|Assignment: Practicum – Week 9 Journal Entry
Develop diagnoses for clients receiving psychotherapy*
Analyze legal and ethical implications of counseling clients with psychiatric disorders*
* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.
Select a child or adolescent client whom you observed or counseled this week. Then, address the following in your Practicum Journal:
Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
Using the DSM-5, explain and justify your diagnosis for this client.
Explain any legal and/or ethical implications related to counseling this client.
Support your position with evidence-based literature.
Use this case scenario
Case Study 1 – Jack
Jack is a 7 year old male Grade 1 student who lives in Toronto with his parents. He is the only child to two parents, both of whom have completed post-graduate education. There is an extended family history of Attention Deficit/Hyperactivity Disorder (ADHD), mental health concerns as well as academic excellence.
Jack is an intelligent and caring young boy who presents with significant potential to excel academically. In his spare time, Jack enjoys spending time with his friends, and participating in physical activities such as swimming, running and skating. He also enjoys participating in social events, and is often invited to play dates and birthday parties. It is noteworthy that he did not know his address or home phone number, could not print his surname, and recognized only a few pre-primer words.
While Jack interacts well with peers his own age, his parents note that he can be easily led and influenced by others. They also report that Jack gets upset when he does not receive recognition or feels that he has been ignored. His teacher notes that he sometimes acts ‘socially immature’, and that he often demonstrates attention-seeking behaviour.
Jack describes difficulties with focusing, and sitting still in class. He recognizes that he is able to ‘hyper focus’ on some activities of interest, however he often has difficulty sustaining his attention at school. His parents and teacher indicate that Jack is restless, and often requires reminders to help him stay on task. He is described as “constantly running around” and presenting with difficulties listening and following instructions. Jack’s teacher indicates that he often blurts out answers and interrupts other students in the classroom. Jack recognizes this tendency in himself, but says that he ‘can’t stop’ in spite of his best intentions.
Jack has always had challenges falling asleep, and sometimes finds that he wakes up in the middle of the night. When he wakes up he finds that he has a difficult time getting back to sleep – sometimes staying awake for as long as an hour and a half.
His mother reports difficulties at home with following routines and remembering instructions. His parents describe emotional reactivity as well as confrontational behaviours demonstrated both at home and at school. His teacher notes that Jack is very defiant towards listening to instructions, but generally interacts well with his peers. He is easily frustrated and emotionally impulsive – Jack has had several incidents of hitting, crying outbursts, and inappropriate behaviour. Behavioural concerns with aggression, lying, arguments, and disruptive behaviour were noted in pre-school program at age 4.
Jack presents with a diagnosis of Attention-Deficit/Hyperactivity Disorder, combined type. He also presents with Oppositional Defiant Disorder.
A. Behavioural Intervention:
Jack has participated in a coaching program that focuses on strategies for managing his focus in multiple environments, as well as with self-regulation and control. He has been working on a capacity building program to promote health behaviour change and improved performance. Accommodations with the school have been implemented to improve Jack’ ability to manage instructions, ask for help when he needs it, and take responsibility at home and at school
B. Medical Intervention:
In the time since his diagnosis one year ago, a trial of stimulant medication has been conducted. The medication type and dosage have been adjusted several times in order to find the best balance:
Biphentin Vyvanse Strattera Concerta