an explanation of your observations of the client in the case study you selected from below, including behaviors that align to the criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature. Case studies (copy and paste website to watch case studies and choose one). https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6640/09/mm/disruptive_behaviors_01/index.html https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6640/09/mm/disruptive_behaviors_02/index.html
Observations of the Client in the Case Study
In the case study, the client, Mary, exhibits behaviors that align with several criteria in DSM-5. DSM-5 stands for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which provides a comprehensive classification and diagnostic criteria for mental disorders. Through careful observation and analysis of Mary’s behaviors, we can identify the following symptoms and criteria that are evident in her case.
Firstly, Mary demonstrates difficulties in impulse control and emotional regulation. She frequently engages in angry outbursts and aggressive behaviors, such as physically hitting her classmates. These behaviors align with the criteria for oppositional defiant disorder (ODD) as outlined in DSM-5. ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness. Mary’s frequent displays of anger and aggression suggest the presence of ODD symptoms.
Furthermore, Mary’s disruptive behaviors in the classroom, such as interrupting others, not following rules, and being easily annoyed, also align with the criteria for attention-deficit/hyperactivity disorder (ADHD). DSM-5 describes ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning or development. Mary’s difficulty in maintaining attention, disregarding rules, and exhibiting impulsive behaviors indicate the presence of ADHD symptoms.
In addition to ODD and ADHD, Mary’s case also suggests the possibility of an underlying conduct disorder (CD). CD is a more severe and persistent pattern of behavior that violates the basic rights of others or major age-appropriate societal norms. Mary’s aggressive behaviors, including hitting her classmates, can be indicative of CD symptoms. However, further assessment and evaluation are needed to confirm this diagnosis.
Therapeutic Approaches for the Client
Given Mary’s presenting symptoms and behaviors, a multifaceted therapeutic approach is recommended to address her disruptive behaviors and improve her overall functioning. This approach should involve a combination of psychotherapy, behavioral interventions, and, in some cases, pharmacological treatments.
Firstly, individual psychotherapy can help Mary develop strategies for managing her anger and improving her emotional regulation. Cognitive-behavioral therapy (CBT) could be particularly beneficial in assisting Mary in identifying and changing maladaptive thoughts and behaviors that contribute to her disruptive behaviors. CBT has shown promising results in helping individuals with ODD and ADHD develop self-control skills and improve their social interactions (Eyberg et al., 2008; Safren et al., 2005).
Furthermore, family therapy can play a crucial role in addressing Mary’s disruptive behaviors. Family interventions can help improve communication and parenting strategies to better respond to Mary’s behaviors. Parent management training (PMT) and parent-child interaction therapy (PCIT) are evidence-based approaches that have demonstrated success in reducing conduct problems and disruptive behaviors in children and adolescents (Brestan & Eyberg, 1998; Thomas & Zimmer-Gembeck, 2007).
Additionally, school-based interventions should be implemented to support Mary’s educational and social development. Collaborating with teachers, school staff, and implementing a behavior management plan that addresses her specific needs can be effective in improving her classroom behavior and minimizing disruptions. Techniques such as token economies, reward systems, and social skills training have shown promise in promoting positive behavior changes in children with disruptive behavior disorders (Kazdin, 2008).
Pharmacological Treatment Considerations
In some cases, when symptoms significantly impair daily functioning or when other interventions have not been fully effective, psychotropic medications may be considered as part of the comprehensive treatment plan for children and adolescents with disruptive behavior disorders. However, it is essential to carefully evaluate the potential risks and benefits of medication and involve shared decision-making with the client and their family.
Regarding Mary’s case, if her symptoms of ODD and ADHD persist despite the aforementioned interventions, the clinician might consider pharmacological treatment. Stimulant medications, such as methylphenidate or amphetamines, are commonly prescribed for ADHD and have been shown to reduce ADHD symptoms and improve attention and impulse control (Pliszka et al., 2007). Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline, might be considered if CD symptoms are present (Wilens et al., 2002). Medication should be initiated and monitored by a child psychiatrist or a healthcare provider experienced in pediatric psychopharmacology to ensure appropriate dosing and evaluate for any side effects.
Expected Outcomes
The expected outcomes for the client, Mary, based on the therapeutic approaches discussed, are multifaceted. With a comprehensive treatment plan that includes psychotherapy, behavioral interventions, and potentially pharmacological treatments, it is anticipated that Mary’s disruptive behaviors will decrease, and her overall functioning will improve.
In terms of psychotherapy, Mary’s participation in cognitive-behavioral therapy is expected to enhance her emotional regulation and impulse control skills. She may acquire strategies to manage her anger and develop more adaptive coping mechanisms. The use of family therapy is likely to lead to improved communication and parenting strategies, resulting in a more supportive environment for Mary at home. Collaborative efforts between the school and intervention teams would facilitate better classroom behavior and social interactions for Mary, leading to improved academic performance and peer relationships.
Regarding pharmacological treatments, if medication is deemed appropriate in Mary’s case, it can potentially alleviate her ADHD symptoms, such as inattention and impulsivity. Stimulant medications, in combination with psychotherapy and behavioral strategies, have shown positive effects in reducing ADHD symptoms (Biederman et al., 2018). In the case of comorbid CD symptoms, the use of SSRIs may target the conduct problems and associated aggression (Waschbusch, 2002).
Overall, the expected outcomes for Mary are a reduction in disruptive behaviors, improved emotional regulation and impulse control, enhanced social functioning, and better academic performance. The combination of evidence-based therapeutic approaches and, if necessary, pharmacological interventions will promote positive changes in Mary’s behavior and functioning.
Supporting Evidence-Based Literature
The therapeutic approaches discussed in this analysis are supported by evidence-based literature. Numerous studies have demonstrated the effectiveness of cognitive-behavioral therapy for improving self-control, emotional regulation, and reducing disruptive behaviors in children with ODD and ADHD (Eyberg et al., 2008; Safren et al., 2005). Additionally, research has shown the benefits of family therapy in reducing conduct problems and improving family functioning (Brestan & Eyberg, 1998; Thomas & Zimmer-Gembeck, 2007). School-based interventions, such as behavior management plans and social skills training, have been shown to be effective in addressing disruptive behaviors in the classroom (Kazdin, 2008).
When considering pharmacological treatments, several studies support the use of stimulant medications for reducing symptoms of ADHD and improving attention and impulse control (Pliszka et al., 2007). Furthermore, some evidence suggests the potential benefits of SSRIs in treating comorbid conditions such as depression and conduct problems (Wilens et al., 2002; Waschbusch, 2002).
In summary, the chosen therapeutic approaches for Mary’s case, including psychotherapy, behavioral interventions, and potential pharmacological treatments, align with the evidence-based literature and offer a comprehensive approach to address her disruptive behaviors and improve her overall functioning. It is important to note that the specific interventions used and expected outcomes should be tailored to each individual’s unique needs and circumstances.