HOW TO CONDUCT AN ASSESSMENT INVOLVING SUBSTANCE ABUSE IN MIDDLE CHILDHOOD TO ADOLESCENCE EXAMPLE CASE STUDY

My Name: Susan Lancaster

Client Name: Michelle

Age Range: Middle Childhood to Adolescence

Description of Problem

Michelle was referred to me by a local agency due to being arrested for possession of heroin with intent to sell. While in custody, she was also drug tested and the results came back positive for heroin and marijuana, which added to her initial charges. Although, my client has not received any prior assistance for substance abuse, she is unwilling to enter a treatment program, even though it has been court mandated. She has also stated that she is not going to stop doing drugs and does not care what happens to her. My client then stated that she should just kill herself because it would be better than the life that she is living now.

With this in mind, one major problem that I would like to address in order to properly assist this client is how to reduce her current level of substance abuse. Two things that may be included in this process are the administration of a comprehensive substance abuse assessment test, along with possible implementation of a substance abuse treatment plan. A second major problem that I would like to address is how her social, biological, and psychosocial development may be negatively affecting her overall sense of self during two stages of growth. This is because she has stated that she does not care what happens to her and even threatened self-harm and/or suicide. However, in order to determine which specific treatment methods and overall plan may be required to suit her substance abuse and possible developmental needs, I would first need to acquire further information about her background history, cognitive development and current overall psychological state.

Background History

After meeting with Michelle for approximately 2 hours, she began feeling comfortable enough in my presents, to discuss some of the reasons that she may be experiencing a substance abuse problem. When I asked her why she was doing drugs, she stated that this began around the age of 11 (middle childhood) because she was exposed to marijuana within her home environment. According to Michelle, her parents were both regular users and there were many times when it was left on the kitchen table, or they would smoke it in front of her with their friends. At the time, she also tried to tell her parents that this was illegal and wrong but they said that her opinion didn’t matter because she was just a kid and to mind her own business.

According to my client, one day she had a friend spend the night, and they tried some of the marijuana that had been left on the kitchen table. Since, then she has become a regular smoker and believes that she is addicted to this drug. My client also stated that when she turned 12, she began hanging out with a new friend who sells heroin. According to her, this friend asked her to try this drug and also gave her some to sell. My client said that she wasn’t sure if she wanted to sell this drug and knew that it was wrong, but didn’t want to say no and lose her new friend. Michelle then stated that she also started having awful feelings about herself during this time because she didn’t feel like she was loved by her parents.

Since Michelle has experienced these issues during middle childhood, her cognitive, social, biological, and psychosocial development was also negatively affected. This may also be because according to Erikson’s psychosocial theory, “the combination of adult expectations and children’s drive toward mastery sets the stage for the psychological conflict of middle childhood, industry versus inferiority, which is resolved positively when children develop a sense of competence at useful skills and tasks” (Berk, 2009. p.330). This means that a child’s overall sense of self will develop in a positive manner, each time he or she successfully completes a useful skill and/or task. According to this theory, peer and adult social interactions during this stage, will also determine whether the child’s sense of self develops toward an industry or inferiority direction. This is because these social interactions affect specific aspects of the child’s individual development. These aspects are also as follows:

Self-Concept - children develop this mental impression of self, based on social comparisons that can include appearance, abilities and behaviors that others exhibit toward them. An example of how this may be affecting Michelle is due to her poor relationship with her parents. This is because if she doesn’t feel excepted or loved, it may have left her with feelings of (inferiority).

Pride In Accomplishment - This is when a child will gain a sense of inner pride because he or she successfully completed a task and/or possesses a certain skill. However, this sense of pride may be undeveloped or never gained, if the child can’t successfully complete a certain task or does not possess a specific skill. Michelle might not feel this sense of accomplishment (industry) because her parents may never praise her for skills that she does develop (inferiority).

Moral Responsibility - This is determined by how a child is able to develop and choose to practice the difference between right and wrong. Michelle may not have developed (industry) because her parents choose drugs even when she has asked them to stop. Therefore, she may not be able to comprehend the difference between right and wrong, so she has developed inferiority.

Cooperative Participation - This sense of accomplishment occurs when a child feels good about being involved and offers individual contributions in a social situation. Michelle has made it clear that she is unable to work and accomplish certain tasks with her parents. They don’t listen to her in order to initiate positive changes (industry) and just ignore her desire to help them improve the overall family environment. Therefore, she may feel a sense of inferiority due the lack of power that is needed to initiate a better family life.

Current State

I also asked my client if she is trying to deal with or reduce her level of substance abuse on her own and she stated that she is not, because the drugs are everywhere. She feels like when she is at home, there will always be marijuana available. Her parents have also recently stated that since she turned 13, they will allow her to smoke it whenever she wants to. They are also aware of the fact that she has been selling heroin but feel like they’re too overwhelmed with personal issues to really focus on her problems. Michelle then stated that she feels bad for causing legal issues but at the same time, the ongoing poor relationship with her parents has made her feel like drugs are her only mental release and that her friend who sells heroin, is the only person who really cares about her. She has also stated that she recently started thinking about suicide a lot because she doesn’t want to live this life, if she won’t have parents who love her.

