Mr. and Mrs. Lawson brought their 4-year-old adopted daughter, Clara, to see Dr. Mason, a psychiatrist. Clara was polite in greeting Dr. Mason, but did not smile and kept her gaze down as she took a seat. Mr. and Mrs. Lawson sat next to Clara and began explaining their concerns. They described Clara as a quiet child who has recently begun throwing temper tantrums, during which she is inconsolable. Her sleep and eating patterns have changed, and she no longer wants to go to preschool.
1. What other information should I learn during the interview with the family? What are some other questions I should ask?
3. Although I need more information to begin treatment, what factors might I take into consideration in designing an effective intervention for this family?
4. When I am preparing to diagnose Clara, what type of information would go into each axis of the DSM-IV classification system? I am not asked to enter a diagnosis, only describe the kind of information that would be entered in each axis.
5. Do you think that diagnosing Clara would be beneficial or harmful? Explain why.
These very short case descriptions are always problematic because of how much we don't know about the individual. With that in mind, let's look at the questions.
1) First of all, I would want to know if any unusual event has happened in Clara's life recently. Has there been a change in the family setting (parent returning to work, new baby, conflict between parents, etc)? Has Clara had any problems at school that they know of, such as trouble with another student or a teacher? What kind of changes have occurred in her eating and sleeping patterns? Have the parents made any changes in their discipline or other interactions with Clara? I would also like to know exactly what is going on immediately before Clara has a tantrum; in other words, the antecedent. Is Clara tantruming because she is trying to avoid something she doesn't want to do, or to get something she wants, or to receive attention from her parents? What do the parents do during the tantrum (do they try to comfort Clara, or send her to her room, or ignore her)?
Another issue with Clara is her adoption. If Clara was adopted as a newborn, this is a much different situation than if she has been adopted only recently after being removed from a neglectful or abusive situation. Information about when and how Clara was adopted would be important, along with information about the birth parents if it is available (often it is not). If the birth parents had a history of mental illness, or ...
Explains the possible diagnoses suggested by the short case study of an adopted 4-year-old child with behavioral and emotional changes. Also explains the DSV-IV axes and what type of information is included under each axis. This solution is approximately 1000 words.