{"id":1060,"date":"2020-08-19T19:31:36","date_gmt":"2020-08-19T19:31:36","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=1060"},"modified":"2022-07-26T20:06:44","modified_gmt":"2022-07-26T20:06:44","slug":"case-studies-disorders-of-childhood-and-adolescence","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/case-studies-disorders-of-childhood-and-adolescence\/","title":{"raw":"Case Studies: Disorders of Childhood and Adolescence","rendered":"Case Studies: Disorders of Childhood and Adolescence"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Identify disorders of childhood and adolescence in case studies<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Case Study: Jake<\/h2>\r\nAn 11-year-old boy, Jake, was referred to an inpatient unit of the Children\u2019s Hospital for further diagnostic evaluation and treatment by the pediatric liaison team on call. He was socially isolated at school and in the <img class=\"alignright wp-image-4509\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/18032232\/boy-portrait-blue-300x219.jpg\" alt=\"A young boy making an angry face at the camera.\" width=\"261\" height=\"190\" \/>rural community where he lived. He had behavioral difficulties at home and difficulties in adhering to the boundaries set by the parents. His mother labeled him as a \"troublemaker\" and he was oppositional at school with inappropriate behavior. He was frequently interfering with teaching in the classroom. Although he wanted to socialize with other children, he was clumsy and aggressive in his attempts to initiate contact. Teachers and other children\u2019s parent's complaints objectified the presence of behavioral problems. His behavior was described as aggressive and violent. His play and his reactions were often inappropriate and fear-provoking to others\u2014i.e., he performed animal amputations, made and collected poisons, destroyed objects, and set fires.\r\n\r\nJake was born at full term and was described as a quiet baby. In the first three months of his life, his mother became worried as he was unresponsive to cuddles and hugs. He also never cried. He has no friends and, on occasions, he has been victimized by bullying at school and in the community. His father is 44\u00a0years old and describes having had a difficult childhood; he is characterized by the family as indifferent to the children\u2019s problems and verbally violent towards his wife and son, but less so to his daughters. The mother is 41\u00a0years old, and describes herself as having a close relationship with her children and mentioned that she usually covers up for Jake\u2019s difficulties and makes excuses for his violent outbursts.[footnote]Kolaitis, G., Bouwkamp, C.G., Papakonstantinou, A. et al. A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability, and 47,XXY syndrome in combination with a 7q11.23 duplication, 11p15.5 deletion, and 20q13.33 deletion. <em>Child Adolesc Psychiatry Ment Health<\/em> 10, 33 (2016). https:\/\/doi.org\/10.1186\/s13034-016-0121-8[\/footnote]\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/7b976659-fcd7-465f-9864-08fc6e1ee1d1\r\n\r\n<\/div>\r\n<h3>Treatment<\/h3>\r\nDuring his stay (for two and a half months) in the inpatient unit, Jake underwent psychiatric and pediatric assessments plus occupational therapy. He took part in the unit\u2019s psycho-educational activities and was started on risperidone, two mg daily. Risperidone was preferred over an anti-ADHD agent because his behavioral problems prevailed and thus were the main target of treatment. In addition, his behavioral problems had undoubtedly influenced his functionality and mainly his relations with parents, siblings, peers, teachers, and others. Risperidone was also preferred over other atypical antipsychotics for its safe profile and fewer side effects. Family meetings were held regularly, and parental and family support along with psycho-education were the main goals. Jake was aided in recognizing his own emotions and conveying them to others as well as in learning how to recognize the emotions of others and to become aware of the consequences of his actions. Improvement was made in rule setting and boundary adherence. Since his discharge, he received regular psychiatric follow-up and continues with the medication and the occupational therapy. Supportive and advisory work is done with the parents. Marked improvement has been noticed regarding his social behavior and behavior during activity as described by all concerned. Occasional anger outbursts of smaller intensity and frequency have been reported, but seem more manageable by the child with the support of his mother and teachers.\r\n\r\nIn the case presented here, the history of abuse by the parents, the disrupted family relations, the bullying by his peers, the educational difficulties, and the poor SES could be identified as additional risk factors relating to a bad prognosis. Good prognostic factors would include the ending of the abuse after intervention, the child\u2019s encouragement and support from parents and teachers, and the improvement of parental relations as a result of parent training and family support by mental health professionals. Taken together, it appears that also in the case of psychiatric patients presenting with complex genetic aberrations and additional psychosocial problems, traditional psychiatric and psychological approaches can lead to a decrease of symptoms and improved functioning.\r\n<h2>Case Study: Kelli<\/h2>\r\nA 15-year-old girl, Kelli, is referred to a neurologist due to unexplained symptoms of involuntary, uncontrollable <img class=\"alignright wp-image-4511\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/18033020\/book-bored-college-education-preview-300x200.jpg\" alt=\"A girl sitting with a book open in front of her. She wears a frustrated expression.