Behavioral Disorder in Latino Boy Living with the Grandparent

Behavioral Disorder in Latino Boy Living with the Grandparent

Behavioural disorders are common mental health illnesses that affect children and adolescents. These disorders are disruptive, often limiting the social and cognitive functionalities of the sufferer. Anxiety, depression, obsessive-compulsive disorder (OCD), oppositional defiance disorder, attention deficit hyperactive disorder, and conduct disorder are some behavioural disorders that affect children and adolescents listed in the diagnostic and statistical manual for mental health illnesses. (DSM-5). These disorders are often unpredictable and prolonged, lasting over six months. The consequential presentation seen in persons with these disorders and their unpredictability makes managing these individuals difficult. Schooling institutions often have to bear the burden of these presentations, sometimes in the face of inadequacy in expertise to handle children with these disorders. Panic disorder is an example of a behavioural and social disorder common among school-going children and adolescents.

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Case Study

The case presented is of a 13-year-old Latino boy living with his grandmother. The client was brought to the clinic with complaints of chest pain, shortness of breath, and pulse. He was reported to have experienced these symptoms on multiple occasions. The symptoms began eight months before the hospital visitation and have since been intensifying. The client has been experiencing more episodes of these symptom manifestations in the past two months. This prompted the client’s grandmother to bring him to the hospital. The client’s grandmother also reported that the symptoms were accompanied by tremors, sweat, and sometimes nausea. The client’s symptoms had no predictable pattern and were often sudden in onset. The client has no history of drug or substance abuse. His past medical history is negative for any significant physical or mental health illness.

The client lives with his grandmother and his two other siblings. The client’s grandmother is a 70-year-old retired nurse. She has been living with her grandchildren since their mother’s incarceration in a local nursing home four years ago. She is stable financially and has insurance coverage. She is wary of her health and that of her grandchildren and often subjects them to routine medical checkups. The client’s grandmother is a known diabetic and hypertensive and is currently on medications. She has no history of alcohol and substance use. Her past medical history is negative for any mental health illnesses.

The client’s mother is incarcerated in a nearby nursing home with multiple illnesses. His mother has a history of panic disorder. The client’s grandmother reports that the client’s mother was an alcoholic and often neglected her parenting duties. She was also violent and often used excessive force on her children. She was diagnosed with substance abuse disorder and schizophrenia. She has since been living in a local nursing home.

The client has two siblings, aged 10 and 8. They are both schooling and in grades nine and 7. The younger child seems to be doing well in school. Her medical history is negative for any childhood mental health illness or physical illnesses. The older sibling struggles in school. Several complaints of defiant behaviour have been reported against him. He also has anger issues both at school and at home. He was recently diagnosed with oppositional defiant disorder by the family psychiatrist and is receiving therapy.

Assessment Procedures

The assessment process seeks health information that guides the client’s diagnosis. Getting the client’s personal information and biodata is the preliminary step in the assessment. This gives information on the client’s age, where they live, and gender. This information helps identify age-related, gender-related, and environmental factors that put the client at risk for mental health illnesses. Most behavioural disorders affecting children and adolescent illnesses often occur before the adolescent turns 18 years old. Information on age may thus be valuable in determining whether the client still falls within this diagnostic criteria. Gender and the location where a client lives are equally important as they also give a trajectory on the likelihood of an individual developing a specific illness.

Subjective data on the client’s manifestation is the second assessment point. This encompasses data on the symptoms’ onset, severity, and frequency. It also gives information on other personal details contributing to the client’s suffering. This information includes past medical and medication history, family history, and social history. Past medical and drug history will enable the determination of underlying illnesses contributing to the symptoms manifested. Several somatic pathologies often present with symptoms that resemble those seen in mental health illnesses. It is important to establish the presence of any underlying diseases or comorbidities to distinguish whether the symptoms presented are a factor of the systemic pathology or a mental health illness. Family history may give information on the presence of a mental health illness in the client’s genetic lines. Several mental health illnesses have a genetic predisposition, and the likelihood of developing them is higher in individuals with first-degree relatives having the disorder. Social history may inform the client’s behaviour in their work environment. Childhood behavioural disorders have considerable negative impacts on occupational and psychosocial functioning. Individuals with these illnesses perform poorly in social functionalities such as interpersonal relations and schooling (Ogundele, 2018). Social history may reveal social indicators in an individual that are suggestive of a mental health illness

