Write an analytical report in response to the detailed case notes attached describing an adolescent with behavioural problems. Demonstrate understanding of the theory and application of cognitive-behaviour therapy to such problems.
Referral
CASE NOTE
Tom is a 16 year old boy who was referred to your service by his Family and Community Services (FaCS) case worker. The referral requests full psychological assessment and treatment recommendations. You are yet to see this family, but you already have the detailed background below.
Also read: Application of The Cognitive Psychology in Mental Illness or Trauma
Subject Background
Tom has had a long-standing history of challenging behaviour and emotional issues at home and school; with no clear diagnostic profile or previous ongoing treatment. To date, he has not had any additional assessments, aside from a paediatric review. The most recent report from his paediatrician notes that he has deferred any opinions until Tom is assessed by a psychologist. There are no medical issues noted at present or throughout his development.
Family Background
Tom lives at home with his parents, Helen and John, and his four younger siblings. Neither Helen nor John work and they are under considerable financial strain. They have recently moved into a more affordable neighbourhood; but are concerned about the peers Tom has now drawn towards. It has been reported that Tom’s new peer groupare in trouble with the police a lot. Helen is highly stressed and has started seeing a drug and alcohol counsellor. John thinks all psychologists are a waste of time and believes that the family would be better off if everyone left them alone to their own business. John has a history of criminal activity and is frequently in and out of gaol; so he does not worry about Tom going down the same path as he did. John also believes that Helen is not doing a good job as a mother to Tom; John reported that Helen spends more time drinking with her friends than looking after the home and children.
Helen describes her relationship with Tom as conflictual and although she tries to be warm, he knows how to push her buttons; so she fluctuates between screaming at him and ignoring him. John stated that Tom is well behaved around him, but it took a long time to ‘beat that into him’. John also thinks that society is too soft on kids these days and all they need is a strong hand to keep them in line. John said that now Tom is getting older they are spending more time together at the TAB and beer garden; but only if Tom has behaved for his mother. Helen and John said that the other children are generally ok, but they are happy for them to do as they please as long as they are home by 6pm and do as they are told when at home. They also reported that the kids do bicker which is a pain and it’s not uncommon for the kids to be aggressive with each other.
More to read: Cognitive behaviour therapy (CBT)
Presenting Problem History
Tom was first identified as having difficulties in pre-school; where he had difficulty with aggressive behaviour and getting along with others. This continued as a pattern throughout his primary years, with Helen and John frequently being called up to the school. Tom also has a history of being suspended for aggressive and non-compliant behaviour. Tom was reported to be impulsive and restless; however, his teachers stated that he could sit still in class and complete his work without any problems. At times he could be really attentive but at other times he was easily distracted and would annoy others rather than pay attention in class. Tom was known as the class clown –and was not very popular with his peers. Tom also likes thrill seeking experiences and would engage in risky behaviour –this was usually based on impulsive decisions.
Academically, school reported that Tom was capable but not motivated. Tom complained that the work has always been boring or too easy –so he chooses not to do it. Most of the disruptive behaviour at school got worse in Grade 5, when he was expected to start completing assignments and more homework –which he refused to do. He is now in Year 10 and at risk of school dropout. He frequently truants and his teachers suspect that he is hanging around with older children who are known to engage in illegal activities. His current constellation of behaviours include; impulsivity, truancy, antisocial acts, non-compliance, emotional meltdowns, anger at perceived negative evaluation, irritability, avoidance of school based tasks, aggression, risky behaviour and interpersonal conflict with parents, teachers and students at school.
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The report should follow and be structured under the headings below:
The response should answer all aspects of the marking rubric.
Clinical Assessment (~650 words)
-Accurately describes assessment techniques that would be recommended within a thorough multi-modal characterisation of the condition.
-Evidence for Assessment
Presents a strong evidence-based rationale for each of the assessments recommended.
-Limitations of Assessment
Highlights process issues and limitations of these assessment procedures.
Diagnostic Hypothesis (~550 words)
-Identifies noteworthy clinical features and proposes at least two diagnostic hypotheses with a well-explained rationale for them.
-Differential diagnosis
Draws attention to areas of confusion and suggests methods for making a differential diagnosis.
Treatment Plan (~800 words)
-Proposes a detailed CBT-driven approach for treatment referring closely to the assessment and diagnosis presented above.
-Evidence for Treatment Plan
Presents a compelling evidence-based rationale for the intervention strategy based on theory covered in the workshop and the relevant academic literature.
Case Formulation (figure)
Presents a schematic case formulation summarising the factors influencing the development and outcome of this case (figure on a separate page)