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Carlyn Fortune 1. Does Cindy meet diagnostic criteria for any DSM-5 disorder? If so, which one(s)? Defend your answer. What are advantages and disadvantages of assigning a mental disorder to a case such as this one involving several behavior problems? I believe Cindy does meet diagnostic criteria for a DSM-5 disorder. First and foremost, I believe she may have oppositional defiant disorder, or ODD. Some signs that Cindy has this disorder are excessive arguments with adults, refusal to follow rules, mean and hateful talking, active defiance, frequent temper tantrums, and school refusal behavior. To be diagnosed with ODD, the behaviors must be present for at least six months. In Cindy’s case, she has been missing school for at least two years. Two risk factors for developing ODD are inconsistent parental discipline, and marital conflict between parents; both of which apply to Cindy’s situation. Cindy likely also has generalized anxiety disorder. She expressed not wanting to participate in certain classes due to being “in the spotlight,” and reported social anxiety; only wanting to interact with her small circle of friends. Major depressive disorder should also be considered in Cindy’s case. Teachers observed Cindy to be what they considered depressed. Although she scored in a normal range on the assessment, she still had depressive symptoms such as feeling unloved, poor schoolwork, fatigue, and suicidal thoughts. Giving a proper diagnosis is advantageous in several ways. Without having a diagnosis, it’s difficult to predict what treatment will work best. It will hopefully also reduce anxiety associated with feeling as if something is “wrong” with you. Receiving a proper diagnosis will hopefully lead to a helpful way of treating symptoms. 2. Explore the issue of comorbidity or the occurrence of several problems in an individual. What childhood problems are most closely related? Childhood problems that are closely related are structured around familial relations. Detachment, conflict, isolation, and enmeshment or overinvolvement of family members in each other’s lives are all dynamics that lead to comorbidity. In Cindy’s case, comorbid disorders she suffers from are her drug use, depressive symptoms, and dysfunctional family relationships. 4. How might you change your assessment protocol for a youth with several behavior problems? What questions become more pertinent? Assessment protocol for youth with multiple behavior problems need to address a variety of things. Not only is a youth’s self-assessment important, but parent and teacher assessments also need to be taken. Child behavior checklists should be completed by parents. Direct observation of the youth should be conducted.

Questions pertinent to youth assessment address parental involvement and behavior. The child’s upbringing and familial structure need to be considered. 5. How might you change your treatment program for a youth with several behavior problems? How should dual therapy procedures be conducted? Why and how might family therapy become more crucial? A treatment program for a youth with several behavior problems needs to encompass adults in every area of the child’s life. Parents, siblings, other immediate family members, teachers, counselors, church community, etc. should all be considered with how they influence the youth as well as how the youth behave around these adults. Dual therapy procedures should be conducted with the intention that addressing one problem will lead to the reduction of symptoms and behaviors in other problems. In Cindy’s case, focusing on her refusal to attend school would reduce her other delinquent behaviors, drug use, anxiety, and depression. Modeling, role-playing, and cognitive behavior therapy are all tools that should be used to address this disorder and behaviors. Family therapy is crucial in the success of changing a youth’s behavior and managing a diagnosis because many of the behaviors stem from developmental issues. Family dynamics and familial structure play a huge part in children’s behaviors. Cindy’s parents, for example, did not interact with many people outside of one another. This isolation that Cindy was essentially brought up in led her to develop social anxiety. For Cindy’s school refusal, her parents were involved with contracts and problem-solving, communication, and peer-refusal skills. They were better equipped to communicate effectively, define issues, and develop solutions to those issues. 6. Cindy’s case appeared to be chronic. How might you alter your assessment or treatment of a youth if you know his or her problems have lasted a year or longer? The assessment and treatment of youth suffering from chronic issues must address internalized and externalized behaviors. Cindy’s external behaviors are what people on the outside noticed. Behaviors such as physical and verbal aggression, temper tantrums, noncompliance, and skipping school. However, to get to the cause of these behaviors, Cindy’s internal behaviors need to first be addressed. Her symptoms of fear and anxiety, depression, fatigue, suicidal ideation, and social withdrawal require attention first so that she is in the right frame of mind to change her behaviors associated with school refusal. The long-term effects of youth that skip school are increasingly detrimental. As adults, they become at greater risk for depression and anxiety, marital issues, criminal behavior, occupational stressors, and excessive alcohol use.

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