Chapter 10. Gabriel’s Case: Spoiled or Troubled?

10.1 Screen 1

Clinical Choices
true
true
You must read each slide, and complete any questions on the slide, in sequence.
Separation Anxiety Disorder
Individual displays fear or anxiety concerning separation from attachment figures—anxiety that is unreasonable or excessive for the individual’s age group. Individual’s excessive anxiety features three or more of the following symptoms: Repeated separation-related upset Repeated loss-related concern Repeated fear of experiencing separation-caused events Repeated resistance to leaving home Repeated resistance to being alone Repeated resistance to sleep-aways Repeated separation-focused nightmares Repeated separation-triggered physical symptoms Individual’s symptoms last 4 weeks or more for children and at least 6 months for adults. Significant distress or impairment. (Information from: APA, 2013)
Disruptive Mood Dysregulation Disorder
For at least a year, the individual repeatedly displays severe outbursts of temper that are extremely out of proportion to triggering situations and different from ones displayed by most other people of his or her age. The outbursts occur at least three times per week and are present in at least two settings (at home, at school, with peers). Individual repeatedly displays irritable or angry mood between the outbursts. Individual receives initial diagnosis between 6 and 18 years of age. (Information from: APA, 2013)
Oppositional Defiant Disorder (ODD)
Individual repeatedly displays angry/irritable mood, argumentative/deviant behavior, or vindictiveness. At least four of the following symptoms are present over the past 6 months: Losing temper Touchy or easily annoyed Angry and resentful Argues with authority figures Actively defying or refusing to comply with requests from authority figures Deliberately annoying others Blames others for own misbehavior Is spiteful or vindictive The symptoms produce distress in the individual or others, or negative affect social, educational, or other areas of functioning. (Information from: APA, 2013)
Conduct Disorder (CD)
The individual repeatedly behaves in ways that violate the rights of other people or ignore the norms or rules society, beyond the violations displayed by most other people of the individual’s age. At least three of the following features are present over the past year (and at least one in the past 6 months): Frequent bullying or threatening of others Frequent provoking of physical fights Using dangerous weapons Physical cruelty to people Physical cruelty to animals Stealing during confrontations with a victim Forcing someone into sexual activity Fire-setting Deliberate destruction of others’ property Breaking into a house, building, or car Frequent lying Stealing items of value under nonconfrontational circumstances Frequently staying out beyond curfews, starting before the age of 13 Running away from home overnight at least twice Frequent truancy from school, starting before the age of 13 Significant impairment (Information from: APA, 2013)
Attention Deficit/Hyperactivity Disorder (ADHD)
Individual presents one or both of the following patterns: For 6 months or more, individual frequently displays at least six of the following symptoms of inattention, to a degree that is maladaptive and beyond that shown by most similarly aged persons: Unable to properly attend to details, or frequently makes careless errors Finds it hard to maintain attention Fails to listen when spoken to by others Fails to carry out instructions and finish work Is disorganized Dislikes or avoids mentally effortful work Loses items that are needed for successful work Is easily distracted by irrelevant stimuli Forgets to do many everyday activities For 6 months or more, individual frequently displays at least six of the following symptoms of hyperactivity and impulsivity, to a degree that is maladaptive and beyond that shown by most similarly aged persons: Fidgets, taps hands or feet, or squirms Inappropriately wanders from seat Inappropriately runs or climbs Is unable to play quietly Is in constant motion Talks excessively Interrupts questioners during discussions Is unable to wait for turn Barges in on others’ activities or conversations Individual displayed some of the symptoms before 12 years of age. Individual shows symptoms in more than one setting. Individual experiences impaired functioning. (Information from: APA, 2013)
Specific Learning Disorder
During school-age years, the individual develops 1 or more of the following learning or academic difficulties for a period of at least 6 months: Incorrect or slow and effortful word reading Poor understanding of what is read Spelling difficulties Difficulties with writing Problems with numbers or calculations Problems with mathematical reasoning The level of functioning in the affected area is well below that typically displayed at the individual’s chronological age (Information from: APA, 2013)
Autism Spectrum Disorder
Individual displays continual deficiencies in various areas of communication and social interaction, including the following: Social-emotional reciprocity Nonverbal communication Development and maintenance of relationships Individual displays significant restriction and repetition in behaviors, interests, or activities, including two or more of the following: Exaggerated and repeated speech patterns, movements, or object use Inflexible demand for same routines, statements, and behaviors Highly restricted, fixated, and overly intense interests Over- or underreactions to sensory input from the environment Individual develops symptoms by early childhood. Individual experiences significant impairment. (Information from: APA, 2013)
Psychoanalysis

