But First...
- 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