\" width=\"239\" height=\"159\" \/>behavior that includes eye-blinking, shoulder shrugging, frequent throat clearing, and randomly moving her arm around in circles. These symptoms have been present since she was in preschool and have increased in intensity. She told the doctor that she had difficulty reading because she was constantly blinking and had to re-read sentences over and over. She tried to control the behaviors at school because kids in her class called her \"weird\" and \"freakshow,\" but by the time she got home she was exhausted, experienced more involuntary movement, and had difficulty completing homework. When asked how she felt about her symptoms and experience, she began crying and asked if there was medication to \"just make everything stop\" so she could be \"normal.\"\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/da56c6d3-ad1a-41ce-98e5-c2829a55f3cb\r\n\r\n<\/div>\r\n<h3>Treatment<\/h3>\r\nKelli may benefit from a course of comprehensive behavioral intervention for her tics in addition to psychotherapy to treat any comorbid depression she experiences from isolation and bullying at school. Psychoeducation and approaches to reduce stigma will also likely be very helpful for both her and her family, as well as bringing awareness to her school and those involved in her education.","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Identify disorders of childhood and adolescence in case studies<\/li>\n<\/ul>\n<\/div>\n<h2>Case Study: Jake<\/h2>\n<p>An 11-year-old boy, Jake, was referred to an inpatient unit of the Children\u2019s Hospital for further diagnostic evaluation and treatment by the pediatric liaison team on call. He was socially isolated at school and in the <img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-4509\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/18032232\/boy-portrait-blue-300x219.jpg\" alt=\"A young boy making an angry face at the camera.\" width=\"261\" height=\"190\" \/>rural community where he lived. He had behavioral difficulties at home and difficulties in adhering to the boundaries set by the parents. His mother labeled him as a &#8220;troublemaker&#8221; and he was oppositional at school with inappropriate behavior. He was frequently interfering with teaching in the classroom. Although he wanted to socialize with other children, he was clumsy and aggressive in his attempts to initiate contact. Teachers and other children\u2019s parent&#8217;s complaints objectified the presence of behavioral problems. His behavior was described as aggressive and violent. His play and his reactions were often inappropriate and fear-provoking to others\u2014i.e., he performed animal amputations, made and collected poisons, destroyed objects, and set fires.<\/p>\n<p>Jake was born at full term and was described as a quiet baby. In the first three months of his life, his mother became worried as he was unresponsive to cuddles and hugs. He also never cried. He has no friends and, on occasions, he has been victimized by bullying at school and in the community. His father is 44\u00a0years old and describes having had a difficult childhood; he is characterized by the family as indifferent to the children\u2019s problems and verbally violent towards his wife and son, but less so to his daughters. The mother is 41\u00a0years old, and describes herself as having a close relationship with her children and mentioned that she usually covers up for Jake\u2019s difficulties and makes excuses for his violent outbursts.<a class=\"footnote\" title=\"Kolaitis, G., Bouwkamp, C.G., Papakonstantinou, A. et al. A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability, and 47,XXY syndrome in combination with a 7q11.23 duplication, 11p15.5 deletion, and 20q13.33 deletion. Child Adolesc Psychiatry Ment Health 10, 33 (2016). https:\/\/doi.org\/10.1186\/s13034-016-0121-8\" id=\"return-footnote-1060-1\" href=\"#footnote-1060-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_7b976659-fcd7-465f-9864-08fc6e1ee1d1\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/7b976659-fcd7-465f-9864-08fc6e1ee1d1?iframe_resize_id=assessment_practice_id_7b976659-fcd7-465f-9864-08fc6e1ee1d1\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h3>Treatment<\/h3>\n<p>During his stay (for two and a half months) in the inpatient unit, Jake underwent psychiatric and pediatric assessments plus occupational therapy. He took part in the unit\u2019s psycho-educational activities and was started on risperidone, two mg daily. Risperidone was preferred over an anti-ADHD agent because his behavioral problems prevailed and thus were the main target of treatment. In addition, his behavioral problems had undoubtedly influenced his functionality and mainly his relations with parents, siblings, peers, teachers, and others. Risperidone was also preferred over other atypical antipsychotics for its safe profile and fewer side effects. Family meetings were held regularly, and parental and family support along with psycho-education were the main goals. Jake was aided in recognizing his own emotions and conveying them to others as well as in learning how to recognize the emotions of others and to become aware of the consequences of his actions. Improvement was made in rule setting and boundary adherence. Since his discharge, he received regular psychiatric follow-up and continues with the medication and the occupational therapy. Supportive and advisory work is done with the parents. Marked improvement has been noticed regarding his social behavior and behavior during activity as described by all concerned. Occasional anger outbursts of smaller intensity and frequency have been reported, but seem more manageable by the child with the support of his mother and teachers.<\/p>\n<p>In the case presented here, the history of abuse by the parents, the disrupted family relations, the bullying by his peers, the educational difficulties, and the poor SES could be identified as additional risk factors relating to a bad prognosis. Good prognostic factors would include the ending of the abuse after intervention, the child\u2019s encouragement and support from parents and teachers, and the improvement of parental relations as a result of parent training and family support by mental health professionals. Taken together, it appears that also in the case of psychiatric patients presenting with complex genetic aberrations and additional psychosocial problems, traditional psychiatric and psychological approaches can lead to a decrease of symptoms and improved functioning.