Psychoanalysis uses treatment techniques such as free association, or letting the client talk about whatever comes to mind, and therapist interpretation, which involves giving insight and offering an opinion on patterns noticed in the client’s free association and other indicators such as dreams. A psychoanalyst treating Gabriel would see him 3–5 times per week for several years. Psychoanalysis is costly, and it requires a long time commitment.
Interpersonal Therapy

Interpersonal therapy focuses on problems in significant relationships in the patient’s life. Interpersonal therapists treat patients by focusing on their current relationships with the most important people in their lives. These people include partners and spouses, parents, roommates, and children. For Gabriel, these would be his parents.
Behavioral/Sociocultural Therapy

Behavioral therapy involves helping patients change maladaptive behaviors. In Gabriel’s case, you would focus on the behaviors of both Gabriel and his parents, which makes this particular therapy sociocultural in nature. You would teach Emily and Mateo to reinforce his positive behaviors and ignore his negative behaviors. You would give Gabriel tips on how to focus on tasks such as reading. Finally, you would help Emily and Mateo master strategies for improving their parenting skills.
Medication

Medication involves taking a chemical agent prescribed by a medical doctor to alter brain chemistry, which subsequently alleviates symptoms. A psychiatrist, who has a medical degree (MD), would be able to prescribe ADHD patients a medication, such as Ritalin or Adderall, to treat the neurochemical imbalances in the brain. In Gabriel’s case, medication will help reduce his ADHD symptoms. As a therapist, you would continue to meet regularly with Gabriel and his parents in order to monitor his symptoms and to refer him to a psychiatrist to adjust the dose of his medication as necessary.

Taryn A. Myers, PhD, Virginia Wesleyan University

A teacher talks to the parents of a child named Gabriel.

10.2 Screen 2

Begin

Please note: Clinical Choices allows you to enhance and test your understanding of the disorders and treatments covered in your textbook, in a simulated case study environment. It is not intended to replicate an actual intake interview or therapy session or provide training on therapeutic techniques. Clinical Choices is for educational purposes only and is not intended as a substitute for clinical training.

10.3 Screen 3

Get instructions for the interview
true

The receptionist hands you the intake paperwork prior to your interview with your new client, Gabriel, and mentions that his parents have brought him in after several meetings with the staff at Gabriel’s school about his behavior. Select the button below to review the paperwork before you begin the interview.

New Client
Gabriel: Case #11017

Psychological Clinic

Intake Paperwork

Client Name: Gabriel

Parent/Guardian Name(s) (if minor): Emily and Mateo

Age: 6 years old

Gender: Male

Ethnicity: Biracial (Caucasian and Latino)

Occupation: Elementary school student

Current living situation: Lives with parents

Why are you seeking services at our clinic? We have received numerous complaints from Gabriel’s teachers about his outbursts in class. They’ve called us in for several conferences and told us that Gabriel won’t listen to instructions from adults, and also that he is struggling with his schoolwork.

10.4 Screen 4

Begin the interview

You will now ask Gabriel and his parents a number of questions you would typically ask during the intake interview. As you conduct the interview with Gabriel and his parents, begin to think about his symptoms, what his diagnosis might be, and later, what type of treatment might be most helpful to him. Select the “play” button to hear Gabriel’s and his parents’ responses to your questions. To read the transcript for these answers, select the “transcript” button.

10.5 Screen 5

Ask the next question

“Hi, Gabriel! It’s good to meet you. I’m a doctor, but I’m not the kind of doctor who will give you shots or anything like that. Instead, we’re going to talk about what’s going on with you at home and at school. Mom and Dad—Emily and Mateo, right?—it’s nice to meet you, too. What we are doing today is called an intake interview. I’m going to have you tell me why you are here today, and I’m going to ask you some questions that I ask everyone who comes here. This information will tell me how best to help you. This may mean having you continue to come to see me here at this clinic, or you may meet with another doctor. Let’s start. Gabriel, why do you think you are here today?”