After listening to everything that my client has said, I’m am convinced that she not only suffered from abnormal development during middle age but is starting to process skewed cognitive thinking that is associated with the start of adolescence as well. According to (Dahl. 2004), it is essential, “not only to deepen our understanding of specific neurobiological changes during adolescent development, but also to broaden our knowledge of how behavioral, familial, and social influence interact, in multifaceted ways, with the development of the biological systems of interest” (p. 2). While, (Walker., Stephens., Neighbors., Rodriguez & Roffman. 2011), believe that “this is time in which individuals are particularly likely to engage in health-risk behaviors, with marijuana being the most prevalent illicit drug used. Perceptions of others' use (i.e., norms) have previously been found to be related to increased marijuana use. Additionally, low refusal self-efficacy has been associated with increased marijuana consumption” (p. 727). Not only can these things occur during this stage but (Esposito-Smythers, Kahler, Spirito, Hunt & Monti. 2011), believe that “alcohol and other drug use disorders (AOD) and suicidal behavior commonly co-occur among adolescent clinical populations” (p.728).

With this in mind, I believe that my client is using drugs because her social, biological, and psychosocial development has prevented her from developing a normal level of cognitive thinking. Therefore, I am confident that her level of substance abuse may be reduced if her negative sense of self can be increased via a proper treatment plan.

Suggested Interventions

In order to successfully treat these factors, I would implement intervention methods that may initiate growth with Michelle’s overall social, biological, and psychosocial development. Therefore, the first thing that should be addressed is my client’s claims of possible child neglect and/or endangerment which also may be causing her drug use. I believe this because according to (Shelton & Van Den Bree. 2010), “children from homes characterized by poor family functioning are at increased risk of drug initiation and drug use" (Hawkins, Catalano, & Miller, 1992). Parent-to-child hostility and an absence of warmth are associated with increased cigarette and alcohol use (Brody & Forehand, 1993; Melby, Conger, Conger, & Lorenz, 1993; Shelton et al., 2008). Substance use is argued to offer a means of coping with poor family functioning, but may also reflect increased affiliation with peers (who may themselves experiment with and use substances) to gain social support and a sense of belonging (Brody & Forehand, 1993; Melby et al., 1993). Parent–child relationships that are nonsupportive or characterized by conflict can also undermine adolescents’ ability to regulate their behavior in a goal-oriented way, with self-regulation linked to levels of alcohol use.

In order to address this issue in a professional manner, I would have to follow any ethical codes that concern the welfare of a child. Therefore, since this child’s cognitive development may be affected due to a lack of adequate parental care I would make a referral to Child Protective Services. This way, my client’s home environment would be investigated by proper authorities. The second thing that I would do is offer treatment that may decrease my client’s feelings of inferiority which may have occurred during middle childhood. This could be accomplished by having her parents referred to classes, which may teach them better skills to increase Michelle’s overall sense of self. Some techniques that may develop a positive sense of self involve offering the child continuous encouragement, praise, warmth, and love. 

When researching Piaget’s cognitive development theory, he believed that there are also several cognitive changes that occur during adolescence. One specific change concerns how they think about the relation between self and others, which is called imaginary audience. During this time, adolescents start to believe that they are the focus of everyone’s attention and overall concern in life. As a result, they will also become extremely self-conscious. A second change during the adolescent stage of development is called personal fable. This is when they become convinced that others are continuously thinking and observing them. During this time of overgrown perspective thinking, adolescents will also develop an inflated opinion of themselves because they think they are uniquely special. It’s like the world can’t touch them kind of thinking. When adolescents experience imaginary audience and personal fable, it can also affect their overall problem solving strategies and predictions of consequences.

Since, my client has reached adolescence and therefore, may be experiencing imaginary audience and personal fable I would offer her personalized treatment for this via weekly therapy sessions. I could also accomplish this by teaching her that she can be who she really is because others are not completely focused and/or concentrated on her. It’s also okay to have acne or other things that may cause insecurity because we all go through this stage and have these feelings from time to time. I would also be sure to address any specific concerns that may cause her reduced levels of self-confidence and self-worth. If I was going to educate my client about personal fable, I would show her videos about teens that died from overdosing on drugs, like heroine. I’m also confident that over time, Michelle may begin to change her cognitive development because she would start to understand that this risky behavior has real-life negative consequences.

A third thing that I would do to help my client reduce her urge to use drugs is refer her to a teen based substance abuse treatment program. This way she would be able to recovery with peers who are experiencing the same issue, while also building a strong support system.

Conclusion

Michelle is a 13 year old female who was referred to me by a local agency after a recent drug arrest. She also tested positive for heroin and marijuana. Although, she hasn’t received any prior treatment for substance abuse, she is unwilling to enter a court mandated treatment program. My client has stated that she won’t stop doing drugs and has no concern about what may happen. She also stated that she would rather kill herself then live the life she has now.

