Case History
“Raul is 14 years old. His younger brother, Jose, is 13. They were
raised together by their parents. The two boys, along with their younger
sister, Maria, age 8, were recently removed from their parents’ custody by
Arizona Child Protective Services.
The two boys have experienced regular physical and verbal abuse by
their father, Alberto Lopez. Mr. and
Mrs. Lopez are illegal immigrants from Mexico. They are both migrant workers in the Western USA, moving continuously
throughout California, Oregon, Arizona, Idaho, and Colorado to follow the
availability of seasonal farm work. The
children have not attended school regularly due to the family’s mobility, and
Raul has often been left in charge of the younger two children when the Lopez’s
have been working long days, sometimes seven days a week during picking season.
The family has had two encounters in the past year with INS, but has
escaped by fleeing and hiding. They live in fear of deportation and/or arrest.
Mr. and Mrs. Lopez do their best to feed and clothe their children while also
sending money home to family members in need in Mexico. Money is very tight, and resources are
limited.
Mr. Lopez had bouts of drinking before he and his family slipped over
the US border three years ago. But since
that time, due to the stresses of migrant life, he has abused alcohol
regularly. He will drink whatever he can
afford or obtain free of charge. Mr.
Lopez often becomes violent when he is drunk. He routinely loses patience with his children, demeans them verbally,
blames them for his stresses, and beats them with his hands or belt.
He also batters his wife when he is
drunk. He breaks objects and/or throws
them at his family. The children have
all suffered bruises, contusions, and occasional broken bones, for which
medical care has not been available. When
Mr. Lopez is sober, he hates himself for how he is treating his family, and he
sees a priest whenever he can to confess his behaviors and start again. The
family often attends Catholic Church services in their native language, run by
Catholic missionaries.
The three children came to the attention of CPS because of Raul’s
behavior. Raul was caught setting fire
to a German Shepherd who was outside in the backyard of family in a nearby
town. The family was away for the
day. Raul had smashed a window and
entered the house, and stolen jewelry and coca cola. He ran from the police
when they arrived at the house. When
interviewed, he was defiant and denied any wrongdoing.
Others in the community report that Raul has
been involved in fights with their children, and that he is often seen verbally
taunting other kids. The police picked
up Raul, along with his younger brother and sister, who were apparently
horrified at what Raul had been doing to the dog. Jose and Maria were trying to
save the dog.
While left in charge of his younger siblings, Raul has been verbally
and physically abusive to them, “to keep the discipline”, he says. He is worried about his younger brother,
Jose, because he believes that Jose “acts like a little girl.” Jose appears nervous and shy. He speaks in a
barely audible voice. He has problems getting out of bed in the morning,
daydreams most of the day, bites his nails continuously, wets the bed at night,
cries a lot, does not seem to have any interest in sports or physical
activities, and does not connect well with other children.
When interviewed by
CPS, Jose seemed to blame himself for how his father is acting, believing that
he is the main cause of the family’s stress. Jose did seem very bonded to his younger sister, Maria, however, and
seemed to view himself as her protector” (American
Academy of Child and Adolescent Psychiatry. 2004).
Diagnoses For Raul:
After reviewing all details of this case and AXIS I diagnoses
which are listed in the DSM-IV-TR, I believe that Raul may be experiencing:
·
Attention-Deficit and
Disruptive Behavior Disorders: Conduct
Disorder (312.8)
Adjustment Disorders (with): Disturbance of Conduct
(309.3)
·
Child or Adolescent
Antisocial Behavior (V71.02)
·
Phase of Life Problem
(V62.89)
According to (Facts for Families. 2004), “conduct disorder
refers to a group of behavioral and emotional problems in youngsters. Children
and adolescents with this disorder have great difficulty following rules and
behaving in a socially acceptable way” (p. 1). Since, these children suffer from certain behavioral disorders
that cause lack of control they may also experience several social problems in
a normal setting if the disorder is left untreated. Some of these problems can
include bullying and intimidating others, initiating physical altercations,
forcing sexual activity, and using weapons to harm people and/or animals.
In a “normal” society, children who suffer from conduct disorder may also be viewed
as bad or delinquent instead of being evaluated by a mental health
professional. If this lack of adequate support and treatment continues with
Raul, then he may also experience oppositional defiant disorder as he gets
older. This may be especially true in his case because he might eventually
begin to defy the “authoritative” abuse that is occurring at the hands of his
father. Therefore, treatment of his suspected diagnoses must be addressed as soon as possible.
Diagnoses For Jose:
After reviewing all details of this case and AXIS 1 diagnoses
which are listed in the DSM-IV-TR, I also believe that Jose may be experiencing:
Adjustment Disorders (with): Mixed Disturbance of
Emotions and Conduct (309.4)
·
Child or Adolescent
Antisocial Behavior (V71.02)
·
Age-Related Cognitive
Decline (780.9)
·
Phase of Life Problem
(V62.89)
Adjustment disorder with mixed
disturbance of emotions and conduct usually occurs due to a stressful life
event and may cause negative behavioral changes and a lack of emotional
stability. This disorder normally affects children who are under the age of 18 and
symptoms may include anxiety, sadness and/or a disruption of normal routine. When
this disorder is present, it may be possible to affectively overcome these
symptoms with the right support. Therefore, a suitable treatment plan will need to be implemented
to address this possible disorder. If this occurs, it is also possible that
many of Jose’s other disorders and/or conditions will improve or be reduced
over time.
Recommendations For Treatment
After evaluating this case, I also believe that these boys may be
experiencing different disorders and/or other conditions for several reasons.
However, the main factor could be due to a difference in cognitive processing
of incoming environmental stimuli. This is because most individuals have the
ability to process symptoms of trauma like fear, anger, helplessness and
sadness on different levels. This may also be individually determined based on
what coping mechanisms are most needed to successfully support psychological
and/or physical survival. Regardless, of varying symptoms, there are several
strategies which can be used with both Raul and Jose to address these
individual disorders and/or other conditions. These include:
1. Early Intervention –
This is a key factor in order to offer the best possible support and treatment
before behavior/s get worse.
2. Comprehensive
Evaluation – This will help determine whether Raul and Jose may be suffering
from other existing disorders like (PTSD) due to years of physical and psychological abuse. If this
is the case, then that could also be what initially contributed to the onset of
their current disorders and/or other conditions.
3. Treatment Plan – A trained
professional can devise an individualized plan for Raul and Jose by gathering
information and support from teachers, family members, and any pertinent
medical staff that may exist. This plan may also include behavioral therapy and
psychotherapy which can help both boys control these maladaptive behaviors and
better adjust within their psychological and physical environments. However, in
this case, I don’t believe that these treatment plans will be successful unless
the parents take an active approach by obtaining suitable treatment for their
issues as well.
4. Medication – This can be prescribed
to Raul and Jose, because they are exhibiting issues with specific behavior/s
that may be directly related to their individual disorders.
References:
American
Academy of Child and Adolescent Psychiatry: Facts for Families/Conduct Disorder
2004. Retrieved on September 19 2012 via the World Wide Web at http://www.aacap.org/galleries/FactsForFamilies/33_conduct_disorder.pdf
BehaveNet: APA Diagnostic
Classification DSM-IV-TR. Copyright (2000). American
Psychiatric Association. Retrieved on December 20 2012 via the World Wide Web at http://behavenet.com/apa-diagnostic-classification-dsm-iv-tr