Physical assessment helps in the confirmation of diagnoses. It gives a general overview of system functionalities and physiologic and anatomical normality. Physical assessment findings may indicate bodily involvement of the mental health illness. A mental status examination is a valuable assessment point when assessing a client with mental health illness.

The client presented with chest pain, palpitations, and diaphoresis in the case study above. Subjective findings revealed that the client is a 13-year-old male living with his grandmother. He has no known underlying mental health or physical illness. His family history was positive for several mental health illnesses. His mother was diagnosed with panic disorder and schizophrenia, while his younger brother had an oppositional defiant disorder. The findings on family history give a trajectory to the likelihood of a mental health illness in the client. Philips (2022) reports that offspring of schizophrenic parents have up to a one-third chance of developing any mental health illness in their lives. Friedman (2021) also reinforces the familial and genetic involvement in mental health illness. The propensity to create any form of mental health illness is higher in families with kin suffering from a mental health disorder. These findings significantly increase the prospects of the client in the case of having a mental health illness. As noted in the case, his younger sibling and his mother have a history of mental health illnesses.

The client was also exposed to violence early in his life. Per his grandmother’s report, the client experienced parental neglect from his mother and was occasionally subject to excessive force and violence. Children exposed to negative childhood experiences and other adverse childhood events are at a higher risk of developing behavioural and emotional dysregulation disorders in their middle childhood and adolescence. (Ma et al. (2021) reiterate the nexus between adverse events in childhood and child externalizing behaviour and consequent behavioural disorder. These events are highly predictive of these disorders and are important assessing points during mental health illness diagnosis. These finding further strengthens the suspicion of a mental health illness in the child in the case study.

Diagnosis

The DSM outlines symptoms of various mental health illnesses. It is a valuable tool in the diagnosis of various mental health illnesses. The client in the case presented had a positive diagnosis of panic disorder. Panic disorder is a type of anxiety disorder characterized by sudden panic attacks. DSM-5 describes panic as an attack of sudden intense discomfort or fear (Kim, 2019). Panic disorders are common among children and adolescents. The criteria for diagnosing a panic disorder as per the DSM include having developed at least one episode of a panic attack followed by at least one month of frequent attacks, or worry of having an attack and the presence of a maladaptive behaviour to these attacks, such as avoiding school for fear of such attacks.

Of significance when diagnosing a panic disorder is the distinction between a panic attack from other conditions and a panic disorder. While panic attacks are periodic, minimal, and often have an identifiable trigger, panic disorders are frequent and recurrent. The hallmark feature of panic disorders is an attack that is sudden in onset and has no predictable pattern. There is no defined trigger factor for the panic seen in panic disorders, and the affected individual lives in constant fear of when another attack will happen (Cackovic et al., 2022). This contributes to the psychosocial problems seen in individuals with panic disorders. Panic attacks occur periodically in many people and are often in response to a life stressor. Complete healing and recovery often occur after having a panic attack.

Panic attacks are not limited to panic disorders. They have been associated with symptom severity of other mental health illnesses. Diminished responses to therapeutic interventions in other anxiety disorders and suicidal tendencies and ideation have all been associated with panic attacks. Substance abuse disorders and medications such as amphetamines and corticosteroids. Panic attacks may also arise from systemic pathologies such as vestibular dysfunction or hyperthyroidism. It is thus imperative that panic attacks from other mental and physical illnesses are ruled out when diagnosing a panic disorder.