Therefore, one main goal of treatment would be to implement a plan that may reduce her current level of substance abuse. While, a second major problem that I would address is how her social, biological, and psychosocial development may have caused issues with her heightened level of inferiority. This distorted way of thinking may have also begun in middle childhood due to negative home and parental factors. Some of these include drug use by parents and their refusal to work with her to improve the overall family setting. They seem to also lack the ability to offer regular love and respect, which is needed to build a healthy parent/child relationship.

Currently, my client is also exhibiting developmental issues that may be associated with the onset of adolescence, which include a negative sense of self, risky behavior and thoughts of suicide. Some of these symptoms may also be associated with an unhealthy home environment, and due to peer pressures to fit in with friends who abuse and sell drugs. Therefore, I would address all of these issues by contacting CPS to investigate her home environment, recommending parenting classes, offering weekly therapy sessions via my office and referring her to a teen based substance abuse treatment program. Once all of these things are implemented, I am confident that this may reduce my client’s current level of substance abuse, while also developing a more positive sense of self.

 References:

L.E. Berk. (2010). Development through the lifespan. Boston, Massachusetts. Allyn & Bacon.

Dahl, R.E. (2004). Adolescent brain development: A period of vulnerabilities and opportunities. Annals of New York Academy of Sciences, 1021, 1-22. Retrieved on June 15 2012 via the Kaplan Library.

Psychology of Addictive Behaviors: Social Norms and Self-Efficacy Among Heavy Using Adolescent Marijuana Smokers. Walker, Denise D., Neighbors, Clayton, Rodriguez, Lindsey M., Stephens, Robert S., Roffman, Roger A. (2011) Vol. 25, No. 4, 727–732. Retrieved on June 17 2012 via the Kaplan Library.

Journal of Consulting & Clinical Psychology: Treatment of Co-Occurring Substance Abuse and Suicidality Among Adolescents: A Randomized Trial. Esposito-Smythers, C., Kahler, W, C., Spirito, A., Hunt, J., Monti, P.  (2011). Vol. 79, No. 6, 728–739. Retrieved on June 17 2012 via the Kaplan Library. 

Journal of Research on Adolescence: The Moderating Effects of Pubertal Timing on the Longitudinal Associations Between Parent–Child Relationship Quality and Adolescent Substance Use. Shelton, H. K., Van Den Bree, B, M. (2010). Vol. 20 No. 4, 1044-1064. Retrieved on June 18 2012 via the Kaplan Library.  

HOW TO CONDUCT A NEUROPSYCHOLOGICAL ASSESSMENT (EXAMPLE CASE STUDY)

Name: Susan Lancaster

Client Name: Ben

Age Range: Adulthood

My current patient is a 70 year old African American male named Ben. He stopped exercising, watching his diet, and has gained 25 pounds after retiring. He also wears glasses for nearsightedness and has had a recent stroke. During his hospital stay, a PET scan was given and the results confirmed that he had a unilateral stroke which involved the left hemisphere and temporal-parietal, including part of Broca’s area. When the stroke occurred he was also not rendered unconscious but did experience post-stroke amnesia. Although, his amnesia seems to be improving, his physician still referred him to my office for a neuropsychological examination during his stay in the hospital.

Upon greeting Ben, he shook with his left hand and seemed to be experiencing an issue with movement of his right hand and arm. When trying to communicate with me, he also exhibited slow and slurred speech along with difficulty in forming articulated sentences. Since, this occurred, I gave him a brief assessment by asking him to identify and name certain objects around the office. The results indicated that he was having difficulty with word finding and naming of these objects. Therefore, I further tested him by using the Mini-Mental Status Exam or MMSE. He acquired 24 points out of 30 due to having issues with counting and spelling backward, recalling words from memory, identifying the correct date and day of the week, and when trying to draw the two intersecting figures.

I than spoke to his wife and she stated that Ben may be experiencing issues with hearing loss, unclear thinking, memory, and coordination because he is bumping in to things on his right side. She also requested to have his intellectual abilities assessed. Therefore, since Ben suffered from a left side stroke, he may experience a reduction in some functions which are required to successfully perform certain tasks. Since, this is the case the overall purpose of this work will be to first identify some tests that may be used to measure Ben’s current level of sensory perception, cognitive speed, constructional ability, verbal and spatial memory, verbal fluency, intelligence, achievement, personality, possible malingering, and daily functioning. Upon completion, I will then provide my recommendations for rehabilitation and a prognosis of his expected recovery.

TESTING & ASSESSMENT

Repeatable Battery for Assessment of Neuropsychological Status (RBANS) – Since, Ben was previously tested with the MMSE and certain deficits were measured, the RBANS could also be used to measure Ben’s current level of Fluid Intelligence, Crystallized Intelligence, and Memory. If there are deficits within these areas of functioning, it could also indicate Dementia. One other major benefit of using a screener is that it can identify specific tests that may be best for Ben’s individual needs.  Therefore, only certain tests that are provided in this work would be needed. 

