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 6th 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.
