although signs of ADHD can sometimes appear in preschoolers or even younger children, diagnosing the disorder in very young children is difficult. That's because developmental problems such as language delays can be mistaken for ADHD.
  
  So children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.
  
  https://www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/drc-20350895
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  Making changes to my document dossier on the case study as the requirement was to present the case as a summary-not official documents. It was unclear at that time when I began the project that a case study overview was expected-I ended up creating documents for the student (Walter Kovacs...you know Rorsach from the Watchmen...ya-well waste of hours of work). Nonetheless, I took considerations that were mentioned to be by the professor
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  Case Study of “Kovacs”
  
  
  ONTARIO, CANADA
  
  
  As Presented by: Carmelo Bono
  
  
  Nov/26/2019
  
  
  
  
  Contents:
  
  
  1.1 Case History
  1.2 History of Presenting Issues and Observations
  1.3 Past Psychiatric/Psychological/Academic History
  1.4 Past Medical History
  1.5 Family History
  1.6 Current Treatment Plans, IEP’s, Other Issues
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  1. 1 Case History
  Name: (Kovacs)
  For this case and the purpose of its release into the public, the student will be referred to as Kovacs; this is not his given name. Pronouns in lieu of the name “Kovacs” will also be used, he, his, and him.
  
  
  Current Caregiver: “FF”
  FF (Foster Family) as Miss Kovacs is recently deceased.
  
  
  Age: Currently 11 years old.
  
  
  Grade: Presently in Grade 6
  
  
  Observations:
  
  
  Areas of Need:
  -Attention Skills
  -Self-Regulatory Skills
  -Anger Management Skills
  -Empathy Skills
  -Difficulty understanding instructions
  
  
  Areas of Strength:
  -Energetic
  -Inquisitive
  
  
            Kovacs’ case is up for review after switching from Ontario Elementary School A to Ontario Middle School A. He is completing his sixth grade in elementary school A and then transferring to middle school A. The purpose for the transfer is that the student is able to get more specialized assistance at middle school A. Current guardians of Kovacs are their foster family “FF”.
  
  
  1.2 History of Presenting Issues & Observations
  
  
  History of Presenting Issues and Observations
  
  
  The cognitive theory in which states that hostility is fostered from a hostile attribution bias, is noticeable in the way that Kovacs reacts to many of his peers. He may become defensive or rude because he feels judged or looked down on by them. This is because the hostile attribution bias is a negative form of thinking which forces individuals to interpret blank stares or faces as hostile body language towards them (the misinterpretation of facial expression or social situations).
  
  
  
  
  1.3 Past Psychiatric/Psychological/Academic History
  
  
  Past Psychiatric History
  
  
  Started therapy and counselling after mother was detained for prostitution charges and then locked-up for a shot time following a drunk and disorderly conduct charge. Kovacs was put into the foster care system with FF, at which time FF wanted to give him the care and help he needed to have a “normal life”
  
  
  He resented his mother which was proven after he was removed from his home and put into the foster care system. Behaviourists developed a theory in which the aggression and actions of the individual with the disorder is a learned behaviour. Leading treatments to become more focused on developing positive self-esteem. This has been a feat, since early in Kovacs’ childhood where he received cruel beatings from his mother.
  
  
  Kovacs was diagnosed with ADHD at the age of 7 (grade 3) and received IPRC identification for supports in the classroom placed on Adderall* as prescribed by the doctor.
           
  Past Psychological History
  
  
  Currently Kovacs’ identification as a student with ADHD is seemingly not a misdiagnosis, but actually not a complete diagnosis. Kovacs’ psychiatrist has developed a reason to believe diagnosis is CD (Conduct Disorder), specifically ODD (Oppositional Defiant Disorder) that is comorbid with ADHD.
  
  
  The psychodynamic theory states that the disorder is result to unresolved problems from deep in the psyche of the individual between themselves and the parent. But Kovacs’ mother is a character who single handily influenced the development of CD within Kovacs’ because of her parenting style which was low warmth and low support.
  
  
  Notes released to build the diagnosis from Dr. Malcolm Long, the school diagnostician who Kovacs is interviewed by. In a sitting he was asked to look at ink blot for initial evaluation by Dr. Malcolm Long who he first told it looks like a “pretty butterfly”; however in later sittings, Kovacs claimed in his head (Kovacs) is thinking of a dog with a head wound which he came across earlier in life.
  Past Academic History
  
  
  (for the purpose of anonymity, the schools have been called by their provincial location to ensure clarity of procedures within that province are acknowledged); in the event of more than location/school being mentioned, they will be referred to in chronological introduction as per student’s experience).
             