The genesis of panic attacks is thought to be a false perception of a threat among individuals. Clients with panic attacks respond disproportionately to things they perceive to be a threat to their existence. These self-perceived threats may be common life situations perceived by other persons to have no harm during the diagnosis and management of panic disorders. It is also important to differentiate panic responses from actual threats and those from false alarms or things considered to have no significant threat to life.

In the case study provided, assessment findings were indicative of the presence of mental health illnesses. The client was particularly at high risk of a behavioural disorder due to his childhood experiences and genetic predisposition to mental health illnesses. The client had symptoms of a panic attack. The manifestations of palpitations, chest pain, sweating, and shortness of breath were consistent with those seen in a panic attack. The symptoms manifested by the client are also in concert with the DSM description of a panic attack. The assessment findings on the client revealed that these symptoms are often abrupt in onset and have no identifiable trigger or pattern. These descriptions distinguish a panic disorder from a panic attack. Unlike panic attacks, panic disorders often have no identifiable pattern or triggers and are abrupt.

Assessment findings also revealed that the client had been experiencing panic symptoms for over eight months, but the last two months saw an increase in the frequency of symptomatic manifestations. This further confirms a panic disorder. As per the DSM criterion, a positive diagnosis is made in the presence of recurrent episodes of panic followed by at least one month of persistent concerns of attack. This was the case in the client’s case study outlined above. His last two months before visiting the clinic saw him have more frequent attacks.

The client had no known mental health or physical illnesses. His medical history was also negative for past medical conditions that could have been contributing to the symptoms observed in the client. The client also had no history of substance use. These findings ruled out systemic pathologies as causal factors for the client’s panic attacks. It also ruled out specific medication use as a reason for the panic attacks. This further confirmed the presence of a pathologic panic disorder.

Treatment Goals

The overall treatment goal is to lower the frequency of panic attacks and enhance the psychosocial functionalities of the client. To achieve this, the client will be expected to adhere to his antianxiety medications if prescribed, track their symptoms, and follow up with his caregiver and healthcare providers. The family will also be involved. Their role in this regard is to help the client track his symptoms and inform the healthcare providers of relapse, adverse reactions to medication, and general follow-up services. Another goal is to equip clients with coping strategies to manage their symptoms. To attain this, the client will undergo behavioural therapy targeted at providing him with the best methods to handle his fears.

Description of Interventions to be Utilized

Approaches to panic disorder management encompass both pharmacologic and non-pharmacological approaches; pharmacotherapy with benzodiazepines and antidepressant medication maintains effectiveness in alleviating the symptoms of this disorder. Selective serotonin reuptake inhibitors are the first-line agents in the management of panic disorder. Adjunctive use of SSRIs and benzodiazepines is recommended for patients with coexisting conditions experiencing severe symptoms.

Non-pharmacological interventions such as cognitive behavioural therapy and breathing therapy are the mainstay psychological interventions used in panic attacks. These modalities maintain effectiveness in symptomatic relief of panic attacks. Their adjunctive use with pharmacotherapy is superior to either agent used alone. They are effective in the presence of comorbidities. Breathing training uses the capnometry biofeedback mechanism to lower panic and decrease hyperventilation that often characterizes panic disorders (Cackovic et al., 2022). Slow breathing techniques are especially beneficial to clients with coexisting asthma and hypertension.

Psychotherapy with cognitive behavioural therapy is another modality that is beneficial in the management of panic attacks and panic disorders. This modality equips the client with effective coping strategies for their panic attacks. CBT is based on the fundamental belief that panic attacks are a consequence of physiologic arousal in response to a perceived bodily threat, as posited by cognitive behavioural theories (Robinaugh et al., 2019). This therapeutic modality seeks to equip clients with panic attacks with the skills necessary to confront and overcome causal factors for these attacks.

