The client is 18-year-old black male, living with the parents in Smithfield, NC. He speaks English as his first language and attends high. His family is a middle-class family, with the parents working in white-collar jobs in various different organizations in Raleigh, NC. The client is covered by the health insurance of the parents, in which they are subscribed to Blue Cross Blueshield.
Presenting Problem:
The client described himself as being easily aggravated by small things and has a short temper. The teacher of the client, commented that the client was frequently involved in fights during the school times. The mother of the client also mentioned that the child sometimes refuses to act on her requests, such as doing house chores and constantly bullies her small sister and brother.
History of Present Illness:
The client mainly comes to the clinic, with the parents, with regards to the above problems. The main concerns of his parents, is the behavior of the client while at home, and the various complaints by the teachers and the disciplinary board in the school, about his aggressive behavior. The parents are also concerned about the poor academic performance of their child. The parents of the client, have reported for about over a year, the client has constantly been bullying his siblings, and sometimes even fighting them. The client has also, on several occasions, ignored request from the parents, to wash his clothes or perform other common house chores. The parents admit that even they noticed the behavior as early as when he was aged 7, they initially brushed it off, and though that he would grow out of it, and learn to live in harmony, with the friends or siblings. When he reached adolescence, the parents thought the behavior was largely a characteristic of people reaching this stage of life. As such, the thought that the problem will slowly go away as he matured.
The report from the school is very similar to the report offered by the parents. At school, the client is describing as being troublesome, with little regards to following orders or school rules. On the other hand, the client has been easily irritable and gets into fights easily. On several occasions, the child has been transferred to other schools, as well as getting suspended, due to the problem of following rules and not heeding to authorities. In one instance, the client has been accused of causing major physical harm to some of his classmates, in one of his fights. The teachers describe that his irritability, make him to have little concentration in class, which further makes him to perform poorly in school work. The poor performance in school is majorly attributed to his behavior, which makes him to have trouble concentrating in class or undertaking any activities, especially those that require the formation of groups, due to the fact that he has trouble forging good relationships with others.
Past Psychiatric History:
From the accounts of the parents, the client does not have incidents, relating to visits to the psychiatrists. Furthermore, the patient has never been hospitalized, due to mental illness or disorders. However, he was taken as outpatient at the age 12, in a psychiatric clinic. In this, the teachers noted how he had difficulties in forging peaceful relationships with other students, as well as disobeying some of the school rules and people in authority. The client was reported to be easily irritable and as such, engage in arguments or fights, with anyone, regardless of the age or authority. On the other, while at home, the client would easily get into fights and quarrels with his siblings, regardless of the issue at hand. Furthermore, the client was noted to result fighting as the only method of resolving conflicts. The parents also noted that the client would at times ignore their calls or requests and orders. His bedroom was highly unorganized, with little attention given to tidiness, which was part of his chores in the house.
At the time the client was brought to the office by the parents, he was evaluated, but there was no official diagnosis given to him or the parents. As a result of this, the provider mainly referred him to undertake a family therapy or psychoeducation. The intervention was highly successful as the parents were able to have some little information, on what was the problem with their child. Furthermore, through the family therapy and psychoeducation, it was noted that there was some significant improvement in the behavior of the child, both at school and home, until the current episode, which necessitated the parents to bring him to the clinic.
As a result of the condition, there was really no need for the psychoactive or stimulant medication as some of the pharmacological intervention to the problem facing the client, owing to the main reason that the psychotherapy, mainly seemed to be effective. However, it should be noted that there is no a one-size-fits-all treatment option, for the children as well as the teenagers that suffer from ODD. Despite all this, the most effective treatment plan for the disorder, are mainly tailored towards the behavioral symptoms as well as the needs of the client. It should also be noted that some of the treatment options are majorly determined, based on a number of different things.
These include the age of the client, the nature and severity of the behaviors and whether the client has another mental health condition, which exists at the moment. Due to the nature of the behavior of the child, as it touched on both school and home life, it was largely agreed that he be enrolled in a social skills programs as well as some school based programs. These programs mainly teach the adolescents as well as the children, how to relate positively with other peers and also help them improve they’re on their school studies. Furthermore, the therapy is usually considered to be very successful, especially when done in a natural environment.
Medical History:
At the time of the presentation, the client had no fever. He was weighing 165lbs, with a height of 6 ft. and 3 inches. His BMI index, was thus 21.18. From the BMI, it is seen that the client is healthy, as it falls within the acceptable range of 17.1 to 24.2 for this age, weight and height. The client has no known allergies, to any drugs or food. Furthermore, there is no history of head or head or trauma injuries, which have led to the loss of consciousness. Furthermore, the client has no major physical injuries, except for scars on his face, which are majorly attributed to the fights that he has engaged in, while at school and at home.
Developmental History:
Developmental Stages: The mother acknowledged that she had some good prenatal, while pregnant with the client. The mother admitted that she always took care of herself and watched her nutrition as well as exercise, while she was pregnant. However, the mother admitted that it was a stressful period, owing to the fact that they were jobless and had little money to support themselves. It should be noted that stress and anxiety, especially in pregnant women, increase the chances and risks of the infants, to develop ADHD and ODD, as well as other complications (Burke & Loeber, 2010). From various literatures, one of the factors that increase the risk of getting ODD is the participation of smoking during pregnancy. However, the mother denied engaging in any substance abuse, during the pregnancy (Sadock, Saddock, & Ruiz, 2015).
Developmental Milestones in Toddlers
The mother stated that the client started walking when he was about 20 months old. Furthermore, in most her visits to the doctors, the client was never diagnosed with having some problems with his cognitive development. The mother stated that he grew up normally, just like his siblings. The mother also acknowledged that the client started uttering words when he was 2-years-old. He also started his toilet training at the age of 3, and before the end of the pre-school period, the client had gained perfect control of his bowel. The cognitive abilities of the client were also well developed during this period.
Substance Use/Abuse History:
Substance 1st use/amount Period of heaviest use/amount Method of use Last/current use/amount
Amphetamines He denied None None None
Bath salts He denied None None None
Benzodiazepines He denied None None None
Caffeine Pa He denied None None None
Crystal Meth He denied None None None
Ecstasy He denied None None None
Energy drinks He denied None None None
Heroin He denied None None None
Marijuana He denied None None None
Methadone He denied None None None
Narcotics He denied None None None
Nicotine He denied None None None
PCP/Acid He denied None None None
Spice He denied None None None
Other (specify) NA None None None
The client denied ever engaging in substance abuse. Furthermore, the parents also admitted that they had never smoked but occasional ingested alcohol.
Psychosocial History:
One of the main things that is very relevant to the clinicians, in planning for the treatment of their clients, is the social and personal history of the client (Sadock, Sadock, & Ruiz, 2015). The client is current in his 12th grade, however, he is not behaving like normal teenagers of his age. The client does not have romantic relationships, but likes to play football. The client is the first born in a family of three. His siblings are twin girls, who are in their 7th grade. The family has never separated, and the client has lived with his parents the entire time.
On the other hand, the client has been suspended and transferred to other schools, due to various disciplinary problems. He has been described as being short-tempered and high-headed, as he rarely follows instructions. He frequently engages in arguments as well as fights with most people that he disagrees with on some issues. The client comes from a middle-class family, which is able to provide most of his necessities.