Mental Illness - Case Study Example

? Case Study Lecturer: Case Study Introduction/Background The case study of mental illness involves the child who was suffering from Asperger Disorder (AD) which is also a disorder known as Asperger syndrome. Asperger disorder is one of the autism spectrum disorders, which are characterized by repetitive behaviors and social interaction difficulties (Amaral, Dawson and Geschwind, 2011). AD differs from other autism spectrum disorders because there is absence of speech or language delays and symptoms are less severe in asperger syndrome unlike other autism spectrum disorders, which have language delays and severe symptoms. AD is one of the mental illnesses commonly experienced among varied children during their childhood development process; thus, many children develop cognitive difficulties, language skill problems and lack effective nonverbal communication skills. The exact cause of AD is unknown but many researchers have attempted to base their arguments on the genetic basis as the major cause of asperger syndrome. Although there is no clear treatment for AD, cognitive behavioral therapy, social skills therapy, speech therapy, physical therapy and other intervention measures are among the effective therapies for improving symptoms and function of the patient. Mental Health History The client is a six years old child who grew up well and did not have any linguistic or speech problems but started experiencing some minor problems earlier at the age of five years. The child started having trouble in some basic elements of social skills including failure to make friendships with other children, lack of emotional reciprocity and impaired nonverbal behaviors. When the child was admitted in school, the teacher realized that the child displayed some repetitive behaviors, which were sometimes abnormal. Parents of the child also had already noticed earlier some displayed behaviors, activities and interests of the child which were repetitive but they could not take them seriously. Some of the behaviors of the child became apparent after the age of 5-6 years and this was the period their parents started seeking medical attention. For example, the child could memorize camera model figures but could care little about photography. Although these behaviors kept changing from time to time, they typically became narrowly focused and even dominated social interaction in the extent that the family members of the child became worried and stressed. According to Matson, Matson and Rivet (2007), repetitive motor behaviors are among the major symptoms for asperger syndrome but these behaviors tend to change from time to time. In addition, the client developed problems in understanding figurative language and ended up using language literary something that forced the teacher of the child to employ effective teaching intervention strategies and prepare Individualized Education programs in order to meet the demanding learning needs of the client. Although the child had excellent auditory and visual perception, some differences in perception with motor, emotion and sensory perception became apparent. The client was diagnosed and the diagnostic criteria required the treatment of the impairment social interaction, repetitive behaviors and many other problems. Rodriguez (2012) argues that employing effective diagnostic criteria and carrying out comprehensive assessment process in a multidisciplinary team approach is vital. Earlier intervention was carried out because AD does not have clear treatment but some therapies offered to the client included, Cognitive Behavioral Therapy (CBT), social skill therapy, physical, speech therapy and other intervention programs were carried out. Assessment Process The first step of diagnosis is the assessment process, which includes observation and evaluating developmental history of the child. The medical professions or qualified social workers with experience should carry out assessment process in order to determine the causes and symptoms; thus offer effective therapeutic interventions to the patient. The first step of diagnosis to people with mental illness problems includes assessment process and earlier diagnosis. This is because people who are diagnosed and treated earlier have a high chance of being successful in learning institutions and they are able to improve their health status; hence eventually living independently. The diagnosis for ASD has increased for the past decades but the treatment for this disorder has not yet been detected; however, earlier intervention programs and cognitive behavioral therapy can reduce the asperger disorder. Brooke (2009) argue that the diagnostic criteria for asperger syndrome should focus on language development, sustained impairment in social interaction, restricted and repetitive behavior patterns, as well as, interests and activities that can cause clinically significant impairment in significant functioning areas. The assessment process that followed focused on identifying what the clients does in making things better, what works better for the client and what will facilitate the continuation of the desired behaviors in order to improve the health of the client. The assessment program focused on the needs of the client, capabilities and aspirations in all functioning areas of life. In order to carry out assessment process effectively, the