Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript

But First...

Aaron's Point of View

  • Easily distracted, difficulty paying attention in class
  • Stressed about studies
  • Worried about being expelled
  • Lost without structure of prison life
  • Overwhelmed with being reacquainted with family and friends

Presenting Problems

Chua Zi Yang

Chia Ka Mun, Elicia

Tan Si Min, Lynn

Zhang Jinming

Other's Point of View

  • Restless throughout sessions with psychologist
  • Mother: felt that Aaron did not need therapy
  • Father: concerned about Aaron’s academics, fluctuating moods and impulsive aggressive behaviours
  • Stepmother: refusal to stay with Aaron

Presenting Problems

  • 17 years old, male, mixed (Australian and Chinese)
  • Source of referral: mother
  • Previous psychological problems: ADHD (diagnosed when he was 12 years old)
  • No siblings or step-siblings
  • Released from prison four months earlier after serving 11-month term (marijuana possession)

History

Early growth and development

  • Normal developmental milestones
  • High energy level
  • Talkative
  • Difficulty sitting still
  • Messy
  • Disorganised

Family history

  • None had ADHD diagnosis
  • Mother presented with some traits that paralleled his ADHD symptoms

Childhood experience

  • Parents’ divorced
  • Little contact between parents

Psychosocial History

Past treatment

  • Diagnosed with ADHD at 12
  • No psychotherapy
  • Was on Ritalin

Current treatment

  • Two clinical assessment interviews
  • Current problems and background
  • Parenting skills and perspectives
  • Rapport and involvement
  • Aaron - Youth Self Report (YSR)
  • Parents - Child Behaviour Checklist (CBCL)
  • Different perspective
  • Note: No Behaviour observation, Neurocognitive assessment or IQ test

Treatment History

ADHD, Combined type

  • Inattentiveness
  • Hyperactivity-impulsivity
  • Affect social and academic functioning

Comorbidity, Oppositional defiant disorder (ODD)

  • Angry/irritable mood
  • Argumentative/defiant behaviours

Differential diagnosis

  • No depression
  • No assessment on substance abuse

Diagnosis

  • Hyperactivity, impulsiveness, inattention and disorganisation from an early age
  • Mother has traits that paralleled his ADHD symptoms
  • Difficulty controlling frustration and anger
  • Parents’ separation, ongoing discord and continual change of schools
  • unstructured environment, inconsistent discipline, and minimal supervision
  • Believed that all social interaction would lead to contention and negative reactions from others
  • Established himself as an entertainer → helped him make friends and provided positive sense of self

Predisposing Factors

  • Recent release from prison and move to his mother’s house
  • Transition from structured environment to free environment, accentuating his difficulties in regulation of emotions and behaviours
  • O levels stress, re-establish social relationships, monitor impulsive and risky behaviour

Precipitating Factors

  • Inattention and disorganisation
  • difficult to concentrate on processing new information
  • Limited skills for controlling impulsivity and hyperactivity and dealing with consequences
  • Negative expectation of interactions and struggles controlling frustration
  • Ill-equipped to deal with unfulfilled goals
  • Limited structure, monitoring, discipline and emotional support for Aaron
  • Mother’s mood swings

Perpetuating Factors

  • Strong relationship with father
  • Parents supported his therapy
  • Father willing to be involved
  • Aaron
  • Motivated to attend therapy
  • Able to communicate openly and candidly with the therapist
  • Above average intelligence
  • Resisted any urge to use drugs

Protective Factors

  • Reframe presenting problems to highlight skills
  • A plan to deal with situations that might put him at risk
  • Learn to label and rate his moods
  • Use the CBT 5-part model
  • Techniques to break cycle (impulsive actions -> conflict)
  • Stop-think, self-statements, distractions, simple relaxation techniques
  • Self-monitoring skills
  • Developed own external structure

Treatment

Alternative Treatment

Prognosis

ADHD and Oppositional Defiant Disorder

Therapeutic Eurythmy

  • Highlights speech and musical activity in relation to movement
  • Client is taught to imitate patterns of movement shown by the therapist and to eventually perform them in joyful, concentrated and precise way
  • Examples of exercises:
  • Throwing a ball to each other to a rhythm
  • Clapping different types of rhythms
  • Jumping to spoken letters in a sequence eg BMDNRL
  • Aims to develop an individual's ability to concentrate and be aware of feelings in a controlled, coordinated and skilful manner
  • Shown to decrease hyperactivity in children

Majorek (2004)

Alternative Treatment

  • Small sample size (N=5), subjects are boys aged 8.5 - 10 years.

  • Although shown to aid in reducing symptoms of ADHD, it is largely deemed as a pseudoscience

Limitations

  • Western context:
  • Expressive emotions as the culture norm
  • Hence clients might be more receptive towards therapeutic eurythmy (expressive art movement)

  • Asian context:
  • More pragmatic and less expressive
  • Clients might be unwilling to try the therapy - absurd? Merely a psuedoscience?
  • But adapted to cultural/folk dance? exercise movements?

Singapore Context

Greene, R. W., & Doyle, A. E. (1999). Toward a transactional

conceptualization of oppositional defiant disorder: Implications for assessment and treatment. Clinical Child and Family Psychology Review, 2, 129-148.

Majorek, M., Tüchelmann, T., & Heusser, P. (2004). Therapeutic

Eurythmy—movement therapy for children with attention deficit hyperactivity disorder (ADHD): A pilot study. Complementary Therapies in Nursing and Midwifery, 10(1), 46-53. doi:10.1016/S1353-6117(03)00087-8

References

Learn more about creating dynamic, engaging presentations with Prezi