Case Study 1.2 – Temper Tantrums
Patient Background:
This case involves a 12 – year – old boy named Brandon. Brandon was brought in to receive a psychiatric evaluation for his temper tantrums. These tantrums are believed to be contributing to the patient’s diminishing school performance. The patients mother states that things have always been challenging; however, they have become worse since the patient began middle school. The patient’s teachers report that although the patient is academically capable, the patient struggles with making friends. Those classmates that genuinely try to be nice and engage the patient, the patient mistrusts. On the other hand, those classmates that are less genuine and feign interest in the patient’s toy cars and trucks, the patient seemingly trusts. Further, teachers have also reported that the patient often cries and rarely speaks in class. Recently, numerous teachers report that they have heard the patient screaming at other male peers. This typically takes place outside of the classroom in the hallway; however, this behavior has happened within the classroom as well. Teachers have not identified a cause for this behavior, though they have assumed it is from peer provocation. During the interview with the psychiatrist, the patient responds with “nonspontaneous mumbles” to most inquiries; however, when asked about his toy cars, the patient is stated to have “lit up.”
The patient can adequately name his toy cars, though his eye contact during times of communication was rather poor. When asked about school again, the patient shows the psychiatrist his cell phone with a string of texts containing hateful messages from peers. The patient also reveals that many of his male peers would say “bad words” to him and shout in his ears, which he did not like because loud noises upset him. From a developmental standpoint, the patient’s mother claims that the patient has always been “very shy” and lacked friends. Additionally, the patient’s first word was spoken at 11 months and by age three was able to form short sentences. The patient is said to have always taken things literally; thus, has always been unable to understand jokes and things of similar ilk. The patient’s father is said to display similar characteristics.
Upon examination, the patient was timid and overall nonspontaneous. His eye-contact was poor and below average. The patient stumbled over his words at times, paused excessively, and sometimes repeated words and/or parts of words rapidly. The patient revealed that though he felt alright, he was scared of school. The patient appeared sad, brightening only when speaking of his toys. He denied suicidality and homicidality, psychotic symptoms, and was overall intact cognitively.
Diagnosis:
The patient was diagnosed with Autism Spectrum Disorder without accompanying intellectual impairment, with accompanying language impairment: childhood-onset fluency disorder (stuttering).
Ethical and Professional Interpretation of Assessment Information:
When it comes to ethical and professional interpretation of assessment information, psychologists/psychiatrists must base their reports, recommendations, diagnostic and/or evaluative statements on data that adequately substantiates their findings. Assessments used to garner information must be valid and reliable as established by professionals, and assessments need to adequately take into consideration things like competence, language preferences, etc. Additionally, when it comes to interpretation, professionals must take into consideration the overall purpose of the assessment and the myriad other test factors, such as abilities, cultural components, personal, and linguistic factors that may impact professionals’ conclusions and/or diminish the precision of their interpretations (APA, 2010, Section 9).
Assessment Battery:
To begin, the patient will undergo a full medical examination. This will rule out any possible medical, disease, or natural causes for the patient’s symptoms and behaviors.
The patient will also undergo the Wechsler Intelligence Scale for Children (WISC) to assess his overall intelligence. This assessment includes language, symbol, and performance-based questions.
The patient will also be taking the Stanford Binet-Intelligence Scale to measure any sort of cognitive disabilities that may have been missed initially.
A formal clinical interview will be conducted, which will last between 30 to 60 minutes and will allow me to ask questions about the patient’s childhood and personal history, such as the patient’s school history, recent life experiences, and general family background. This kind of assessment is less structured and enables the patient and their families to provide insight in their own words/ways. A great deal of valuable information comes from these sort of measures.
Moreover, I think observing the patient in his natural settings would be beneficial in garnering a more precise picture of why the patient is having temper-tantrums so that we can better formulate a treatment plan for the patient that will enable him to function better inside and outside of school.
A final assessment that the patient will be given is the Childhood Autism Rating Scale (CARS), which is a 15-item behavior-rating scale that assists in identifying children with autism and distinguishes them from developmentally disabled children who are not considered autistic. This assessment is adequate for children over the age of two and incorporates items from five well-known systems for diagnosing autism. Each of the items comprises a specific characteristic, ability, and/or behavior. The measure utilizes a seven-point scale, which gauges the degree to which the patient’s behavior diverges from that of a “normal” child of the same age (Reinforcement Unlimited, n.d.).
Pros and Cons:
In the case study selected, there were not any clear instruments utilized other than a clinical evaluation. The referring psychologist did not recommend additional assessments; thus, therein resides the most primary con. Additional assessments that I proposed and ordered for the patient will benefit the patient, his parents, and teachers due to their ability to provide more profound insight into the patient’s condition. While it is very possible that the patient is suffering from autism, we do not know the severity of it, which is why additional measures are required. These measures will also help us rule out any other underlying causes for the temper-tantrums that the patient is exhibiting.
References:
Vahabzadeh, A., Beresin, E., and McDougle, C. (n.d.) Case 1.2 Temper Tantrums. In DSM-5 Clinical Cases. Retrieved from http://dsm.psychiatryonline.org.proxy-library.ashford.edu/doi/full/10.1176/appi.books.9781585624836.jb01#x54979.8281746
Reinforcement Unlimited. (n.d.). Autism Resources: Assessment Procedures. Retrieved from http://www.behavior-consultant.com/aut-dx-devices.htm
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct including 2010 amendments: Standard 9: Assessment (Links to an external site.)Links to an external site..Retrieved from http://www.apa.org/ethics/code/index.aspx?item=12
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