Halstead-Reitan Battery (HRB) – This can be used to measure Ben’s visual, auditory, tactual input, verbal communication, spatial/sequential perception, analysis of information, formation of mental concepts, judgment, motor output, attention, concentration, and memory. The Halstead-Reitan is typically used to evaluate individuals with suspected brain damage and may also be a good way to acquire useful information which confirms that damage is due to a stroke, the location of that damage, and if it’s getting worse, getting better or staying the same. Therefore, one other major benefit of this test is that it can confirm which side of Ben’s body is affected by touch, sound, or visible movement. There are also eight tests that are included in this particular battery which are as follows:

1. Category Test – This test can be administered to study Ben’s current level of abstract reasoning by measuring functions that involve visual, auditory, tactual input, verbal communication, spatial and sequential perception, analysis of information, forming mental concepts, making judgment, motor output, attention, concentration, and memory. His score will be determined by the number of errors and specific cutoff values for age and education level.

2. Tactile Performance Test / Seguin-Goddard Formboard – This is a form board based test that could be used to evaluate Ben’s current level of sensory ability, motor functions, memory for shapes and spatial location, along with his brain's ability to transfer information between the right and left hemispheres. When using this test it can also confirm brain damage and which side of Ben’s brain it may have occurred on.

3. Speech Sounds Perception Test (SSPT) – This test involves 60 different nonsense syllables which are presented by a tape recording. One main thing that this could be used for is to measure Ben’s current level of focused attention. This could also provide information concerning the acuteness vs. chronicity of Ben’s specific brain damage.

4. Reitan-Indiana Aphasia Screening Test – Aphasia can be defined as a loss of ability to comprehend or use spoken or written language due to brain damage. The test involves a set of questions that most normally impaired individuals would be able to understand. The overall purpose of this test would be to measure any language-related difficulties, non-verbal tasks, and right/left confusion that Ben may be experiencing.

5. Reitan-Klove Sensory-Perceptual Examination – This test has auditory, tactile, and visual components. One specific component involves measuring the ability to specify which side of the body is affected by touch, sound, or visible movement. Therefore, it may confirm that Ben is unable to perceive stimulation on the right side of his body.

6. Rhythm Test / Seashore Rhythm Test – This is a nonverbal auditory perception test that could be used to measure Ben’s current level of attention and concentration when listening to patterns of sounds. This particular testing method is also extremely sensitive to brain dysfunction.

7. Trail Making Test / Trails A & B – This test can be administered to assess Ben’s current ability to hold several tasks in mind at the same time and overall level of cognitive speed. This is because it will measure Ben’s level of scanning and visuomotor tracking, cognitive flexibility and divided attention. The process would include two separate parts that are identified as A and B. Part A will require him to first draw lines that connect consecutively numbered circles on a work sheet and Part B will require him to connect the same number of these circles on a different worksheet, while alternating between the two sequences. He will also be advised to connect these circles as fast as he can without lifting his pencil from the worksheet. The scores will be based on his level of memory and the time that it takes to complete these tasks. The purpose of this test will be to determine if Ben’s level of working memory and cognitive speed have been affected.

8. Ancillary Test / WAIS-III – This is a revision to the WAIS-R and could be administered to study Ben’s current level of intelligence. Its main composite scores involve Verbal IQ, Performance IQ, Full Scale IQ Verbal Comprehension, Working Memory, Perceptual Organization, and Processing Speed.

Paced Auditory Serial Addition Test (PASAT) – This can also be used to assess Ben’s level of working memory, attention and cognitive speed but overall, it is very difficult. Therefore, I don’t believe that this is the best method for Ben because he may show invalid deficits, due to lack of comprehension for difficult tasks.

Tinkertoy Test – This can be used to measure Ben’s ability to complete planning, initiating, and structuring of behaviors. It is mostly used with patients that may have dysfunction due to neurodegenerative diseases and can also measure constructional ability. This is because it would be completed by asking Ben to construct whatever he wants with 50 Tinkertoys.

Rey Osterreith Complex Figure Test – This test would be completed by asking Ben to copy a complicated line drawing from memory. When using this test, it can identify whether he may be experiencing deficits with constructional ability, visuospatial abilities, memory, planning, attention and working memory. If he did show signs of difficulty when trying to use these functions in a normal manner, then it may also indicate the presents of Dementia.

California Verbal Learning Test (CVLT) – This could be used to assess Ben’s current level of verbal and spatial memory. It would be performed by first asking him to read a specific list aloud which contains sixteen common words, with each belonging to one of four categories. Once, this was completed I would then ask him to recall as many of these items as possible. I would then record this number and whether or not he was able to make adequate use of category information. One other major benefit of using this test is that if Ben was unable to make use of category information, then this may indicate Alzheimer’s Disease or if he made repetition errors, then this may indicate Parkinson's Disease.