physician employed the technique of face to face interview with the client family members of the client. This is vital because it enabled the soil worker to hear the story of the client and the way the client has survived so far, what the client needs and the way the client believes that things are getting better in varied functioning areas of life. The social worker realized that the client was comfortable being in a group or with other people around and even wanted to communicate with them but the client did not know how to do it. The client also had some nonverbal communication problems such as facial expression, eye contact and many others. Green (2001) argues that the cognitive ability of AD children usually allows them to articulate social norms in context with theoretical understandings of the emotions of other people; however, these kids have difficulty in acting on this experience in real life situations. During the evaluation process, it was noticed that the client had good language and cognitive skills. Amaral, Dawson and Geschwind (2011) argue that a child with asperger disorder may seem like any other normal child behaving differently because they have good language and cognitive skills. Individuals with asperger syndrome want to fit in the social interaction process but they lack means of doing it unlike children with autism who are totally uninterested with others. The client seemed socially awkward, and did not understand conventional social rules, as well as, lacked social empathy; thus seemed not to understand nonverbal communication especially use of gestures. Collaborative Care Planning Collaborative approach was chosen as an effective intervention strategy for improving medical adherence and other varied care offered to the client. The collaborative approach is vital in care planning process because it involves varied stakeholders including social workers, community, family members and the client. These groups work together as a team and they employ a multidisciplinary approach towards improving the medical adherence of the patient. Varied researchers have attempted to reveal the significant of collaborative care as an effective intervention approach towards meeting the desired needs or intended goals of patients (Rouse and Bardelman, 2009; Tucker,2000).  Additionally, the collaborative approach may involve intervention with the client or family members and other community or social works including community nurses and teachers; thus contributing to better care provision. First, the intervention with the client may involve individuals meeting with the client and the therapist; thus establishes trust, as well as, set treatment goals. The treatment goals of the client are to reduce repetitive behaviors and improve nonverbal communication behaviors through working as a team towards improving medical adherence. Secondly, collaborating with the family members of the client to enable them identify the weakness, strengths and demanding goals of the client. This strategy is helpful in environmental modification of the client and it helps the client to cope up with the surrounding environment. Family members can collaborate with the community and social workers to offer support to the client including helping the client to improve medical adherence. Collaborative strategy is seen as a resilience building strategy where the primary focus is to help the client meet the demanding goals and improve medical adherence. Many researchers advocate the collaborative care planning in the society because this strategy is not labor intensive and it is imperative because it can serve best the interest of patient with mental illness (Alfaro-LeFevre, 2002; Carpenito-Moyet, 2007). Collaborative care planning is one of the convenient and most effective nursing approaches for delivering high quality care services in the community than any other approaches. Collaboration between the client, parents and social workers can help the client to improve cognitive, language skill problems and nonverbal communication skills. This is because the process involves working together as a team; thus, it can contribute to better results since developing effective therapeutic and teaching interventions requires a multidisciplinary approach. Therapeutic Interventions Earlier treatment intervention can play significant roles in improving the health status of the client and the following are among the significant intervention approaches employed in decreasing the presence of AD symptoms. One of them is the CBT and the main aim of using the CBT protocol was to reduce the asperger syndrome symptoms of the client. Cognitive behavioral therapy is one of the effective therapeutic therapies for improving well-being of clients with asperger syndrome. CBT is an efficient psychotherapeutic intervention measure employed in helping patients with mental illness to improve their social and cognitive behaviors (Klin, Volkmar and Sparrow, 2000). CBT is based on the idea that problems does not only results due to environmental conditions but also behaviors or the way individuals interpret their thoughts, which end up impacting their feelings and actions (Taylor, DeQuinzio and Stine, 2013). Psychological theorists argue that people learn the negative thinking ways through negative reinforcement process; therefore, the use of CBT approach is vital because it can contribute