Biopsychosocial in Social Work - Book Report/Review Example

Biopsychosocial in Social Work Introduction: Consent from the guardian and school authorities have been obtained prior to utilizing Harry’s case in this report. Names have been changed to protect the anonymity of the subject and the respondents. This is likewise done to shift the focus on the topic and not to the persons involved. Much care and an adherence to confidentiality have been given in acquiring information presented in this report. Information was obtained through immersion, observation, interview, and review of records (growth and development chart, dental records, family data form,etc.) Baseline Data: Subject: Harry Sex: Male Date of Birth: December 22, 1999 Mother: Maureen (38 years old, single mother working as a local store manager) Father: James (40 years old, working as a full time computer programmer) Parents were divorced 7 years ago, when Harry was just 2 years old. School: Middle School (3rd grade) Diagnosis: Attention Deficit Hyperactivity Disorder (diagnosed when Harry was 7 years old) The subject has been brought to the counselor for complaints of shoving while waiting in line at the drinking fountain and striking out a classmate who cut the line before him. Narrative records written by his teachers show that Harry could not keep still in class. He would run from the back of the room to the teacher’s table or roam around the classroom, disrupting his classmates in the process. When in his seat he would tap his pencil and fingers noisily or dig would dig in his school bag seemingly looking for something. Moreover, he would blurt our answers before the teacher would be done completing the question. Surprisingly, his answers would be correct at times. During a field trip to the museum, he touched and broke an artifact when he was strictly instructed not to touch anything. Teachers reported that he has “exceedingly short attention span” and would not be able to finish his seatwork because he would be distracted by noises as trivial as the chirping of the birds outside the classroom window. Harry was also evaluated to be fairing poorly in reading, writing and arithmetic. He has difficulty differentiating the small letters b and d, and would, at many times, confuse one for the other. He was able to attain certain mastery for computations. For example, he can answer 5 x 5 equals to 25, but when he is not reviewed of this past lesson, he would simply answer 55 for the same question. He is not fluent in reading sentences and would sound “choppy” as he would read a wordy by syllables slowly. Harry’s baseline data showed that he was born on December 22, 1999 and is currently residing with Maureen, a single mother. His parents were divorced when Harry was just 2 years old. Maureen reported that he had a particularly hard time during the labor and delivery of Harry. She even consented to the use of forceps. During the interview, she verbalized that she had no difficulty with her present financial situation with having to juggle the expenditures all alone. Her accounts have further shed light on the signs and symptoms manifested by Harry at home. She reported that Harry could not sit still to finish his entire meal. He would even play with the dog in between mouthfuls and watch television while chewing his food. He would often leave homework unfinished and there was a time when he left the faucet running because he ran hastily out. The water seeped out from the bathroom and even caused Maureen to slip and hit her head, causing a concussion. All the aforementioned manifestations coincide with the diagnosis of Attention Deficit Hyperactivity Disorder. As a pharmacologic intervention, methylphenidate hydrochloride (Ritalin) 20 mg once a day was prescribed to manage his signs and symptoms. Physical Development Harry is now 9 years old and his records show that he has gained 2 inches as compared a year ago. (From 52 inches he now measures 54 inches.) He has also increased in weight by 2 kg (from 26 to 28 kg). This pattern of gaining steadily 2 inches in height and 2 kg in weight per year since he was 7 years old has been recorded in his growth chart. These figures assume a steadier pace of growth in height and weight, as compared to the rapid pace during early childhood and the prepubescent growth spurt (Hockenberry 1153). Harry has also shed some of his deciduous teeth, and is very evident when he grins widely. His dental records (and observation) show that his lateral incisors are erupting. He has lost some of his “baby fats” and has a acquired a much slimmer look with longer legs. This change was very much obvious in the comparison of two photographs, one taken when he was 4 ½ years old and the other taken during his 8th birthday. Psychosocial Development The developmental task of the school-age child centers on industry versus inferiority (Pillitteri 832). A sense of industry is gained when a child learns how to do a task and is praised for completing such. Inferiority sets in when he is hindered to accomplish or even initiate a task. It is imprinted in his mind that he cannot do it in the first place. If this inferiority cannot be resolved, then the school-age child can carry this conviction up until he grows up and this would greatly interfere with his performance, may it be in school or in other occupational settings. Harry, clearly, has difficulty achieving a sense of