Boston Naming Test – This could be used to measure the overall impact of Ben’s left-side stroke on his level of verbal fluency. It would be completed by asking him to identify a series of pictures that are included in 60 large ink drawings. One, major strength of this test is that it can measure Ben’s current level of visual-perceptual abilities and language production. However, one limitation is that it may measure varying results if used on patients from different cultures. 

FAS – This can be used to measure Ben’s current level of verbal fluency. It would be completed by having him recall and produce words for letters F, A and S within 60 seconds. If he experienced lower word production, then this is an indication that he may have left frontal lesions. One, major strength is that it can be used to quickly determine whether Ben needs to be referred to a pathologist or speech therapist for further testing and treatment. However, one limitation is that it cannot differentiate between depressed patients and those with dementia.

Wechsler Adult Intelligence Scale IV (WAIS-IV) – I could use this to measure Ben’s overall level of intelligence. When using this test, I would acquire measurements via four index scores that represent major components, along with two broad scores. These are as follows:

1. Full Scale IQ (FSIQ) – This is a score that will identify Ben’s total performance of VCI, PRI, WMI, and PSI.

2. General Ability Index (GAI) – This is the score of six subtests which are included in the VCI and PRI. There are also 10 subtests within each of the four components and five supplemental subtests that can be measured, if needed. The four components are as follows:

Verbal Comprehension Index (VCI)

This will measure Ben’s level of verbal comprehension and includes: Similarities (subtest) - abstract verbal reasoning, Vocabulary (subtest) - learned, comprehension and verbal expression, Information (subtest) - general information that is acquired from culture, and Comprehension (supplemental) - abstract social conventions, rules and expressions.

Perceptual Reasoning Index (PRI)

This will measure Ben’s level of perceptual reasoning and includes: Block Design (subtest) - spatial perception, problem solving, and visual abstract processing, Matrix Reasoning (subtest) - spatial/inductive reasoning, nonverbal abstract problem solving, Visual Puzzles (subtest) - spatial reasoning only, Picture Completion (supplemental) - how quickly one perceives visual details, and Figure Weights (supplemental) - analogical/quantitative reasoning.

Working Memory Index (WMI)

This will measure Ben’s level of working memory and includes: Digit Span (subtest) - mental control, concentration and attention, Arithmetic (subtest) - concentration when manipulating mathematical problems, and Letter-Number Sequencing (supplemental) - attention, mental control and concentration.

Processing Speed Index (PSI)

This will measure Ben’s level of processing speed and includes: Symbol Search (subtest) - visual perception, visual analysis and scanning speed, Coding (subtest) - visual/motor coordination, motor/mental speed, visual working memory, and Cancellation (supplemental) - visual and perceptual speed.

Wide Range Achievement Test 4 (WRAT4) – This is designed to assess patients that are between 5 and 94 years of age and it measures functions that are needed for things like proper communication, effective learning, thinking, reading, spelling words, and doing mathematical calculations. Therefore, I could use this test in combination with previous records and current interviews from collaterals to measure Ben’s overall level of achievement.

Minnesota Multiphasic Personality Inventory (MMPI) – This is a paper and pencil inventory that can be used to assess Ben for possible psychological and psychiatric symptoms associated with his overall personality. However, the MMPI is not perfect so a revised version can also be used which is called the MMPI-2. This contains 567 test items and new scales were added to measure further traits that may be associated with abnormal behavior. This test also establishes a higher degree of overall construct validity because the revision process was carried out while addressing and establishing evidence of both convergent and discriminant validation. Furthermore, when using this test, the L Scale (L) could measure malingering which may occur if Ben exaggerates or lies about his current condition due to certain motivational factors.

Test of Memory Malingering (TOMM) – This test could be used to measure unexpectedly poor performance, unexpectedly low effort and also identify malingering over true memory impairments. The test includes two learning trials along with one retention trial and can be administered by hand or via a computer. 

Wisconsin Card Sorting Test (WCST) – This can be used to measure Ben’s executive functions and according to (Lezak, Howieson & Loring. 2004), these are needed for “volition, planning, purposeful action, and checking” (p. 611). The process will include a number of stimulus cards that are different in design, quantity and color which will be presented to him. I will then decide whether he needs to match the cards based on color, quantity or design. He will then be given additional cards and will need to match each to one of the stimulus cards, while making separate piles of cards for each one. During this process, he will not be told how the cards are supposed to be matched, but will be told if he is right or wrong. Throughout this test, the matching rules will also change and he will receive scores based on things like how long it takes him to learn the new matching rules and other errors. The overall purpose of this test would be to measure Ben’s current level of abstract thinking, concept reasoning and formation.

STROOP Test – This can be used to assess Ben’s working memory and attention along with performance of response inhibition, response conflict, and/or selective attention. Since, these additional functions can be measured the scores will also identify his overall level of concentration effectiveness.