<\/p>\n<h2>Case Study: Kelli<\/h2>\n<p>A 15-year-old girl, Kelli, is referred to a neurologist due to unexplained symptoms of involuntary, uncontrollable <img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-4511\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/18033020\/book-bored-college-education-preview-300x200.jpg\" alt=\"A girl sitting with a book open in front of her. She wears a frustrated expression.\" width=\"239\" height=\"159\" \/>behavior that includes eye-blinking, shoulder shrugging, frequent throat clearing, and randomly moving her arm around in circles. These symptoms have been present since she was in preschool and have increased in intensity. She told the doctor that she had difficulty reading because she was constantly blinking and had to re-read sentences over and over. She tried to control the behaviors at school because kids in her class called her &#8220;weird&#8221; and &#8220;freakshow,&#8221; but by the time she got home she was exhausted, experienced more involuntary movement, and had difficulty completing homework. When asked how she felt about her symptoms and experience, she began crying and asked if there was medication to &#8220;just make everything stop&#8221; so she could be &#8220;normal.&#8221;<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_da56c6d3-ad1a-41ce-98e5-c2829a55f3cb\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/da56c6d3-ad1a-41ce-98e5-c2829a55f3cb?iframe_resize_id=assessment_practice_id_da56c6d3-ad1a-41ce-98e5-c2829a55f3cb\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h3>Treatment<\/h3>\n<p>Kelli may benefit from a course of comprehensive behavioral intervention for her tics in addition to psychotherapy to treat any comorbid depression she experiences from isolation and bullying at school. Psychoeducation and approaches to reduce stigma will also likely be very helpful for both her and her family, as well as bringing awareness to her school and those involved in her education.<\/p>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1060\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Case Study: Childhood and Adolescence. <strong>Authored by<\/strong>: Chrissy Hicks for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability.... <strong>Authored by<\/strong>: Gerasimos Kolaitis, Christian G. Bouwkamp, Alexia Papakonstantinou, Ioanna Otheiti, Maria Belivanaki, Styliani Haritaki, Terpsihori Korpa, Zinovia Albani, Elena Terzioglou, Polyxeni Apostola, Aggeliki Skamnaki, Athena Xaidara, Konstantina Kosma, Sophia Kitsiou-Tzeli, Maria Tzetis . <strong>Provided by<\/strong>: Child and Adolescent Psychiatry and Mental Health. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/capmh.biomedcentral.com\/articles\/10.1186\/s13034-016-0121-8\">https:\/\/capmh.biomedcentral.com\/articles\/10.1186\/s13034-016-0121-8<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Angry boy. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.pxfuel.com\/en\/free-photo-jojfk\">https:\/\/www.pxfuel.com\/en\/free-photo-jojfk<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><li>Frustrated girl. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.pickpik.com\/book-bored-college-education-female-girl-1717\">https:\/\/www.pickpik.com\/book-bored-college-education-female-girl-1717<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-1060-1\">Kolaitis, G., Bouwkamp, C.G., Papakonstantinou, A. et al. A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability, and 47,XXY syndrome in combination with a 7q11.23 duplication, 11p15.5 deletion, and 20q13.33 deletion. <em>Child Adolesc Psychiatry Ment Health<\/em> 10, 33 (2016). https:\/\/doi.org\/10.1186\/s13034-016-0121-8 <a href=\"#return-footnote-1060-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":17,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"A boy with conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), borderline intellectual disability...\",\"author\":\"Gerasimos Kolaitis, Christian G. Bouwkamp, Alexia Papakonstantinou, Ioanna Otheiti, Maria Belivanaki, Styliani Haritaki, Terpsihori Korpa, Zinovia Albani, Elena Terzioglou, Polyxeni Apostola, Aggeliki Skamnaki, Athena Xaidara, Konstantina Kosma, Sophia Kitsiou-Tzeli, Maria Tzetis \",\"organization\":\"Child and Adolescent Psychiatry and Mental Health\",\"url\":\"https:\/\/capmh.biomedcentral.com\/articles\/10.1186\/s13034-016-0121-8\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Case Study: Childhood and Adolescence\",\"author\":\"Chrissy Hicks for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Angry boy\",\"author\":\"\",\"organization\":\"\",\"url\":\"https:\/\/www.pxfuel.com\/en\/free-photo-jojfk\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Frustrated girl\",\"author\":\"\",\"organization\":\"\",\"url\":\"https:\/\/www.pickpik.com\/book-bored-college-education-female-girl-1717\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"03dd2b9c-d9c1-44e1-a66c-c52e91630fcb, 96312068-cd2b-4b83-97c1-fa08a762e3a0","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1060","chapter","type-chapter","status-publish","hentry"],"part":156,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1060","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":18,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1060\/revisions"}],"predecessor-version":[{"id":7553,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1060\/revisions\/7553"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/156"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1060\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=1060"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=1060"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=1060"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=1060"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}