industry because he has also difficulty completing simple tasks. His mother account attested to this difficulty: “ There was a time when frustration got the best of me.. I would tell him to set the table or pick the things up, but the next thing I know I was the one doing the task myself. When I would ask him shy he didn’t do the job, he will answer that the cannot remember being told to do so…” Maureen has seen the impact of this disorder in Harry’s disposition at times. She remembers him saying, “I just couldn’t finish it…” when he tried to finish an origami project in art class. When interviewed, Harry shed light on his feelings: “I’m sad because I’m not doing well in school. I can’t even finish my origami project…I just couldn’t…it’s just hard to remember all those steps…” Maureen, seeing the difficulty of her child asked the help of a counselor on how to handle her son and his difficulty in completing tasks. She was taught about Erik Erickson’s developmental task and the implications of this when not accomplished. To cultivate a sense of industry to Harry, she was taught that she should assign age appropriate tasks to him, something he could finish using his own capacities. Before starting, she was taught to break the chore into manageable steps and present them in clear and simple manner, putting emphasis that she should provide constant reminders for Harry to finish it. She utilized these acquired learning on a simple task of setting the table for Harry. She recounts: “I told Harry that he will have to set the table for our dinner, and I made sure he was all ears when I told him this. I instructed him first to wipe the table using the wet rag in the kitchen. Second, he had to go to the cabinet and get the glasses. He should put these in the table. Third step was to get the plates and utensils, and also put them in the table. I had to remind him time and again to do the task, and that he shouldn’t run out without finishing it. I sounded like a wounded recorder, but I had to embrace these measures because these were the ones that worked with my son…worked it did because he did get to finish the job…I served his favorite viand as a reward for this behavior.” This small accomplishment boosted Harry’s self-esteem as reflected in his statements, “I did it mom! I finished it!” Intellectual Functioning A child who belongs in the age range of 6 to 12 belongs to Piaget’s cognitive development described as concrete operational, wherein a child is able to use mental representations to what is happening to them (Hockenberry 1153), such as in the concept of conservation where a child learns that a taller glass will not necessarily mean that it has more quantity of liquid as compared to a shorter glass. School-age children are expected to understand relational terms. Relational terms are used to classify which one is to the left, and which one is to the right, and which is the first, and which is the second. Children with Attention Deficit Hyperactivity Disorder have difficulty retaining concepts ( Pillitteri 832). In Harry’s case, he has difficulty retaining the spelling of words because he could not remember which letter came first in a certain word. He has particular difficulty spelling words with I and e, as in belief which has I preceding the E, and receive, which has E preceding the letter I. As aforementioned, Harry has problems in manipulating numbers, and this is because he cannot retain the concept of reversibility, wherein the arrangement in space does not change the properties of the environment (Hockenberry 1154). Although children with ADHD have the capacity to read, they have difficulty reading words with many syllables. Harry’s teachers told him he sounded “choppy” because he would retain the pronunciation of the first syllable, but then lose it the moment he came to the pronunciation of the succeeding syllables. Moral Development Under Kohlberg’s Moral Development, older school-age children are able to see an act as to its intentions rather than focusing on its consequences, as compared to younger school-age children wherein reward and punishment still guide their judgment (Hockenberry 1154). Older school-age children begin to see the core why rules exist, and that is to promote the safety and welfare of self and others. Because Harry is impulsive, to the point that others may deem his behaviors and actions as defiant and uncaring, this development could not be achieved smoothly. When Harry hit his classmate, he did this on impulse because he had to do something to appease his needs and wants. Harry’s impulsivity has lead to many accidents and mishaps, but the continued occurrence points out that he is unable to learn from experience. His mother, with the help of the counselor, addressed this by giving out punishment for the deliberate action, and not for the inability to retain concepts and sequences. This is to put emphasis that something was wrong with Harry’s behavior, and not to Harry himself. Maureen states: “If I would punish him and tell him some of his privileges were lost because he hit someone or shouted during queuing, I would tell him that his behaviors were the ones that were bad, and not him. I want him to have better social skills, but not to the expense that I will belittle him…” Maureen would tell Harry to go sit in a chair for 15 minutes (“a time out”) when he deliberately did something wrong. Interpersonal Development