Rivermead Behavioral Memory Test (RBMT-E) – This test could be used to measure Ben’s current level of memory when it comes to completing everyday activities, such as remembering things. Two examples of this could be to determine if he can remember an upcoming appointment or where keys are located. One major benefit of this method is that it can also be used to monitor any changes that may occur with his condition over time.

RECOMMENDATIONS

     Regardless, of which test method/s may be used, I believe that Ben will show some type of cognitive deficit within certain areas of cognition. This is because if he is currently exhibiting symptoms that may be associated with sensory perception, cognitive speed, constructional ability, verbal and spatial memory, verbal fluency, intelligence, achievement, personality, and/or daily functioning. In general, it can also be difficult to offer rehabilitation for patients that experience cognitive deficits after a stroke. However, in some cases, the patient may re-gain some or most of this lost ability when treated with a combination of medication and rehabilitation. Therefore, if assessment scores determine that Ben has deficits with certain functions, the following recommendations would be made: 

1. I would refer Ben for therapy that can teach him ways to compensate for existing memory problems and prescribe a medication that is used for Alzheimer’s to try and increase his level.

2. I would ask his wife to make modifications to his home environment so it is easier to maneuver the area without crashing into things.

3. I would refer Ben for therapy that can increase his level of functioning within several areas.

4. I would refer Ben to a hearing specialist to determine his level of current hearing ability.

5. I would refer Ben to a dietitian so he can learn how to eat better and lose weight.

6. I would also advise Ben to consider joining a local exercise program to address his weight.

7. I would refer him to a physical therapist to address the loss of ability with his right side.

PROGNOSIS

     If it is confirmed that Ben is suffering from cognitive deficits due to a left sided stroke, it is difficult to predict what his long-term condition might be. However, since he was never rendered unconsciousness and was able to verbally speak and follow commands after the stroke, he may have a much easier time gaining back some or even all of the cognitive abilities that have been lost. However, one major disadvantage is that Ben may not recover completely due to his age. This is because when brain damage occurs, it can be easier to heal and recovery when the patient is younger and in excellent health. Therefore, I am not confident that Ben will fully recovery from the effects of his stroke. Although, if he follows all recommendations on a regular basis, and has a good support system among family members, health professionals, and school staff, his condition may improve at a substantial level.

SUMMARY

    This paper addressed a 70 year old African American male named Ben. He had stopped exercising, watching his diet, and gained 25 pounds after retiring. He also wears glasses for nearsightedness and had a recent stroke. During his hospital stay, a PET scan confirmed that he had a unilateral stroke which involved the left hemisphere and temporal-parietal, including part of Broca’s area. When the stroke occurred he was also not rendered unconscious but did experience post-stroke amnesia. Although, his amnesia has improved, his physician still referred him to my office for a neuropsychological examination during his stay in the hospital.

When greeting Ben, he shook with his left hand and experienced an issue with movement of his right hand and arm. When trying to communicate, he also exhibited slow and slurred speech along with difficulty in forming articulated sentences. I then gave him a brief assessment by asking him to identify and name certain objects around the office and he had difficulty with word finding and naming of objects. Therefore, I further tested him with the Mini-Mental Status Exam or MMSE. He acquired 24 points out of 30 due to having issues with counting backward, spelling backwards, recalling words from memory, identifying the correct date and day of the week, and when trying to draw the two intersecting figures. His wife also stated that Ben may be experiencing issues with hearing loss, unclear thinking, memory, and coordination because he is bumping in to things on his right side so she wanted his intellectual abilities assessed.

Therefore, in order to determine if Ben is experiencing a reduction in functions which are required to successfully perform certain tasks, I first identified certain tests that may be used to measure his current level of sensory perception, cognitive speed, constructional ability, verbal and spatial memory, verbal fluency, intelligence, achievement, personality, possible malingering, and daily functioning. Upon completion, I also provided recommendations for rehabilitation and an overall prognosis for Ben’s expected recovery.

Reference:

Lezak, M., Howieson, D., & Loring, D. (2004). Neuropsychological Assessment (4^th ed.).

Oxford: Oxford University Press.

ASSESSING TRANSFORMATIONAL LEADERSHIP

When considering a career path in leadership, it is important to determine what skills I may have in this area and which still need to be developed in order to reach my full potential as a leader. This is important because “if the leader exhibits a willingness to receive and use feedback, a willingness to change and adapt as new contingencies arise, and the ability to learn from both his/her successes and failures, then so will that leader's associates.” When associates are willing to learn by example and apply these aspects in their own work, there may also be an overall higher rate of success within an organization. Therefore, the overall purpose of this paper will be to discuss what area of leadership I would like to develop over the next two years, why this is important based on my career goals and how previous transformational literature may be used to meet these future goals (Bass & Avolio. 2003. p. 2).     