to positive results or create positive change. Many researchers have attempted to argue that CBT is one of the effective therapeutic intervention measures for reducing repetitive behaviors in children with mental illness because it regulates emotional behaviors, develops impulse control and advances cognitive behaviors (Batshaw, Pellegrino and Roizen, 2007; McCartney and Phillips, 2006). This therapeutic intervention method can be incorporated with other intervention measures in order to create significant change to the client. Additionally, it is significant to note that the client was six years old at the initiation of treatment, which is quite young for CBT techniques; however, the intellectual orientation of the client seemed well suited to CBT interventions. The CBT protocol was attempted with diverse modifications for the development level and dual diagnosis of the client. Employing CBT can improve or advance the cognitive and psychological performance functioning of the client. This can contribute to better outcomes of the client in case nurses or physicians will carry out assessment of factors that contribute to the psychical and psychological development of children. CBT has become among the widely intervention measures for treating children with mental illness because this intervention strategy takes into considerations those psychological and social behaviors of a child (Reaven and Hepburn, 2003). Behavioral intervention strategy is a technique that was employed by B.F Skinner when he first conducted two varied experiments in both positive and negative conditions. Hare (2000) points out that the behavioral intervention strategy is significant because it reduces or increases the likelihood behavior of a child with asperger syndrome. Another therapeutic intervention measure that was employed is the physiotherapy or physical therapy and this is also an effective therapeutic intervention measure for treating children with mental disabilities. Physical therapy is one of the healthcare services, which are primarily concerned with the remediation of physiological impairments; thus improving functional ability and quality of life through physical examination (Leaf et-al, 2012). Physical therapy includes screening and examining the client in order to determine the conditions of the patient. The healthcare professional can obtain a history from parents or family members of the client or from any other sources. Varied examination tests or measures are also carried out and this can enable psychologists or physicians to offer effective treatment to the client. Although the research literature on therapeutic interventions for individuals with asperger disorder is still scarce, varied helpful texts are available, which reveals varied approaches and offer a wealth of ideas and teaching strategies for individuals with AD conditions (Klin, Volkmar and Sparrow, 2000; Rodriguez, Thompson, Schlichenmeyer and Stocco, 2012). Understanding the needs of AD children and offering them supportive services to address these needs is imperative. The increased asperger syndrome and lack of clear treatment has enabled many clinicians to increase referrals for special education programs. This has forced educators to pursue further training with unique profile of severe social and communication disabilities in the presence of cognitive and language strengths (Klin, Volkmar and Sparrow, 2000). Intervention strategies including use of IEP intervention approaches, behavioral management techniques, emotional support strategies and activities intended to foster social or communication competence have become among the effective intervention strategies for helping the AD child meet his or her demanding needs. Care providers should embrace the varied range of expression and complication of the disorder; thus make considerate individualized adjustments. Providing earlier intervention programs is significant because it can improve cognitive and social behaviors of the client. Ingvarsson and Hollobaugh (2010) argue that therapeutic intervention approach that may be effective in one AD child may not work in another AD child; thus, earlier intervention program is one of the effective means of reducing repetitive behaviors of children with mental illness. Varied intervention programs such as interacted participation approach, peer coach strategy and many others can be employed in improving the repetitive and restricted behaviors of the client. Individualized Education Programs (IEP) was preferred because this will enable the client to improve the cognitive and social skills; thus achieving the learning demanding needs. The use of social skills and social communication therapeutic intervention approaches were also employed. Pinto (2006) argues that the use of social intervention measure such as social skills is vital in facilitating interaction and improving communication skills. Matson, Matson and Rivet (2007) define social skills as learned behaviors, which allow individuals to attain social reinforcement. In the operant conditioning experiments, training social and communication skills is vital in treating mental illness; thus there is a need for family training and use of community reinforcement approach. Outcome Summary The result for this case study report suggest that cognitive behavioral therapy can be an effective therapeutic intervention for decreasing asperger