The treatment plan in the client’s case above will take a systemic approach employing the principles of cognitive behavioural therapy. This approach recognizes the role the family plays in influencing behaviour. The first step in CBT is laddering. Laddering is a practice technique in CBT training that helps individuals identify and organize their thought processes to establish what causes their fearful or negative thinking. This step can employ circular questioning, where the therapist will ask what fears the client has, what they think causes and precipitates their negative thought processes, and what thoughts make them feel better. By the conclusion of the laddering step, the client will have to establish a rough outline of some of their fears and the environment that causes them to fear or have negative thinking. The family plays a role in this part (Ellis, 2022). In this regard, the grandmother will be required to weigh in on what they think troubles the client and deduce from their past reactions what makes them feel better or alleviate his panic.

Narrowing the thought processes into core beliefs is the next step in this mock session. Core beliefs are the client’s biggest fears, perspectives, thoughts, or assumptions about how the world works. For example, a client may state that they perceive a perfect life where they should not be making mistakes and that sudden fear or negative thoughts kick in when they are about to make a mistake. After establishing the client’s core beliefs, the therapist will conceptualize the contexts of these beliefs before developing a behavioural therapy that challenges the client’s core beliefs.

The behavioural therapy selected for the client will be tailored to challenge the client’s core beliefs. The reframing tactic will be used complementarily to help the clients better understand themselves and offer them another alternative to viewing themselves. The client will be presented with real-life scenarios that challenge their core beliefs. For example, suppose the core belief identified in the patient is fear of feeling worthless whenever they make a mistake or cannot attain their goal in a world they perceive as perfect. In that case, the therapy can be designed so that they do not achieve their goal or make mistakes. In the process, the client will be advised that making mistakes is part of life and does not make them feel worthless.

In a mock CBT training session, the first 10 minutes will be dedicated to skills training. In this step, the therapist will have a session with the client where he will be trained on positive talk of self and the significance of having high esteem and confidence. This will be followed by 30 minutes of parental training. In this step, the ideals of parental intensiveness and autonomy granting as a basis for building confidence in the child are significant. The client’s grandmother will be advised to increase autonomy granting and reduce intrusiveness. She will always be reported to give the client choices and not assert their choices on them, accept the client’s emotional response rather than criticize them and allow the child to learn through trial and error and from making mistakes rather than handling their task. These approaches will boost the child’s confidence and enhance his esteem. A conjoint parent-child meeting will then be availed for another 10 minutes. In this step, the therapist will help the client and his grandmother develop a strategy for improving independence and further identify other fears that confront the child and often result in a panic attack.

The expected outcomes of the mock session include an enhanced understanding of cognitive skills required to confront fears and negative thought processes, the client’s better sense of self, and enhanced parental training skills for the grandmother. A positive reaction is expected from the grandmother. In this regard, she will be expected to understand better the parental skills necessary for handling the child. Changes realized after the mock session will be informed by the enhanced capacity of the client to manage his fears and high self-confidence and esteem. The client’s grandmother will be expected to grant him autonomy over his personal decisions.

Ethical and Cultural Considerations

Several ethical and cultural considerations have to be made when treating the client. The ethical considerations applicable in this case include integrity, respect, and benevolence (Marks et al., 2021). Benevolence requires that the therapist does well for the client by advancing their welfare. The therapist is expected to increase the client’s welfare by providing sound treatment and selecting effective interventions. Integrity will enable the therapist to uphold the client’s beliefs during therapy, while respect allows the therapist to recognize and acknowledge the client’s beliefs and values. The client is a Latino. Cultural considerations should be made in cross-cultural treatment. Specific considerations that may be made in this regard include unfamiliarity with the treatment approach, language barriers, belief in alternative medicines, personal experiences, and the impact of religion or culture on health and health-seeking behaviour. Therapists should provide culturally sensitive and competent care to this patient with consideration of the client’s cultural provisions (Acle et al., 2021). They should employ the principles of culturally effective communication to enhance the client’s confidence in their services.

Behavioural disorders are disruptive and often result in significant functional deficits in the affected individuals. These disorders often affect children and adolescents and are major contributing factors to psychosocial declines seen in these individuals. A thorough assessment of clients presenting with these disorders is warranted to assist in accurately diagnosing these clients. The DSM helps in the diagnosis and ensures that accurate diagnoses are made. Early treatment with psychotherapy and pharmacotherapy can lower these disorders’ symptomatic manifestation, allowing these individuals to lead normal lives.