Gabriel and his parents undergo an intake interview in a clinic.

Transcript

Gabriel: [sulky] Don’t know. They made me come. Who are you?

Mom: [embarrassed] Gabriel, darling, be nice to the doctor! I am very worried about Gabriel. He seems to be getting more and more disobedient. His first-grade teacher has called us in for several conferences. Apparently Gabriel is constantly being sent to the principal’s office for causing distractions in class and refusing to do what she asks him to do. [to Gabriel, pleading:] Gabriel, honey, stop fidgeting, please.

Dad: He’s also being disrespectful to his classmates. He distracts and annoys them in class, apparently. [sternly] This behavior is completely unacceptable!

Mom: His teacher also says that he is can’t sit still and he daydreams instead of paying attention in class – just like he is now. Gabriel, please … sit still. I know it’s hard for kids his age to pay attention, though, so maybe this is just normal?

Dad: [accusing] It’s not normal. You coddle him … you let him get away with all kinds of things!

10.6 Screen 6

Ask the next question

“Emily, Mateo, what other concerns are you having at this time? How does Gabriel act at home?”

Parents explain their concerns about Gabriel’s behavior.

Transcript

Gabriel: [rudely] Nothing! What’s it to you?

Dad: As you can see, he’s so argumentative and stubborn. What a pain!

Mom: Well, it has been hard to get him off the tablet, get ready for bed and go to bed at a reasonable hour. He also won’t make his bed, which is the one chore we are trying to get him to do.

Dad: Hard! How about nearly impossible! We have a battle every night about giving up that iPad, taking a bath and brushing his teeth. He won’t even put his pajamas on by himself! Then, once we put him to bed, he won’t stay there! It’s getting to be more and more of a struggle.

Gabriel: [rudely] Why do I have to put on pjs? You just make me take ‘em off again when I wake up!

Mom: I have to bribe him with an extra dessert to get the iPad, so he can get ready for bed. That seems to work. Getting him to do his reading is a huge ordeal! His teacher says he seems to be slow to catch on with reading, so she asked us to have him read for half an hour at home. I give him more time on the iPad as a reward for reading.

Dad: That’s the main problem – Emily spoils that kid. He’s smart, too… don’t let him fool you…he’s figured out how to get more and more time on the iPad… [aside, to Gabriel:] Son, what have we said about keeping your behind in your seat?

Mom: [martyred] Go ahead, blame me, if it makes you happy, Mateo. Everything is always my fault. If you spent more time with Gabriel and treated him with respect instead of like a drill sergeant he would not be rebelling. His soccer coach is just like you. Gabriel is just a kid, for heaven’s sake! It’s hard for kids to sit still in a classroom or stand in one place for a stupid soccer game.

Dad: Don’t even get me started on soccer! – [harshly] Gabriel, come back here…sit still and pay attention when adults are talking!...He was rude to his soccer coach – again – at Saturday’s game. The coach put him on the sidelines for three minutes. He’s been fooling around at practice instead of doing drills. Then his coach dropped him from the team. The final straw was when he was goalie and refused to stay in the box and pay attention to the game. He drew pictures in the dirt or jumped up and down. I was so angry I had to leave the game. What an embarrassment!

Question 10.1

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
2
Correct.
Of what Gabriel and his parents have told us, think about what is fact and what is opinion.
Incorrect.

Hint

Of what Gabriel and his parents have told us, think about what is fact and what is opinion.

10.7 Screen 7

Ask Gabriel and his parents the next question

“How do you react when Gabriel doesn’t listen to you or misbehaves?”

Gabriel’s parents continue the interview as Gabriel moves to look at the bookshelf in the clinic.

Transcript

Dad: Ugh. Don’t even get me started about his behavior at home. Six years old, and he already has a chip on his shoulder! It’s unbelievable!

Mom: He talks back pretty regularly.

Dad: He knows better than to argue with me, of course, because I will let him have it – a good hard smack on the behind shuts him up. But you ought to hear him and Emily go at it!

Mom: He argues constantly with me… about playing with iPad or my phone, about doing his reading, picking up his toys, getting ready for bed…everything is a struggle.

Dad: It’s because you treat him like your brother instead of your son. The way you argue, you sound more like siblings than mother and son.