For the school-age child, a peer group is very important. These peer groups would usually have their own secret language, manner of dressing and other rules that every member must embrace. Playing by teams as a means of socialization also occurs during school age. For Harry’s case, however, acceptance to a peer group is very hard for him. He is frequently not invited to join a team since his reputation of shoving, pushing and picking a fight would intimidate his classmates and playmates. His classmates dubbed him as a “freak” and a “trouble”. Aside from his behavior which was described as “rude”, he isn’t invited to join the tam because he would always make a mistake, causing the team to lose points and lose the game. To address this, Maureen was instructed to supervise play and to structure activities so that she could intervene if problems do arise. She narrates: “I invited 2 of Harry’s friends over and let them play in the backyard. I has my eyes on them like a hawk…I provided snacks for them so that their activity would have structure to Harry. As soon as Harry was beginning to show signs that he was going to have a tantrum, I immediately intervened...I also went to the coach of their baseball team and discussed Harry’s condition to him. I want him to join the team so that he could go and play with the kids. The coach agreed to help me, and he went to the children to tell them Harry was going to come and play with them. Some of the kids protested, but then the coach said he already made a decision. I was very thankful the coach agreed to extend his help” Factors contributing to the Occurrence of the Disorder There are many factors implicated to the development of this complex disorder and they can be classified into Biological, Environmental and Psychological influences. Studies supporting genetics as a biological influence have revealed that large numbers of parents of those with Attention Deficit Hyperactivity Disorder have exhibited symptoms of ADHD, too, during their childhood (Hockenberry 1158). In Harry’s case, there is a positive family history of ADHD because his male cousin on the father’s side has been recently diagnosed with ADHD. His mother also expressed that Harry’s dad, James, had similar symptoms when he was Harry’s age. “I am in no position to diagnose James, but I have known him since we were only in first grade, and what Harry is showing now is what he has shown when we were Harry’s age. Everybody told him he was a tornado, and he even got the nickname twister for being so hyperactive. Seeing Harry have all these manifestations was like seeing James transforming into a kid once again. James would also get scolded, and was just dismissed as immature and childish. The fruit really doesn’t fall far from the tree. How I deal with Harry now, however, is far different from how James was treated then, I now understand that this is more than what people might say a “chip on the shoulder or a personality defect, because it was more than that. It was a disorder and it was a diagnosis.”—Maureen’s comment when asked to shed light on James similar behavior when they were younger. An environmental factor that would hold true in Harry’s case was his forcep delivery. Studies also show that trauma sustained during labor and delivery could cause damage to the brain, and thus cause ADHD ( Pillitteri 832). As Maureen would narrate: “I really hard a hard time during the labor and delivery of Harry. My obstetrician told me that he was in fetal distress, that his head was very low in the birth canal. I was panicking already, despite all the pain I endured. I could have wanted a normal vaginal delivery but I was already too exhausted. The doctor brought up the possibility of using forceps and obtained my consent. I had a good look at the forceps and it looked like two bent spoons. I could never forget that sight. Conclusion Children with Attention Deficit Hyperactivity Disorder, such as Harry in the case discussed, has special considerations in caring for them. They may not be able to pass and achieve smoothly the developmental milestones expected in their age range, but their condition is not a vindication for them to be neglected, their capacities relegated because their hyperactivity, impulsiveness and inattentiveness are the ones given much emphasis. Children with ADHD need more parental supervision and this is exactly what Maureen, Harry’s mother, did in the case of his son. Parents of these children should ask help from counselors, nurses, or even psychologists who have an in depth education about this condition so that they may be able to educate the parents on how to handle their children. Finishing simple tasks may become a feat for them, but with constant reminders and simple instructions, these children can go and accomplish them. Knowing that if this condition is not addressed properly during the younger years, it can lead to more social and occupational impairment, parents should act now if they see the signs and symptoms. To use the analogy that if children with ADHD are like ticking time bombs, then parents should not wait for the bombs to explode and wreck havoc not only to the family, but more so on the self-esteem of the children. Works Cited Pillitteri, Adele. Child Health Nursing (5th ed.) Care of the Childbearing and Childrearing Family, 2007. Hockenberry, M. et. al .Abnormal Psychiatry. New York: McGraw-Hill, 2006. Read More