 References

Acle, A., Cook, B., Siegfried, N., & Beasley, T. (2021). Cultural Considerations in Treating Eating Disorders among Racial/Ethnic Minorities: A Systematic Review. Journal Of Cross-Cultural Psychology, 52(5), 468-488. https://doi.org/10.1177/00220221211017664

Cackovic, C., Nazir, S., & Marwaha, R. (2022). Panic Disorder. Ncbi.nlm.nih.gov. Retrieved 25 September 2022, from https://www.ncbi.nlm.nih.gov/books/NBK430973/.

Ellis, P. (2022). Here’s Exactly What a Cognitive Behavioral Therapy Session Looks Like. Men’s Health. Retrieved 25 September 2022, from https://www.menshealth.com/health/a33697198/cbt-therapy-session-what-its-like-video/.

Friedman, B. (2021). Is Mental Illness Genetic? Genetic Predisposition Factors. FHE Health – Addiction & Mental Health Care. Retrieved 25 September 2022, from https://fherehab.com/learning/factors-increase-genetic-predisposition-mental-health/.

Kim, Y. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry Investigation, 16(1), 1-3. https://doi.org/10.30773/pi.2019.01.08

Ma, J., Lee, S., & Grogan-Kaylor, A. (2021). Adverse Childhood Experiences and Spanking Have Similar Associations with Early Behavior Problems. The Journal Of Pediatrics, 235, 170-177. https://doi.org/10.1016/j.jpeds.2021.01.072

Marks, J., Rosenblatt, S., & Knoll, J. (2021). Ethical Challenges in the Treatment of Anxiety. FOCUS, 19(2), 212-216. https://doi.org/10.1176/appi.focus.20210001

Ogundele, M. (2018). Behavioral and emotional disorders in childhood: A brief overview for paediatricians. World Journal Of Clinical Pediatrics, 7(1), 9-26. https://doi.org/10.5409/wjcp.v7.i1.9

Philips, L. (2022). Challenging the inevitability of inherited mental illness – Counseling Today. Counselling Today. Retrieved 25 September 2022, from https://ct.counseling.org/2019/08/challenging-the-inevitability-of-inherited-mental-illness/.

Robinaugh, D., Ward, M., Toner, E., Brown, M., Losiewicz, O., Bui, E., & Orr, S. (2019). Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. General Psychiatry, 32(6), e100140. https://doi.org/10.1136/gpsych-2019-100140

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Create a hypothetical case study of an infant, child, or adolescent presenting for therapy. Then, develop a treatment plan and a thorough description of the interventions you would use with the individual and their parents. Provide an overview of suggested interventions for six sessions with a detailed description of one mock session. Your paper should be organized as indicated in the previous week’s assignment instructions.

Think about your previous case presentation. You are extending your case study and will offer details about the family, which are truly important for a colleague. You will also lay out how you will assess the child and family. SM-5 diagnoses for disorders that present in childhood and adolescence. Use this information to determine your diagnosis for the child or adolescent. Although you may see this diagnosis as having more systemic origins, a diagnosis can help the family gain reimbursement of services through insurance or seek resources through other social/ educational systems. This diagnosis and your theoretical conceptualization will inform your treatment goals and interventions. Discuss generally the types of interventions you will use in treatment with one detailed description of a mock session with the family. For example, if you are using a structural family therapy, you would describe the various interventions you plan to use from this orientation but describe in detail how you would work with the family for one session using one or more interventions. The mock session should also explain the family’s reactions and any signs of change from the intervention(s).

Finally, reflect on potential ethical concerns and how you will manage those concerns. Also, discuss the cultural considerations and how you will address those. Reflect on potential ethical concerns and how you will manage those concerns. Also, examine the cultural considerations and how you will address those.