Mom: [to Gabriel] Gabriel, come away from that bookshelf… stop that…sit down in your seat, please. [to therapist] I try to make reasoned arguments with him, but it doesn’t always work!

Dad: He never listens. You can’t reason with him.

Question 10.2

Which of the following diagnoses is a potential explanation for Gabriel’s behaviors at home and at school? Select all that apply. To review the diagnostic criteria for each disorder, select the disorder name.

wCfH0QtRgXJ8o+c+

Separation Anxiety Disorder

bI0LPa9lfHQ+dYqk

Disruptive Mood Dysregulation Disorder

bI0LPa9lfHQ+dYqk

Oppositional Defiant Disorder (ODD)

bI0LPa9lfHQ+dYqk

Conduct Disorder (CD)

bI0LPa9lfHQ+dYqk

Attention Deficit/Hyperactivity Disorder (ADHD)

bI0LPa9lfHQ+dYqk

Specific Learning Disorder

wCfH0QtRgXJ8o+c+

Autism Spectrum Disorder

Correct! It is possible that Gabriel’s defiance is linked to temper outbursts, so the diagnosis could be disruptive mood dysregulation disorder. His defiance of adults in authority positions could be a symptom of ODD or CD. His fidgeting could be a sign of ADHD, and it’s possible that his reluctance to read could be due to a specific learning disorder. Gabriel doesn’t seem particularly upset about being away from his parents, the behaviors persist when he is at home, and he seems to have adequate social and verbal skills for his age, making diagnoses of separation anxiety disorder and autism spectrum disorder unlikely.
Think about all of the symptoms Gabriel’s parents mentioned. There is more than one correct answer.
That is not quite right. It is possible that Gabriel’s defiance is linked to temper outbursts, so the diagnosis could be disruptive mood dysregulation disorder. His defiance of adults in authority positions could be a symptom of ODD or CD. His fidgeting could be a sign of ADHD, and it’s possible that his reluctance to read could be due to a specific learning disorder. Gabriel doesn’t seem particularly upset about being away from his parents, the behaviors persist when he is at home, and he seems to have adequate social and verbal skills for his age, making diagnoses of separation anxiety disorder and autism spectrum disorder unlikely.

Hint

Think about all of the symptoms Gabriel’s parents mentioned. There is more than one correct answer.

10.8 Screen 8

What is happening to Gabriel?

“What is it like for you at school, Gabriel? Do you get in trouble sometimes?”

Gabriel comes back to his parents from the bookshelf as his mother insists, and he explains his concerns with his friends in school to the nurse.

Transcript

Gabriel: Yeah. The teacher doesn’t get it. The other kids get me in trouble. Yesterday, I was finishing up my picture book drawings and I needed the silver marker … and this girl wouldn’t share. [loudly] She’s supposed to SHARE! I tried to take it from her … and her drawing got ripped. Too bad for her – she should have SHARED! Not my fault! Other kids talk and then Miss Martin gets mad at me! [whiny] School is boring… I don’t want to read all day long. Too boring!

Mom: His teacher said she tries to get him back on task, and he talks back to her.

Dad: He does exactly what he’s doing now and blames other kids. Not right, son.

Mom: Like the marker incident. He ripped that girl’s paper and said it was her fault for not letting him borrow her marker.

Gabriel: [interrupting, indignant] It WAS her fault!! She deserved it!

Dad: [raising his voice] Gabriel, stop yelling! Don’t interrupt when adults are talking.

Question 10.3

What behavioral symptoms is Gabriel exhibiting? Select all that apply.

bI0LPa9lfHQ+dYqk

Losing temper

bI0LPa9lfHQ+dYqk

Being angry and resentful

wCfH0QtRgXJ8o+c+

Showing physical cruelty to people or animals

bI0LPa9lfHQ+dYqk

Arguing with authority figures

wCfH0QtRgXJ8o+c+

Provoking physical fights

wCfH0QtRgXJ8o+c+

Stealing

bI0LPa9lfHQ+dYqk

Annoying others

bI0LPa9lfHQ+dYqk

Blaming others for own misbehavior

bI0LPa9lfHQ+dYqk

Being spiteful or vindictive

wCfH0QtRgXJ8o+c+

Using dangerous weapons

Correct! You’ve accurately identified Gabriel’s symptoms of losing his temper, being angry and resentful, arguing with authority figures, annoying others, blaming others for his misbehavior, and being spiteful or vindictive.
That is not quite right. Gabriel’s symptoms are as follows: losing his temper, being angry and resentful, arguing with authority figures, annoying others, blaming others for his misbehavior, and being spiteful or vindictive.