What Area of Leadership I Want to Develop Over the Next Two Years

            One specific leadership assessment test that can be taken to determine what skills may need to be further developed in order to become a more effective leader is called the Multifactor Leadership Questionnaire: Actual vs. Ought (MLQ A/O). This is because it “measures leadership styles which may be grouped under three broad categories. These categories differ in how well they provide positive outcomes for the organization. They also differ in the nature of their influence on followers and associates.” The three broad categories associated with the full range leadership model also include: transformational leadership, transactional leadership & passive/avoidant behavior (Bass & Avolio. 2003. p. 4).

After recently taking the MLQ A/O, I have determined that I do possess a certain amount of skills within all three categories of the full range leadership model. However, some of the scores that are associated with certain components of transformational leadership are lower than comparable “norms” so they will need to be further developed. The main area where below average scores are present is known as “Idealized Influence or (II)” and it includes two components. The first one is called “Idealized Attributes or (IA)” and I received a score of 2.3. This is important because it offers a transformational leader the ability to instill pride in others when they associated with me, disregard personal self-interests to ensure the good of a group, display a high sense of confidence and power, and increase the overall level of respect that I receive from others. The second component associated with “Idealized Influence or (II)” that will need to be developed is “Idealized Behaviors or (IB)” because I received a score of 2.8. This is important because it offers a transformational leader the ability to lead new possibilities in an exciting manner, always consider moral and ethical issues when decision making, specify how important it is to have a sense of purpose, and share personal beliefs and values. The reason that both of these scores are also considered lower than comparable “norms” and must be further developed is because the research validated benchmark has determined that the ideal frequency for these transformational leadership behaviors is 3.0 or higher (Bass & Avolio. 2003).

Why This Area of Leadership is Important Based on my Own Career Goals

Further development of the above components is also extremely important to consider because I plan to pursue a future career as a transformational leader. If all four areas of transformational leadership behavior which include: Idealized Influence (II), Inspirational Motivation (IM), Intellectual Stimulation (IS), and Individualized Consideration (IC) are not at the appropriate frequency of use, then I may never reach and/or exhibit my true potential as an effective leader within that area. If this occurs, it could also mean that I won’t be successful in accomplishing other tasks associated with transformational leadership which include: the ability to stimulate, inspire, and empower others to accomplish great achievements, increase employee morale, be an inspirational role model, get workers to take ownership for their work, and utilize individual strengths and weaknesses in order to assign tasks based on skill-set (Hickman. 2009).

How Transformational Literature May be Used to Meet My Goal

Even if these below average scores are present, there are things that can be done to further develop these skills in order to meet my future career goal. The first step is to review the results of MLQ A/O in an open-minded, positive and optimistic manner. This is because it may initiate a higher level of overall willingness to improve these below average areas. Secondly, I can ask myself probing questions that identify why I exhibit weakness in these areas. Furthermore, the third thing that I can do is devise a plan for future development that covers all areas and/or components of effective leadership behavior. The reason for this is because it will give me an opportunity to not only strengthen my weaker areas but also those that I currently possess (Bass & Avolio. 2003).

Some things that can be included in this long-term plan will be to increase the sense of pride that is instilled in others when they are associated with me, share more of my personal values and beliefs, teach people how important it is to have a strong sense of purpose, spend more time teaching and coaching others, try and get people to look at things from an alternate angle when it may be beneficial in problem solving, and seek many different opinions before making critical decisions. I am also confident that if this plan is regularly followed over the next two years that my effective leadership skills will improve (Bass & Avolio. 2003).

Conclusion

When considering a career path in leadership, it is crucial to develop one’s skills in this area to the highest potential possible. This is because when leaders improve certain aspects of their leadership style, workers may naturally change for the better as well. When this occurs, the overall success rate of a leader, the workers and organization can also increase drastically.

In order to improve and/or develop leadership skills that can initiate these changes, it is also possible to take a leadership assessment test like the MLQ A/O. This is because it used to measure the strengths and weaknesses that are associated with present leadership skills and can offer a guide to what areas need improvement. Therefore, the overall purpose of this paper was to analyze my particular assessment results, discuss what area of leadership I want to develop over the next two years, why this is important based on my career goals and how transformational literature can be applied to meets these future goals.    

References:

Bass, M. B., & Avolio, J. B. (2003). Multifactor leadership questionnaire: Actual vs ought feedback report. Published by Mind Garden, Inc. Retrieved via the World Wide Web at http://transform.mindgarden.com/reports/raw/id/16/evid/102220

Hickman, G. R., Ed. (2009). Leading organizations: Perspectives for a new era (2nd ed.). Thousand Oaks, CA: Sage Publications.

THE NATURE OF EFFECTIVE EXECUTIVE LEADERSHIP

             

             In today’s society, there are many instances when effective leadership will be required. This can be accomplished when a specific leader creates conditions that help a group effectively accomplish a specific set of goals and/or objectives. Ensuring effective leadership is important because it can propel and advance most areas within a business or organizational structure. In order to be an effective leader, some major types of behavior that may also be exhibited can include task-oriented behaviors, relation-oriented behaviors, and change-oriented behaviors.

