Case study of behavioral disorders
Case study of behavioral disorders
According to the signs and symptoms exhibited by the 13-year-old Joe, the two most probable diagnoses for his behavioral disorder are opposition defiant disorder (ODD) and attention deficit hyperactive disorder (ADHD). The primary presumptive diagnosis is, however, opposition defiant disorder while the latter is its differential diagnosis. Additionally, depressive and bipolar mood disorders can be another differential diagnosis for the presented case. Opposition defiant disorder is a behavioral disorder that has defining characteristics such as disobedience and hostility against birth the authority and peers. In order for it to be diagnosed as an ODD, the child must have had the characteristics for at least six months. With Joe’s case, he has had these notable abnormal behaviors both at home and at school since he stated school. According to the teachers’ and parents’ reporting, he has gradually developed them and therefore worsened his social relationship with others within his surroundings (Mash & Barkley, 2014).
Moreover, ODD can be defined by one’s angry and easily irritable mood, defiant behavior, argumentative and vindictiveness. The major other traits expressed when interacting with individuals who are not siblings include those exhibited by Joe. They include being argumentative with the authorities, showing verbal and physical aggression, raising one’s voice and being generally disobedient to authorities, not finishing school work for those who are schooling a factor that leads to poor academic performance, an easy distraction from activities and blaming others when he finds himself in trouble. According to the diagnostic and statistical manual of mental illnesses, there are cardinal signs that can be utilized to diagnose this behavioral disorder. The diagnostic criteria comprise all the characteristics that have been indicated in Joe’s case and therefore the most probable diagnosis is opposition defiant disorder
On the other hand, attention deficit hyperactive disease is a behavioral disorder that is characterized by significant challenges in inattention, hyperactivity, and impulsiveness. This means the ones having the disorder cannot concentrate in activities as they are easily distracted, cannot take instructions, they act without critically thinking of the possible consequences, and they are usually up and about. It is common for children above the age of seven years, a phenomenon that can be noted due to the making of careless mistakes in schoolwork or in other activities. They usually never complete school assignment but avoid any duties that demand sustained attention. They are said to be driven by motor, talk excessively, and blurt out answers in class before one finishes to pose the questions and they find it difficult awaiting turn and therefore intrude and interrupt others. Nevertheless, under normal circumstances neither do they argue with authorities nor do they engage in physical aggression against peers. Thus Joe’s case does not present symptoms that meet the criterion for the diagnosis of typical attention deficit hyperactive disorder (ADHD), but it perfectly fits the symptomatic approach for oppositional defiant disorder (ODD) (Mash & Barkley, 2014).
Causes of oppositional defiant disorder
Various risk factors may trigger the establishment of a certain behavioral disorder in an individual including ODD. These factors are gender, environment, temperament, gestation and birth, intellectual disabilities, multicultural and brain development among others (Huline-Dickens, 2013). Firstly, cultural determinants of mental health that are stipulated to be precursors of ODD include parenting and upbringing in various cultural backgrounds. Cultural beliefs and practices dictate in some instances how one behaves while they have the condition. One’s reaction to a situation especially stressors that may trigger the disease relies on the cultural standards and expectations as well as the defined roles for each gender and age. For instance a kid from a strict background where respect to the authority is valued, the incidence of the disease may be low as compared to cultural backgrounds in which there are less strict guidelines on interaction between children and their seniors.
On the other hand, cultures, myths and kinship arrangements contribute to the development of various personalities among people some of which are more vulnerable to the behavioral disorder than others. Social-cultural factors precisely determine the kind of stressors that one is predisposed to and the kind of relationship that is established between them and close relatives and other people they interact with. The stressors may be severe enough in intensity to cause oppositional defiant disorder or other behavioral disorders. In a similar way, culture affects one’s personality as there are sanctions that influence their conformity. Punishments in a given culture are determined from these standards. If the nature of punishment that is meant to control moral conduct is not strong enough to prevent certain behaviors, they may progress to develop into a typical behavioral disorder. Some behavioral tendencies can be perceived as unacceptable by individuals or acceptable depending on the background with regard to culture and therefore determine if one is indulging in symptomatic behaviors of ODD or desisting from exhibiting them. Culture encourages or discourages some traits such as antisocial behavior, aggression or anger control which may be disturbing to others or self.
Additionally, if culture rewards a behavioral disorder by certain prestigious roles, then it is bound to develop and worsen over time. If a person is having a dormant kind of the disorder but provided with the role of being in charge and dominant over others, then there is the likelihood of the disorder developing as the social interaction with them may include physical and verbal aggression. Moreover, some culturally defined roles may affect an individual psychologically, be damaging and result in the establishment of a mental disorder. Culturally-prescribed inbreeding among individuals of a certain community influences the genetic factors that lead to oppositional defiant disorder. Moreover, culture dictates how people perceive hygiene and practices that are meant to keep hygiene. Cultures influence the distribution and exposure of noxious agents as well as traumata which are the direct causes of the disorder. Diet is also one of the environmental factors that are influenced by cultural preferences. Notably, some foods cause neurochemical imbalances in the brain hence leading to the development of not only behavioral disorders but also other mental conditions.
Secondly, developmental factors that are genetic or physiological in nature are said to cause the disorder. Several neurobiological markers during development such as reduced pulse rate, structural abnormality and functioning of the prefrontal cortex and amygdala, lead to the destruction of these brain areas. They are the ones responsible for attention and behavior modification. Consequently, this can cause ODD and other mental conditions. On the other hand, other theories suggest that it can develop from an authority figure giving too much negative punishment and reinforcement to a child. The children later throughout their developmental stages tend to associate the authorities with the negative reinforcement for more attention (Huline-Dickens, 2013).