Hint

Review your interview with Gabriel and his parents to identify his symptoms.

10.9 Screen 9

Ask more about their family

Question 10.4

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
2
Correct.
Think about the symptoms you’ve identified: losing his temper, being angry, arguing with authority figures, annoying others, blaming others for his misbehavior, and being spiteful or vindictive.
Incorrect.

Hint

Think about the symptoms you’ve identified: losing his temper, being angry, arguing with authority figures, annoying others, blaming others for his misbehavior, and being spiteful or vindictive.

10.10 Screen 10

Next question

“Gabriel, tell me about your family. What’s it like?”

Gabriel talks about his family, while his parents admit their concerns about their work.

Transcript

Gabriel: [nastily] Why do you want to know?

Dad: [angry] Answer the question, son!

Gabriel: [muttering begrudgingly] It’s just me and Mom and Dad. They tell me what to do all the time! Mom especially. She’s ALWAYS there! Dad is always at work.

Dad: [calmer] We are a very stable, normal family. That’s why Gabriel’s behavior is so embarrassing.

Mom: Mateo works as a salesman. I work part-time in retail, so I can be home for Gabriel when he gets home from school.

Dad: You know you don’t have to work. I can provide for us.

Mom: Believe it or not, it’s something I enjoy. I like to get out of the house and have contact with other adults! Plus I think it sets a good example for Gabriel to see both of his parents working and taking responsibility. [to Gabriel:] Sit down, son.

Dad: Taking care of Gabriel is your most important job. If you were home all the time, maybe this wouldn’t be happening!

Mom: [defensively] I am home whenever he’s home! What would I do when he’s at school all day? Don’t get me wrong, Gabriel is the light of my life and I love my son, but I also want to work. I think I can do both well… enough.

Question 10.5

CD7XtdSsgrmp2A6bz19s+M5W4qE534ZRwJ5Q9iJbvRvrM78TiNAuI8pPScfqkTl+8OBbT6HkGLnks0Mv6rtN0IIqN/zjZwwhgiiufj4YfZB/wG5s6P9tcxxZNpkKUkmoTLIU+0T63jWWoHEr5zim8CVdYoOrQyoHkJJpTu5wXLNofcNvV0V0XWbUGRp8bPK1mRrYPTL3SxU1Q8Uj9LGf2PZQKokKxfbGaHY6MyofBc32skGwchk/LxuBvWtuC92DI3VMygJiMRrCcV3H
It seems like Gabriel has a lot of support, especially from his mother. However, there appears to be conflict between his parents, which likely creates stress at home and models disagreement as the norm in interpersonal relationships.

10.11 Screen 11

Ask Gabriel about this

Question 10.6

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
2
Correct.
Think about the remaining problems you have yet to explore.
Incorrect.

Hint

Think about the remaining problems you have yet to explore.

10.12 Screen 12

Does Gabriel have a second disorder?

“Can you tell me more about what it’s like for you at school? Are you having a hard time with your schoolwork?”

Gabriel and his parents explain Gabriel’s difficulties in school.

Transcript

Gabriel: Why do you need to know all this stuff? I don’t know … sometimes when Miss Martin asks me stuff ... I don’t know the answer … [defensively] It’s hard, okay? And reading … it’s sooooo boring. I can read, but it’s soooooo boring!

Dad: I think he just needs to pay attention! He never listens at home – it’s not surprising he doesn’t at school either!

Mom: [plaintively] He’s just a kid. It’s really hard for him to focus. He’s only 6, for goodness sake. [to Gabriel:] Gabriel, please put those toys back right now!

Dad: [firmly] His teacher seems to think it’s more than him just being a kid. He daydreams in class, hums constantly and distracts other children. Apparently he is rude … he interrupts the teacher and other kids. When he does know an answer, he doesn’t wait to be called on. He just blurts it out.

Mom: [defensively] He can read. When he can focus on reading, he reads pretty well for a child his age. He can sound out words no problem and he recognizes common words pretty quickly. [sighs] It’s just hard to get him to actually sit down and read! He won’t focus – he whines and complains and wanders off to do something else. Then he’ll misplace the book, and forget where he left it. Reading with him can be exhausting.