             With this in mind, the main goal of this work will be to analyze effective leadership behavior, after reviewing two specific case studies called “Air Force Supply Squadron” and “Consolidated Products.” This analysis will also be based on the effective leadership behaviors that were exhibited by Colonel Navak in the first case, what that illustrates about effective leadership, and a comparison of the leadership behavior that was presented in both cases. 

Effective Leadership Behaviors That Were Exhibited by Colonel Navak

             After reviewing the case study called “Air Force Supply Squadron” which involved Colonel Navak, there were multiple effective leadership behaviors that were used to improve the overall efficiency of his squadron. The first one was task-oriented behaviors. This is because he organized work activities according to skillset, clarified the expectations of his men, explained the priority of different tasks, set specific goals and standards, explained policies, rules and procedures, monitored the operation and performance and tried to resolve all issues as they arose.

             The second effective leadership behavior that was used is relations-oriented behaviors. This is because he provided support and encouragement, expressed confidence in his men, socialized in a positive manner to build better relationships, recognized accomplishments, provided coaching and mentoring, empowered his men, kept people informed, helped resolved conflicts in a constructive way, and encouraged a higher level of mutual trust and cooperation. While, a third effective leadership behavior that was exhibited is change-oriented behaviors. This was accomplished by monitoring the external environment to detect any threats or opportunities, interpreting events to explain the need for change, encouraging his squadron to view problems and opportunities in a positive way, developing new strategies based on core competencies, encouraging and facilitating collective learning, making changes according to a new vision or strategy, encouraging and facilitating efforts toward major change and keeping his men informed about any progress that was made.

What This Case Illustrates About Effective Leadership

             Once these behaviors were used by Colonel Navak over a period of time, his men [began to see themselves as an essential part of a well-run organization. They began to take pride in their ability to accomplish their mission despite the hardships. Morale and teamwork improved. Before long the squadron became one of the most efficient in Korea] (Yukl. 2013. p. 75).

             Since, this occurred it illustrates and supports the idea that when certain leadership behaviors are used, it can improve overall behavior and efficiency among those in a specified group or setting. I also believe that Colonel Navak may have been considered to be a transformational leader. This is because according to (Robbins & Judge. 2010), transformational leaders are those who “inspire followers to transcend their own self-interests and who are capable of having a profound and extraordinary effect on followers” (p. 309). Furthermore, Colonel Navak’s efforts may also coincide with the Fiedler Contingency Theory. This is because it supports the idea that a leader’s style should be matched with the overall position being undertaken and based on how much control he would have over employees.

Comparing Leadership Behavior That Was Presented in Both Cases

             After reviewing the “Air Force Supply Squadron” and “Consolidated Products” case studies, there were several comparisons associated with leadership behavior. This is because the “Consolidated Products” case study involved a plant manager named Ben Samuels who also initially used task-oriented behaviors, relation-oriented behaviors, and change-oriented behaviors to improve overall efficiency among his employees. Some of these behaviors included building a fitness center for employees, sponsoring yearly picnics and holiday parties for them, avoiding layoffs, getting to know employees by name, visiting and speaking to workers on the floor in a friendly manner, and helping each employee whenever a problem would arise. The reason that he did this is because he believed that if employees are treated with respect and support, they will perform at a higher overall level.

             Even though these positive employer/employee behaviors were exhibited, issues with cost and low production levels became a major issue, so Ben Samuels was replaced by a man named Phil Jones. When this occurred, Phil also exhibited certain leadership behavior associated with task-oriented behaviors. This is because he clarified what was expected, monitored operations and performance, resolved immediate problems that disrupted work, organized tasks to improve efficiency, and explained rules, procedures and policies on a continuous basis. However, he exhibited an extremely low level of leadership behavior that is associated with relations-oriented behaviors and change-oriented behaviors. The result of his leadership skill was a reduction in production cost, an increase in production output, a high turnover rate among supervisors and machine operators, and more negative employee talk about forming a union.

Conclusion

            There are many times when effective leadership will be required to accomplish a specific set of goals and/or objectives. Ensuring effective leadership is important because it can propel and advance most areas within a business or organizational structure. Some major types of behavior that must be present in order to be an effective leader can include task-oriented behaviors, relation-oriented behaviors, and change-oriented behaviors.

             Therefore, the main goal of this work was to analyze effective leadership behavior, after reviewing two specific case studies called “Consolidated Products” and “Air Force Supply Squadron.” This analysis was also based on the effective leadership behaviors that were exhibited by Colonel Navak in the first case, what that illustrates about effective leadership, and a comparison of the leadership behavior that was presented in both cases. The analysis indicated that even though major types of effective leadership behavior may be used there can still be different results due to a variation in individual leader styles.  

References:

Robbins, S. P., & Judge, T. A. (2010). Essentials of Organizational Behavior (11th Edition). Upper Saddle River, NJ:  Prentice-Hall.

Yukl, G. (2013). Leadership in organizations (8^th ed.). Upper Saddle River, NJ: Prentice Hall.