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Separation anxiety

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Six-year-old Emily has been referred to you by a Pediatric Psychologist. According to Emily's parents, Emily has been experiencing a great deal of separation anxiety after recently starting first grade. She has expressed to her parents that she does not want to go to school, because it "isn't fun anymore." What started out as initial reluctance to go to school has now escalated into screaming tantrums, during which Emily cries and bangs her head and fists on the floor.

Her parents have been very concerned about these outbursts and initially let her stay home from school while they tried to figure out what was bothering her. A meeting with Emily's teacher revealed that she often appeared withdrawn and didn't readily participate in the classroom activities. Despite this, Emily did appear to be at grade level in basic academic skills.

At the same time that the tantrums started occurring, Emily also began to refuse to sleep in her own bed; she would only fall asleep if she was in her parents' bed. Sometimes, Emily's parents would wait until she fell asleep and then carry her back to her own room. However, Emily often would wake up and then cry and scream and wake the entire family. Both parents feel tired and frustrated and have now resigned themselves to allowing Emily to sleep in their room. Emily's family is now turning to you for help with a behavior modification program.

1. Briefly recap the case, discussing your observations and clearly identifying a research question.

2. What are the target behavior(s) and why is it important to address this behavior?

3. Which inadvertent reinforcement strategy may have contributed to Emily's school refusal?

4. Formulate a hypothesis regarding what intervention will result in a specific level and direction of desired change in the target behavior.

5. Choose an effective modification program to test the hypothesis for your hypothetical experiment (e.g. such as a token economy, lottery, or positive reinforcement) and discuss how you would implement your program and the rationale for your choice, based upon current scientific literature.

6. How will the proposed behavior plan be monitored and outcomes analyzed?

7. What do you think are the anticipated results? What may be potential issues of response maintenance, response transfer and/or extinction?

8. How has the scientific method guided this experiment?

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This solution discusses a specific case study of Separation Anxiety

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1. Six-year old Emily is experiencing separation anxiety. She is having problems at school, and does not find school to be fun anymore. What began as a refusal to go to school has now turned into a behavioral problem with Emily throwing tantrums. A visit that involved Emily's parents and teachers focused on her withdrawal, and the fact that she does not participate in classroom activities. However, it was noted that she is at grade level in basic academic skills. However, Emily is refusing to sleep in her own bed, and wakes up during the night crying and screaming. Her behavior has led to the frustration of her parents who has given in to her demands and allowed her to sleep in their room. The research question to be explored: Is Separation Anxiety Disorder related to externalizing behaviors associated with attachment figures?

2. Based on the Diagnostic and Statistical Manual of Mental Disorders, Separation Anxiety Disorder is excessive anxiety concerning separation from the home or from those to whom the person is attached (Criterion A). As described in the DSM-IV-TR, "Individuals with the disorder may experience recurrent distress on separation from home or major attachment figures" (p.121). On this basis, the target behavior in the case of Emily includes: (a) social withdrawal, (b) the difficulty with sleeping alone, (c) refusal to go to school, (d) academic difficulties, and (e) social avoidance.

It is important for Emily's target behaviors to be defined clearly, so that they can be clear, specific and observed. Based on the DSM-IV-TR's criteria, the manifestations of the disorder vary with factors such as age, gender and culture. The symptoms could lead to depressed mood, and other more serious disorders such as Agoraphobia, comorbidity with other anxiety disorders. More recent studies have linked attachment styles to clinical disorders. Ling & Qian (2010) found links between attachment in childhood and specific disorders. In addition, the disorder may ultimately limit the person's ability to handle changes in circumstances [e.g., moving, getting married, etc] (p. 123). The basic idea underlying his theory is that children need a loving mother or mother substitute to develop into emotionally healthy adults, and that separation experiences (even minor ones) at an early age may jeopardize this development (van der Horst, and van der Veer, 2010).

3. The parents may have inadvertently reinforced Emily's behavior by allowing her to stay home from school. In addition, it ...

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