Question 10.7

Which of the following symptoms is Gabriel currently experiencing at school? Select all that apply.

bI0LPa9lfHQ+dYqk

Difficulty sustaining attention

bI0LPa9lfHQ+dYqk

Loss of items necessary for activities

wCfH0QtRgXJ8o+c+

Inaccurate reading

bI0LPa9lfHQ+dYqk

Failure to follow through on instruction

wCfH0QtRgXJ8o+c+

Difficulty understanding meaning of what is read

wCfH0QtRgXJ8o+c+

Difficulty with mathematical reasoning

bI0LPa9lfHQ+dYqk

Easily distracted by irrelevant stimuli

wCfH0QtRgXJ8o+c+

Academic skills are below those expected for his age

bI0LPa9lfHQ+dYqk

Blurts out answers

bI0LPa9lfHQ+dYqk

Interrupts others

bI0LPa9lfHQ+dYqk

Frequent wandering from seat

wCfH0QtRgXJ8o+c+

Skills do not meet needs for classroom work

bI0LPa9lfHQ+dYqk

Frequent “on the go” activity

wCfH0QtRgXJ8o+c+

Difficulties with spelling

Correct! Gabriel is exhibiting difficulty with sustaining attention, loss of important items, failure to follow instructions, blurting out answers, interrupting others, and wandering from his seat. You can tell that he is “on the go” and easily distracted by how often his parents have to remind him to sit down during this interview.
That is not quite right. Gabriel is exhibiting difficulty with sustaining attention, loss of important items, failure to follow instructions, blurting out answers, interrupting others, and wandering from his seat. You can tell that he is “on the go” and easily distracted by how often his parents have to remind him to sit down during this interview.

Hint

Think about the symptoms reported by Gabriel’s parents as well as his behavior during your interview.

10.13 Screen 13

Next Question

Question 10.8

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
2
Correct.
Incorrect.

Hint

In making your choice, think about the following symptoms Gabriel exhibits:

  • Difficulty sustaining attention
  • Easily distracted by irrelevant stimuli
  • Frequent wandering from seat

10.14 Screen 14

Next Question

From the File. You remember a former patient who experienced symptoms similar to Gabriel’s. You review this case to help you diagnose Gabriel.

Transcript

ELEANOR: Liam, just wait for the door [INAUDIBLE].

[CRYING]
Shh. Down here. Liam.
BRIAN: Liam, don't you dare. Come here. Come here. It's high up, that.

ELEANOR: Brian, [INAUDIBLE] is coming.

BRIAN: I don't like this.

ELEANOR: Liam, there's cars coming. Straight here now.

BRIAN: Me heart's just stopped beating then.

ELEANOR: Have you [INAUDIBLE]?

BRIAN: Because that was frightening, when he went running to there--

ELEANOR: Give me your hand. Give me your hand. Liam.

NARRATOR: Liam is fearless and impulsive. Brian and Eleanor know that if he sees something across the road, he won't think twice about running towards it, regardless of traffic.

ELEANOR: Liam, not too far in front please. Come here. First time I've told you Liam. If I have to keep telling you the same things, you do not go on the ride. Hold my hand. I'm standing here, and I'm not moving until you hold my hand. One-- two-- hold my hand. Or hold the pram then. Thank you. One or the other.

NARRATOR: He also rarely does what he is told.

ELEANOR: Hold the pram. Second time I've told you Liam. No.

[GASP]

LIAM: I don't like the way you [INAUDIBLE].

ELEANOR: I want you to hold the hand because it's very busy and [INAUDIBLE] get lost.

BRIAN: Liam--

ELEANOR: (STERNLY) Hold the pram. No.

LIAM: I don't need to hold the pram!

ELEANOR: Right. If I tell you one more time, you don't go on the ride. We've not even got into Wickham, Liam.

BRIAN: Calm.

ELEANOR: I don't want to calm. I want him to hold the pram. That's a simple thing.

LIAM: Hi. Hello.

ELEANOR: Liam, not too far in front please.

NARRATOR: Liam is constantly on the go, and he never stays with anything for long.

