Background
The case study features a ten-year-old boy whose parents complain of his constant anger and irritability, accompanied by outbreaks of psychomotor activities, restlessness and resentment towards them and his teachers. At school the boy is not doing well, he often engages into demonstrative behavior such as running and shouting around the class or taking things from other pupils. Moreover, the boy easily loses his composure, refuses to obey teachers or parents and is prone to blaming others for his misbehavior. The Diagnosis of Oppositional Defiant Disorder (ODD) may be suspected given the clinical evidence. It is a health issue characterized by predominance of aggression, a tendency to assume control, and outright irritation in response to requests and demands (Ghosh et al, 2018). The boy’s behavior needs to be changed since, if not treated, the ODD progresses, incorporating such symptoms as cruelty to young children, games with objects that can cause real harm to others, theft, and hooliganism (Szentiványi & Balázs, 2018). Moreover, without timely correction, ODD may lead to drastic consequences for both the patient and his family. As practice shows such patients are prone to early alcoholism, drug abuse, and are often unable to get even secondary education.
Assessment
An assessment package for the ODD diagnostics would include socio-psychological tests adapted to age characteristics, clinical symptoms, and a conversation with parents. Socio-psychological testing allows specialists to evaluate the process of the boy’s growing up and development in terms of its correspondence with such goals as getting an education and entering an independent life. Testing allows specialists to notice emerging problems in development in time and offer timely assistance to the child and his family. Clinical picture of CDD is characterized by such symptoms as the absence of social skills, irritability, contempt for adults and peers, disobedience, and blaming others for one’s bad mood (McKinney & Renk, 2019). If at least four of the described symptoms have been persistent for as long as six months, specialists may speak about ODD development. In this particular clinical case, the boy has been exhibiting symptoms of aggression, lack of self-control, demonstrative behavior, irritability, and disobedience for about a year, which makes ODD diagnosis warranted.
A conversation with parents allowed the specialist to learns more about the peculiarities of the child’s behavior. In particular, it was revealed that the boy constantly seeks to annoy or bully other people and seems to get pleasure from such acts. Moreover, the specialist learned about the personality of the father or mother, and the rules of upbringing adopted in the family. It turned out that the child was unwanted; as soon as nursing period finished mother was glad to return to her career in a big company and the child was left very much to himself. Most of the day he stayed with older relatives who had no wish to communicate with him and preferred to watch TV all day long. Moreover, the parents’ family life is not successful as they have difficulties in finding a common ground and blame each other for the child’s misbehavior. The methods of upbringing adopted in the family is that of punishment and shouting at the child. It is highly likely the lack of parental love may have been conducive to the ODD development.
The target behavior in this particular case of ODD is seen as adherence to norms adopted in the society and cultivating such qualities as diligence, empathy, kindness, politeness and developing communicative abilities. The functions of the target behavior may include getting social attention, as the child clearly lacks love and sympathy, and the desired objects. Receiving social attention, in this case, means getting praise, reward or building positive conversation with parents, teachers, and peers. Desired objects may include positive marks at school, gadgets, or some delicacies.
Treatment Goal
The treatment goal is seen as diminishing ODD symptoms at early stages with the aim of their complete elimination at later stages. According to the relevance behavior rule, it is necessary to choose only such target behavior that will provide additional reinforcements to the child in his natural social environment (Burke, J. D., & Romano-Verthelyi, 2018). In terms of function-based approach, the target behavior for this particular case will aim at getting positive social attention and desired objects. The child has been subject to punishment for too long and this strategy clearly discredited itself. Loving and caring attitude and moral support as a reward for desired behavior is seen as the best way to help the child.
The treatment package will focus on changing the relationship between parents and the boy. The psychotherapists work with the father, mother and other family members, explaining to them how to resolve conflicts peacefully and build trusting relations with the child. The correctional work will be organized around the principles of punishment and encouragement aimed at maintaining correct actions and rejection of incorrect and socially dangerous behavior (Burke et al., 2021). While working with a child, specialists would use methods of art, fairy tale, and music therapy. These methods are designed to teach the child the rules of communication in society, to find alternative ways to express their own desires, anger and irritation. The main goal of psychotherapy in this case will be to let parents understand that the boy needs their attention, love and affection, and to help the child control his emotions.
Evaluation
The data on the changes of the boy’s behavior were gathered from school reports, parents’ and relatives’ assessment of their child behavior and periodical examination of the child by a doctor. The data were put in the child’s health record so that objective evaluation as to the results of the therapy could be made. The data were measured for six months which allowed to get a clear picture of improvements.
On clinical examination, the child is less stressed and more willing to communicate. He is proud of his achievements at school and eager to share with the doctor. School reports show that the boy is more willing to take instructions from teachers and stopped being rude to them and to his peers. Moreover, the boy willingly takes part in school activities such as the football team and the theatre. The parents’ reports show that the child became less aggressive and assertive and is ready to take advice. There has been a great improvement in his communicative skills that allowed him to built trusting relationship with his parents. However, some problems still remain: the child lacks self-control in stressful situations and often blames other for his failures. Maintenance therapy would be needed to offset these negative behavioral traits.
Generalization/Maintenance
Further reinforcement will be needed to support the positive changes in the child’s behavior. Since positive social attention and trust building relationships helped the child to foster his social interaction skills, it is advisable that reward strategy is continued. These may be rewards in terms of visiting places the child wants or granting him desired objects, as well as such immaterial rewards as praise, and expressions of approval. Moreover, the maintenance strategy must include regular conversations with parents to foster openness and help the child to overcome the difficulties he may experience. Regular visits to the doctor are recommended at least throughout a year following the last visit to assess the child’s progress.
References
Ghosh, A., Ray, A., & Basu, A. (2018). Oppositional defiant disorder: current insight. Psychology research and behavior management, 10, 353–367. Web.
McKinney, C., & Renk, K. (2019). Emerging research and theory in the etiology of oppositional defiant disorder: Current concerns and future directions. International Journal of Behavioral Consultation and Therapy, 3(3), 349.
Szentiványi, D., & Balázs, J. (2018). Quality of life in children and adolescents with symptoms or diagnosis of conduct disorder or oppositional defiant disorder. Mental Health & Prevention, 10, 1-8. Web.
Burke, J. D., & Romano-Verthelyi, A. M. (2018). Oppositional defiant disorder. In Developmental pathways to disruptive, impulse-control and conduct disorders (pp. 21-52). Academic Press. Web.
Burke, J. D., Johnston, O. G., & Butler, E. J. (2021). The Irritable and Oppositional Dimensions of Oppositional Defiant Disorder: Integral Factors in the Explanation of Affective and Behavioral Psychopathology. Child and Adolescent Psychiatric Clinics, 30(3), 637-647. Web.
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