Shelia Ward Psych/ 270
ABNORMAL PSYCHOLOGY: ABUSE, ADDICTION, & DISORDERS (AXIA) Clinical Assessment April 24, 2011

Assignment: Clinical Assessment Pre-consultation is the first initial contact with the potential clients, the documents of Clara’s medical history must be submitted for review, along with a documentation from her teachers at the pre-school pertaining to their observations with Clara. At this point any other documentation obtained prior to the adoption that may give further insight to evaluating Clara. In meeting with Clara and her adoptive parents the issue of Clara’s age and environment is the beginning process in evaluating the issues surrounding Clara. I recognize that questioning a four- year old child could appear to be very intimidating and frightening; therefore, the interview will be addressed in several phases to avoid overwhelming Clara. The first phase will initiate Clara be taken to a playroom, and observed by my associate and recorded while playing with dolls. This will give insight into whether Clara demonstrates anger, or touches the dolls in inappropriate places suggestion perhaps sexual abuse. The second phase would be to speak individually with the parents to gather data that will give insight to Clara’s behavior and environment. In asking the pertinent question of whether or not, they have spoken with Clara in terms of adoption is definitely a important aspect of assessing the child, other questions would be to discover at what age did they adopt Clara, what were the circumstance that led Clara to be placed in an element for adoption. Has Clara been exposed to biological interaction with family members? Have there been any changes in the home that may change Clara’s daily routine? Has there been a change in pre-school interactions with new classmates, teachers, or teacher aids? Has Clara displayed any issues of bedwetting, does she have nightmares? I would ask if their perception of Clara’s mannerism has been evolving slowly or rapidly, and are certain days worse than others. Does Clara act the same toward everyone, or does she appear to have distress around any particular person, place, or object? The third phase would be to assemble further idiographic data while conversing with the parents in a casual and relaxed setting avoiding having them feel as though they were accused of any inappropriate actions. Giving them assurance them that in certain circumstance Clara’s behavior may be part of her developmental process, therefore it may be that Clara is asserting her independent characteristics’. Observing other children actions may have prompted Clara to demonstrate acts of tantrum, anger, and reluctance in going to school. The interruption in appetite and sleep may be because her growth patterns are changing. The conversation would inquire about the amount of time they spent with their daughter, what they do during this time, play games, go on walks and so forth, having productive interaction is important in a child developmental process. Although quality time within a family is crucial to growth so is the introduction to social interaction and the benefits that accompany the exposure. The fourth phase of the assessment would be to investigate the parent’s relationship and whether or not it is in a harmonious state, is the home environment conducive to the needs of a family containing small children n. In relation to how they follow the dynamics of school interactions the need to explore their relationships with teachers deems valuable in assessing Clara’s needs.

The fifth phase brings the observational documentation from Clara’s time in the playroom, into the discussion as the interview process begins as we establish the proper tools in conducting the interview it is important not to force the child into thinking that she has done anything wrong, the atmosphere must not be conducted in a sterile manner. Clinical assessment can involve different forms of exploration; those not applicable for her age and cognitive level in this assessment are projective testing, personal, and response inventories. In recognizing the information given that suggests a change in behavioral pattern both neurologically and neuropsychological testing may also be omitted. The need for intelligence testing is one format that would give insight to her interactions in pre-school, and how she is processing the data. Initiating the process of clinical observation will prove to be gainful in evaluating Clara’s behavioral changes. In examining the data and as well as observing Clara’s mannerism the summation indicates that the change in Clara’s behavior is interrelated with her experiences at pre-school. Applying the element of naturalistic clinical observation would be helpful in this case. Placing observation in all aspects of her life would be advantageous in finding pertinent information to aid in assessing the problematic areas and the time frames linked to episodes of distress, and exhibits disruptive behavior. In the event a human presence would not be permissible, the method of videotaping would be the next option in collecting naturalistic data. In gathering analog video coverage and having the opportunity to compare it to another variable analog from previous time frames it allows the opportunity to evaluate the events. Through investigating Clara’s daily functions with clinical observation the results may indicate that she has been exposed to teasing, bullying, and perhaps even physical abuse by other children. It may reveal that she feels singled out by an adult, and she is experiencing levels of distress. These feelings can lead to levels of anxiety, and anger. In affiliating the parental aspect of interaction combined with the adoption element may have provoked confusion, fear, and challenged Clara’s sense of security; however, this does not seem to be the case given the data collected previously. In consideration of the patient’s age, it is highly unlikely that direct mediation between patient and therapist would be deemed, advantageous. A more suitable course would be to implement an intervention treatment plan involving the parental figures; the teachers and the child this will best suit the evaluation process. In addressing the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the five associations used to define disorders, and aid in treatment suggestions are as follows: Axis one clinical disorders, (“DSM IV explained, “2009) - Clara’s expression of somberness combined with reluctance in attending pre-school. In addition her patterns pertaining to sleeping and have changed coupled with outburst of anger and temper tantrums. Axis two personality disorder and mental retardation (“DSM IV explained,” 2009)- In this particular case the patient had not demonstrated any symptoms of mental retardation at infancy or toddler stages, indicating that the child cannot be suitable evaluated pertaining to a personality disorder because of the lack of variables in her lifespan. Axis three, General medical condition (“DSM IV explained,” 2009) - This portion would rely upon the medical notation and medical examination that have been conducted. Without this portion no medical recording would be established. Axis four, Psychological and Environmental Factors (“DSM IV explained,”2009) - The data that has been collected from naturalistic observations would be documented here. Axis five, Global Assessment of Functioning (“DSM IV explained, “2009) - The patients dexterity to operate in her contemporary milieu would be a marginal notation following the examination and observation of the case. In consideration of the child and her age factor it warrants significant detail in developing a treatment plan to assist with an intercession that would support her in accomplishing a transition with ease as she acclimates in her school setting, without experiencing acts of disparagement. PCI therapy coupled with TCI therapy could be a viable source in helping Clara to establish a stronger sense of self, and help in gaining further insight to her diagnosis and treatment options. These forms of intervention will help Clara to enhance her developmental growth process and function with her environment with far less distress.

References: Parent-Child Interaction Therapy. Retrieved April 14, 2011 from http://pcit.phhp.ufl.edu/ Comer, R.J. (2005). Fundamentals of abnormal psychology (4). New York: Worth. Dsm Iv – 2009 – November. Retrieved April 14, 2011 from http://www.dsmiv.net/2009/11 Long- term effects of Bullying in girls and boys - Child. Retrieved April 13, 2011 from http://www.child-psych.org/2009/10/bullies-and-victims-a-risk-for-psychopathology.html Psychology Department, University of Nebraska - Lincoln. Retrieved April 14, 2011 from http://www.unl.edu/psypage/maltreatment/research/nuTCIT.shtml