Question 10.9

6E29OrZEISR2530Mqhxf/FlYSNIIuYNOtHEoxnmkHaip0IJztl/ZhOasEg+voE+6T9GwivQbpI88qLAo7DyR02Ha56eUjjJdJEIrdnQNWHKhiv3P+t7qIkNhkjcGgIv6pbw1/Vfv5ZvCCbFXItPaWWsxsvRpe0JH2QNWILGxEhbObf/4haBZyzxke2U=
Liam and Gabriel don’t listen to what their parents ask them to do. They are both constantly on the go, and they have a hard time keeping their attention on the task at hand. Both sets of parents are very disturbed by their children’s behaviors.

10.15 Screen 15

Choose a treatment

Question 10.10

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
2
Correct.
Incorrect.

Hint

Think about all of the possible factors that may contribute to these disorders.

Question 10.11

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
2
Correct.
Incorrect.

Hint

Think about the type of therapy that would use problem-solving skills.

10.16 Screen 16

What happened to Gabriel?

Question 10.12

Which of the following are the two MOST COMMON treatments for ADHD? Select two answers. To review the diagnostic treatment, select the treatment name.

wCfH0QtRgXJ8o+c+

Psychoanalysis

wCfH0QtRgXJ8o+c+

Interpersonal Therapy

bI0LPa9lfHQ+dYqk

Behavioral/Sociocultural Therapy

bI0LPa9lfHQ+dYqk

Medication

Correct! Behavioral therapy is commonly used for children with both ADHD and ODD. Treatment can focus on rewarding Gabriel for desired behaviors (positive reinforcement) and ignoring (not rewarding) problematic behaviors. Behavioral therapies such as parent–child interaction therapy are essentially behavioral training for parents. This type of therapy would teach Gabriel’s parents to work with Gabriel positively and set appropriate limits while teaching Gabriel appropriate social skills. In addition, medication such as Ritalin and Adderall is the first-line treatment of choice for ADHD. However, medication would treat Gabriel’s ADHD symptoms, but not their underlying cause. To increase the effectiveness of this treatment, he would likely also need therapy to address the problematic behaviors that are a part of both ADHD and ODD.
In making your choice, think about the need to treat both brain chemical imbalances and Gabriel’s misbehaviors.
That is not quite right. Behavioral therapy is commonly used for children with both ADHD and ODD. Treatment can focus on rewarding Gabriel for desired behaviors (positive reinforcement) and ignoring (not rewarding) problematic behaviors. Behavioral therapies such as parent–child interaction therapy are essentially behavioral training for parents. This type of therapy would teach Gabriel’s parents to work with Gabriel positively and set appropriate limits while teaching Gabriel appropriate social skills. In addition, medication such as Ritalin and Adderall is the first-line treatment of choice for ADHD. However, medication would treat Gabriel’s ADHD symptoms, but not their underlying cause. To increase the effectiveness of this treatment, he would likely also need therapy to address the problematic behaviors that are a part of both ADHD and ODD.

Hint

In making your choice, think about the need to treat both brain chemical imbalances and Gabriel’s misbehaviors.

10.17 Screen 17

Next question

EPILOGUE

Gabriel and his mother wait to see the school principal.

After additional testing to confirm a diagnosis of ADHD, you diagnosed Gabriel with both ADHD and ODD. After your diagnosis, working with a child psychiatrist, he began taking Ritalin, starting at age 6. Gabriel is now 10 years old and in the fifth grade. He has continued taking the medication, off and on, for the past four years. Gabriel’s parents refused to participate in behavioral/sociocultural treatment, as his father said it would be “a waste of time and money.” At school, Gabriel received an Individualized Education Program (IEP), which entitled him to services from the school district. The IEP recommended that Gabriel work with a school psychologist and receive extra time and a quiet environment for testing. Gabriel was uncooperative with the school psychologist, so he made little progress. His schoolwork did not improve, but he was quieter at school. At home, he was just as defiant as ever.

Gabriel now has a new reputation: class bully. He is known as a mean kid who will go out of his way to hurt the other boys in his class. His fights have led to suspensions from school, which means that his mother, Emily, has to take time off from work to stay home with him. Emily has given up—she has lost control over Gabriel’s behavior. Mateo, Gabriel’s father, has only gotten angrier and stricter. Gabriel spends a lot of time in his room, grounded.