  Former students of ON elementary school A but moved to ON Middle School A as it is renowned for assisting/specializing in the education of students with behavioural disorders. Not a studious or high-performance student.
  
  
  In grade 3 his provincial testing revealed he was performing below the average of the province in reading, writing and mathematics; but still managing to present scaffolded knowledge to succeed in the class.
  
  
  In grade 4 his participation in class decreased but he was capable of presenting average scores in reading and writing. His mathematics provincial testing proves a difficult learning point for him but modifications are being made to assist his identification as a student with ADHD.
  
  
  Currently in the final portion of his 6^th grade his reading and writing are below average but a pass nonetheless. Mathematics is an increasing issue for Kovacs it seems as he failed the provincial test this year.
  
  
  1.4 Past Medical History
  
  
  Medications
  
  
  Adderall/10 mg each dosage
  àincreased dosages show no sign of improvements
  àPrescribed by Psychiatrist Dr. A. Moore
  
  
  Therapies
  
  
  1-1 sessions meeting with Dr. A. Moore who is practicing cognitive and behavioural therapy to change negative thought patterns as well as enhance self-esteem
  1.5 Family History
  
  
  Kovacs was born by biological mother Miss Kovacs with no known father. Miss Kovacs was verbally and physically abusive to her son (Kovacs) to cruel extents (low warmth and low support). Miss Kovacs used drugs regularly as well as prostituted herself a number of times, one time in which had walked in on her and her “John”. Kovacs was also bullied in the community by peers who he assaulted after consistent torment by them. This assault took place at the age of 10 and resulted in a cigarette burn to the bully’s eye as well as vigorous biting with no end (needed to be held back).
  
  
  Foster family of Kovacs has not been involved with the process too much in regards to Kovacs’ identification for the reason that he scares them and they still want to give him “his best shot” but they are uncertain if they are capable of offering him the help to get the appropriate education he needs. They meet with him for weekends and holidays.
  
  
  1.6 Current Treatment Plans, IEP’s and Issues
  
  
  Drug Therapy
  àPerceived as ineffective
  
  
  Ultimately, since started on the Adderall, Kovacs is still displaying mood swings that are disruptive. The dosage increases seem to have no impact on his disruptive behaviours.
  
  
  Behaviour Therapy
  àUse of a planner
  
  
  Target Behaviour: Self-Regulation
  
  
  One difficulty that needs to be addressed is Kovacs’ attention span. Kovacs can’t pick up on what people are saying to him because he can’t/won’t hear them while they are speaking with him. He gets angry when he hears the same things over and over.
  
  
  In writing down and planning out the routine of the day, he can know when to expect certain things to take place and where he needs to be at that time/what he needs to be doing. This will eliminate the stress of and frustration of scrambling around and allow for his attention to be spent on improving other areas.
  
  
  àChecklist for class
  
  
  Target Behaviour: Attention to instructions
  
  
  In a checklist it is expected that the student will be capable of providing themselves with guidance through a lesson or activity that tells them how to function/behave. At a young age, this is a non-invasive and potentially appropriate action for students-“checking boxes” and watching progress.
  
  
  The difficulty we anticipate is that Kovacs will prematurely check boxes and through off the practice. One idea is having specific checklists for different lessons/situations. This is perceived as a potential way to get past the obstacle of attention.
  
  
  àPWIM
  Target Behaviour: Empathy
  This has been a practice with the classroom teachers and school staff in which Kovacs has recently been able to successfully develop an understanding (however minimally) that sometimes he misconceives the emotions people feel versus the way they look. Using pictures of faces (starting with cartoon ones), we began having him identify words (adjectives) to describe the way people/faces look. He was successful in the beginning with cartoon characters, but gets agitated with identify pictures of human emotions. With limited success, we have been able to identify blank stares as processing. Raised eyebrows as ques to “I’m listening”.
  Smiles are not misconceived, but the lack there of communication afterwards seems to make him resonate with the smile as empty or sarcastic. We are trying to get him to describe aloud what he sees on a person’s face to communicate to that person how he feels. Students do not poke fun at him when he does this but support him by telling him if he is correct or not.
  Kovacs’ is very sensitive to criticism and laughter and has a bit of a colder demeanour. Staff are very careful around him when giving instruction or responded to rapport building questions.
•  and put together the following case study with analysis of the character that I completed in preparation for child psychology-my inspiration for this project.
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