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Difficult Client Case Study: Mary

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Case Study: Mary

Mary is a 10-year-old fifth grader. She is participating in a behavior management school-based group on a referral by her teacher. Mary's teacher described her as very bright, but very disruptive. According to Mary's teacher, Mary often provoked other students in the classroom by calling names, touching and pushing, and trying to distract.

In the group, Mary was very quiet for the first two sessions, but has now begun using some of the same diversionary tactics she shows in class. She talks to other members of the group out of turn, pokes the members sitting closest to her, and laughs out loud at inappropriate times.

When you talk to Mary individually after the session, she shows remorse for her behavior and claims she is "just nervous" and "doesn't really know what to say" during the session. She agrees to focus more during group time and expresses a desire to stay in the group. During the next session, however, Mary soon starts fidgeting and whispering to other members.

Discuss the interventions that you might use if you were the group leader in the case study.

Discuss the rationale for your interventions.

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The following posting helps discuss inventions based on a case study about behavior management in the classroom.

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(1) Discuss the interventions that you might use if you were the group leader in the case study.

Mary appears to be experiencing symptoms of hyperactivity and impulsivity that causes impairment of development in children. Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR [APA], 2000) criteria, behaviors that do not meet the criteria for Oppositional Defiant Disorder (ODD) or Conduct disorder (CD) fits in the category of Disruptive Behavior Disorder Not otherwise Specified (p. 103). The diagnostic criteria consist of clinical presentations, but do not meet full criteria for ODD or DD, but there are clinical significant symptoms. Given that Mary is participating in a behavior management group on a referral from her teacher suggests some behavioral disorder. However, there is not enough information in this case study to make a clinical diagnosis of the hyperactive type such as Attention Deficit Hyperactivity Disorder (ADHD), it is clear that some developmental impairment exists. Based on DSM-IV-TR features, she may present with characterizations of ODD, CD, or ADHD, but does not meet the full criteria for these disorders. The lives of children ...

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