Last week Gabriel took Mateo’s cigarette lighter and set fire to papers in the trashcan in his room. Fortunately, the smoke detector went off and Emily and Mateo were able to put out the fire. Mateo was so angry that he ended up backhanding Gabriel in the face. Emily took Gabriel to her mother’s for the rest of the day.

Things reached a new low today. Emily got a call from the principal to come to school. Gabriel had pulled out a knife during recess and cut another student on the arm. The child had to be taken to the emergency room, and the cut required stitches. The principal asked Emily to call Mateo to come in for a meeting with the principal, Gabriel’s teacher, and the school psychologist. Emily is now worried that Gabriel will be expelled from school.

10.18 Screen 18

Real World Application

Question 10.13

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
2
Correct.
Think about the severity of Gabriel’s behavioral problems.
Incorrect.

Hint

Think about the severity of Gabriel’s behavioral problems.

10.19 Screen 19

Real World Application

Watch this video and answer the questions that follow.

Transcript

NARRATOR: Age five, Liam was diagnosed with attention deficit hyperactivity disorder-- ADHD.

MOTHER: Liam, come on, lad. Your hot chocolate's ready.

NARRATOR: Now, five years later, Liam's life has been transformed.

LIAM: Here you go.

MOTHER: Thank you.

LIAM: One, two, three, four, five.

MOTHER: Excuse me?

LIAM: What?

MOTHER: Whose go is it next?

LIAM: Mine?

MOTHER: No.

NARRATOR: His newfound ability to concentrate is largely thanks to a drug called methylphenidate, best known to most of us by a brand name, Ritalin.

MOTHER: It takes about 30 to 40 minutes for it to work. And it's not like Liam suddenly goes docile. it just basically just has a calming effect on him. He doesn't seem to be as hyperactive on the medication. And he's able to sit quietly, be able to focus on things like his homework, or just basically have a more normal life, really.

NARRATOR: And as for thousands of other children, Ritalin has had a remarkable effect on Liam.

LIAM: Feel calm. I don't feel like-- I feel energy, 'cause I can just run around all day if I wanted to. I'm just calm now and excited as well.

MOTHER: Now without the medication, you could ground Liam and he would go about the next day and do the same thing that he'd been grounded for the day before. With medication, it just enables him to consider the consequences a little bit more clearly of his actions.

Question 10.14

s0G8gBlgSEthsue9hW2PDWcahaEImHQbdfcdU1TreknCqVfzbe+6sGN9gZvxY7jqjFl3Bx2E7ExRmHd7J55+4V1/gT1Rhy58BkA41CT3dU5qZCDifp8AuJW6PdpUUK3JEI7qYsykxX2oXHUlvpQWP91j4SrI3UMKGhJtBpcQQqyZhlqvnDvQSFWE+hbOw1ojBNGz8GVpNYEYwy2yOuunvwKaDdypMxsK
Medication would likely be very helpful in getting Gabriel to control his fidgety behaviors and focus. Gabriel’s school performance would likely improve with his ADHD under control. However, medication would not treat the symptoms of his ODD, so Gabriel would likely still have issues with authority figures.

Question 10.15

GKqx03nLi7hke3MNgXUl6AjSoObJ3/SSs2gU5iiRPX0VQLr2667wd40klBEL/M5xoAXpkcZULBoOfQgEXUEsvTbheAz5wmqHaAHAPZTM9g4gYCViitzuuUTg6QlxNoKZ0GSm1Pfn3ZD864rlJwj9mX+4kCSqApIbC0ppQNTDgZR4xtKD1oB01QKt3Jw6P23oHlHe+VeRa//nrSACk+yIc+cYVY9D1NikdUP12fGQ0xhDSZHJJh5R54t4JZbuExuFxVxJyHUHIY5Mp4rnwMl7BcWIzDXUw/qdvenWjPbTpb4fjTLCbaMvj0hOM8gEskm3BLz72jLuIHfQ3LVYYsXjKhRTSZ/9mxOttrgurqU3ii3HK08S1zH13g==
As you saw in the Epilogue, Gabriel’s behavior got worse, not better, as a result of forgoing behavioral therapy and following his treatment plan inconsistently. Gabriel was on and off the medication, and his parents did not follow through on recommendations for treatment. By rejecting behavioral therapy, Gabriel’s parents could not help him change his behaviors. As a result, at age 10, he is engaging in even more dangerous and disruptive behaviors.