Treatment of oppositional defiant disorder
There are a number of interventions that can be utilized in the treatment of the disorder. The choice of management is largely dependent on the cause of the disorder and therefore it should focus on eliminating the cause before treating the impacts and symptoms of the disorder. Firstly, modification of parenting can be effective in those whose behavioral disorder is as a result of poor parenting which encourages its development (Gottken & Klitzing, 2012). Parents are encouraged to actively involve themselves in the management process of the disorder by being tolerant of some behaviors, rewarding positive behavior as well as punishing the undesirable behavior in a justified manner. The health care providers’ role is to train the parents or guardians on various strategies to use in approaching those having the disorder. They should learn on how to anticipate problematic behavior, manage temper tantrums and ensure consistency in their interaction with the affected. Thus this therapy’s primary objective is to train parents how to communicate better, understand and manage their kids.
Secondly, parents and other caregivers have to be trained on social-emotional skills to solve problems better. These skills help them build and modify parenting techniques. In addition, the child who has the oppositional defiant disorder can also be provided with these social-emotional skills training as a form of therapy primarily to acquire diverse skills and develop a deeper understanding of how to identify and cope with a particular set of emotions. They will enable them to interact with the general public in a more acceptable manner besides allowing them to become good decision makers who rely on critical thinking rather than emotions (Gottken & Klitzing, 2012).
Thirdly, a severe form of the behavioral disorder can be treated by administration of psychiatric medications which are aimed at controlling emotions, feelings, and moods of an individual. However, it should be noted that the other forms of management are preferred in mild to moderate form of ODD before resorting to medication as the last option. Notably, in some instances, more than one or two strategies can be combined in order to manage the disorder effectively. There are no specific drugs for the disorder but it can be controlled by these drugs based on which set of symptoms are exhibited by the patient. Further examination and scrutiny for any underlying mental condition should be done to diagnose and manage them conjointly. Mood stabilizers such as carbamazepine can be used as well as an anti- anxiety drugs such as benzodiazepines.
Another mode of managing the behavior disorder is cognitive behavioral therapy (CBT). The therapy is based on the concept that thoughts and feelings can be managed better if they are expressed. It is designed to modify an individual’s maladaptive assumptions, distortions, and misconceptions and thus formulate his/her experiences more realistically leading to symptom relief. It is a guide to positive thinking whereby the therapist utilizes a range of skills and ideas when interviewing which include active listening in order for the client to elicit information relevant to their difficulties. A psychological formulation of the problem is then made to provide a possible explanation of the problem rather than label the problem. Throughout this process, the therapist works hand in hand with the client to come up with the formulation which can be a hypothesis that can also be used to come up with the most effective interventions that can alter one’s cognitive drive and thinking. Before the therapy, objectives are set by the client collaboratively to ensure a high level of cooperation and maximize any limited time. The sessions of the therapy can be arranged in a series where evaluation is done at given intervals to note any progress and achievement of the set goals. This also helps to make any necessary changes depending on the need and response of the client to the therapy. Moreover, with time the person with the disorder can be trained to become their own therapist upon achieving a certain level of self-control and self-concept to avoid any negative thoughts when faced with certain circumstances. Generally, cognitive behavioral therapy solves behavioral problems by breaking them into small manageable parts that can be easily solved one at a time to alter the existing patterns and hence how one perceives things in their environment. Other related interventions are social training on how to better interact with peers in class as well as in the performance of physical activities, anger recognition, and management, professional support in other associated problems and encouragement (Gottken & Klitzing, 2012).
Controversial ethical issues with the treatments
Some of the ethical dilemmas that are noted in the management of teenage clients with behavioral disorders as Joe are autonomy of the patient, beneficence, and non-maleficence (Perring & Wells, 2014). All ethical principles that govern patient handling and management should be considered while providing any form of intervention to the client. Coercion to the interventions should not be practiced as most of the interventions involved require maximum cooperation, willingness, and involvement of the affected individuals in the setting of specific goals to be achieved. A diverse set of skills is employed to make the client understand their condition and appreciate that they need to be helped to overcome it. This way, the patient autonomy will be upheld. On the other hand, most psychotropic drugs that can be used in the management of symptoms associated with the behavioral disorder exhibit extrapyramidal side effects which may be severe in adults. Therefore a number of considerations should be made with a broad range of consultation between the parents, the client and other specialists and plan on how to manage the anticipated side effects better. Thus both beneficence and non-maleficence issues can be addressed adequately.
The diagnostic and statistical manual for mental illnesses is the most commonly referred to the document in the diagnosis of mental conditions in both adults and children. The problem with the guide is that it does not provide a strict definition of a disorder and the criterion for diagnosis, especially for children. This provides room for misdiagnosis and intervening in a way that may be more harmful to the client. This is ethically unsound and most psychiatrists and other health care providers, therefore, avoid diagnosis of the children, another factor that can also lead to progression of a condition to a worse state (Perring & Wells, 2014). Social labeling of children due to misinterpretation of their symptoms and subsequent misdiagnosis may affect their interaction with others throughout their lives, their social concept, and cognitive development. It may lead to discrimination by other students due to the special treatment and attention that is expected to be offered to the child by both students and teachers at school with close scrutiny of otherwise normal behavioral changes of a developing child. This may affect the development of their personality and to some extent lead to the development of other mental conditions such as depression and antisocial behavior.
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