disorders symptoms in children. As with any single case study report, the outcomes of this study report are limited to generalizability. The extent to which the characteristics of the client, family members and the environment contributed to other results is unclear. The client began earlier treatment and use of varied therapeutic interventions measures were employed; thus by the end of 7th week of treatment period, the symptoms had already decreased to manageable levels. The use of collaborative approach also was found to be an effective approach for helping the client improve medical adherence. This approach enabled the team members to understand the needs, identify the demanding needs and also make effective choices about the client and family objectives. The assessment of the collaborative approach included whether goal achievement is continuously defined and redefined from the perception of the client. Gulanick and Myers (2011) attempt to offer varied intervention programs provided by nurses; thus collaborative approach is argued as among the best approaches for providing better outcomes. Furthermore, the treatment goals were the reduction of repetitive behaviors and improving nonverbal communications. After the evaluation process and follow up that was made after 5 months, the client reported 80 percent improvement of the health status. The client was able to effectively make use of non-verbal communications and improve social interaction skills without any difficulty. Nine months later, the client reported that relationship with the family members, friends and repetitive behaviors improved drastically. Understanding the common characteristics of individual with AD is vital for designing a viable treatment CBT protocol; however, it is the hope that this study will encourage other clinicians and researchers to carry out further research on the potential benefits of CBT and other intervention approaches in the reduction of symptoms in children with asperger disorders. From the research outcome measures, it is recommendable to employ specific problem solving strategies and these strategies should taught the need for handling the frequently occurring troublesome situations. Training clinicians should focus on the necessary needs for recognizing troublesome situations; thus applying significant problem solving strategies in discrepant situations (Klin, Volkmar and Sparrow, 2000). There should be increased nursing research and the teaching approach often couched in verbal instruction and presented in such a manner that verbal steps are in the correct sequence for behavior to be effective. The client or any individual with AD should be given instructions on how to identify a novel situation and these requires a description of the situation and patient knowledge. There is a need to foster generalization of social skills and self evaluations should be encouraged, but this should be done in a concrete and explicit manner. The observation that communication and social skills building are the core intervention component is not new; hence adaptive skills intended to increase self-sufficient should be taught explicitly. Conclusion Although there is no clear treatment for AD, cognitive behavioral therapy, social skills therapy, speech therapy, physical therapy and other intervention measures are among the effective therapies for improving symptoms and function of the client with asperger disorder. The research provided the historical background about the client and revealed the significant assessment process carried out. The medical professions or qualified social workers with experience should carry out assessment process in order to determine the causes and symptoms; thus offer effective therapeutic interventions to the patient. The medical professions or qualified social workers with experience should carry out assessment process in order to determine the causes and symptoms; thus offer effective therapeutic interventions to the patient. The therapeutic interventions provided included the use of the CBT, physical therapy, social skill therapy and other earlier intervention programs were recommended such as use of IEP to improve the cognitive and social skills; thus achieving the learning demanding needs. The case report revealed that CBT can be an effective therapeutic intervention for decreasing AD symptoms in children. It was recommended that understanding the common characteristics AD child is vital for designing a viable treatment CBT protocol; however, it is the hope that this study will persuade clinicians and researchers to carry out further research on the prospective benefits of CBT and other intervention approaches in the reduction of symptoms in children with asperger syndrome. References Alfaro-LeFevre, R. (2002). Applying Nursing Process: Promoting Collaborative Care. Philadelphia: Lippincott. Amaral, D., Dawson, G., & Geschwind, D. H. (2011). Autism Spectrum Disorders. New York, NY: Oxford University Press. Batshaw, M. L., Pellegrino, L., & Roizen, N. J. (2007). Children with Disabilities. Baltimore: Paul H. Brookes Pub. Brooke, S. L. (2009). The Use of The Creative Therapies With Autism Spectrum Disorders. Springfield, Ill: Charles C. Thomas, Publisher. Carpenito-Moyet, L. J. (2007). Understanding The Nursing Process: Concept Mapping And Care Planning For Students. 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