2 EXAMPLES OF A POWERPOINT PRESENTATION FOR PROGRAM DESIGN & EVALUATION PROCESS

ASSESSING THE CASE OF SOPHIE & NATHAN FROM SOPHIE'S CHOICE. A FURTHER LOOK AT DOMESTIC VIOLENCE, SUBSTANCE ABUSE, POST TRAUMATIC STRESS DISORDER & SCHIZOPHRENIA

   

Recently, I watched a movie called “Sophie’s Choice.” Two of the main characters are named Sophie and Nathan who live at a boarding house in Brooklyn NY. Throughout the movie, these characters exhibit several different behaviors that may be due to individual mental illness. These behaviors also negatively affect how Sophie and Nathan interact within their personal relationship and socially with others. Therefore, the overall purpose of this work is to write a case evaluation that first diagnosis which mental disorder each character may have. I will then provide all pertinent findings, treatment recommendations and any ethical considerations that might apply during their overall assessment and treatment plans.

Case Name: Sophie Zawistowska

Background Information

Sophie is a polish catholic and survivor of the Holocaust. During her time there she was also forced to give up her daughter to be exterminated and her son was sent away never to be seen again. She doesn’t have a college level education but is bilingual and possesses a high level of overall writing and secretarial skills. These were acquired after working for her father translating documents during the Second World War. She is currently unemployed with no source of income so she relies on her boyfriend Nathan for financial support. She also believes that he saved her life because she was extremely ill after being released from the concentration camp and he provided her treatment. Sophie also has scars on her wrists from an attempted suicide but she did not disclose whether she received any psychological help to address the issues that may have caused this behavior. 

Behavioral Observations

Sophie is an extremely intelligent woman who always wears nice dresses and is well groomed. She interacts well with others but has a slight issue trying to fully understand the English language and which words should be used. Her mood is normally pleasant unless she experiences a psychological and/or physical altercation with her boyfriend Nathan or discusses certain remnants of her past. During these times she exhibits emotional behavior that is associated with being a battered woman or guilt and anxiety from certain choices that she made in her past. 

Diagnoses

309.81 Posttraumatic Stress Disorder (Chronic Type)

Other Conditions That May Be a Focus of Clinical Attention:

Physical Abuse of Adult (V61.1)

Findings

After considering Sophie’s background information and current behavior, I would diagnose her with Post Traumatic Stress Disorder (PTSD). The main reason for this diagnosis is because according to (DSM-IV-TR. 1995-2013), “when an individual who has been exposed to a traumatic event develops anxiety symptoms, reexperiencing of the event, and avoidance of stimuli related to the event lasting more than four weeks, they may be suffering from this particular Anxiety Disorder.” Research has also shown that most people who suffer with this disorder may have also experienced abandonment and/or severe neglect as children. 

In Sophie’s case, she was exposed to traumatic events that were threatening to the lives of her and her children. This included having to sacrifice the life of her only daughter to save her only son which caused intense feelings of fear, helplessness, and horror at the time of occurrence. Since, this increased level of trauma occurred I suspect that Sophie has continuously recalled the events through cognition of distressing mental images, perceptions or thoughts. However, since these may cause her great psychological distress, she chooses to use total avoidance of the events as a major coping mechanism. This includes continuously making a conscious effort to avoid all feelings, thoughts, or conversations associated with the events.

Since, Sophie lives her life trying to avoid these haunting aspects from her past, it has also caused a feeling of being detached or estranged from many others. One example of this is when she thinks about the "choice" that she made as a mother and it makes her believe that she has less worth than all other mothers. She also exhibits a slight restricted range of affect and high sense of a foreshortened future. Some examples of this are when she always tells Nathan that she is going to die and when telling Stingo that she’ll probably never be able to love him, live a normal life in Virginia or be a good mother for his children.

She also changes the room around at night because she can’t sleep and seems to exhibit an exaggerated startle response during certain physical situations with Nathan. I believe that she is exhibiting these behaviors because she doesn’t want to have nightmares that are associated with her past trauma or experience further physical abuse at the hands of her loving partner. Since, these issues have occurred for several years Sophie also exhibits significant levels of distress or impairment in other areas of functioning. Therefore, she has also become majorly dependent on Nathan to meet her social, economic, psychological and physical needs.

Furthermore, I also believe that Sophie has been a repeated victim of physical abuse during the course of her relationship with Nathan. This occurs because when he experiences certain symptoms associated with his mental illness while abusing substances, he becomes physically violent and aggressive toward her. There are also repeated scenes in the movie when she is crying and tries to conceal visible bruises that he has left on her body. Although, she says that his abusive behavior is okay and allows it to continue due to her extreme level of overall dependency on him.

Treatment Recommendations

When reviewing Sophie’s case, there are some major issues that would need to be addressed. The first one is her psychological need to use avoidance to deal with her past. This is a major issue because it’s preventing her from dealing with feelings of guilt and shame in an appropriate and healthy manner. I would also treat this issue by using one-on-one talk and exposure therapy. This way, she would be able to verbally expose issues from her past in a safe environment and learn coping skills that can be used to manage her overwhelming level of guilt and shame. 

Furthermore, I would also prescribe a selective serotonin reuptake inhibitor to reduce the intensity of these negative feelings. This is because according to (Jaffe & Schub. 2012), “selective serotonin reuptake inhibitors (SSRIs) are the first-line medications used to treat PTSD and are the only medications approved by the U.S. Food and Drug Administration (FDA) for treatment of PTSD.” Finally, I would refer Sophie to an agency that helps women who are victims of domestic violence. This is because she may be able to receive beneficial services like further counseling, a safer place to live and group therapy with other victims.  

Prognosis

When reviewing all of the details of Sophie’s case, I don’t believe that she would do well in treatment and that her overall prognosis is less than fair. This is because if she continues to live in her current environment, further abuse from Nathan will most likely occur and she won’t have the positive support system that is needed to fully recover from her severe level of long-term PTSD. Having a positive support system and acquiring treatment are also major requirements for people who develop this disorder after experiencing trauma because it can reduce symptoms and initiate a faster recovery time. However, up to this point she has only received positive support from their mutual friend Stingo who knows little about PTSD. 

I am also confident that she will never acquire the motivation that is needed to end her relationship with Nathan due to her growing dependency and skewed belief that he is her savior. Therefore, her feelings of guilt and shame will probably get worse and she may also begin to experience issues like low self-esteem and worthlessness due to ongoing occurrences of severe psychological and physical abuse.

Ethical/Legal Considerations

When conducting an assessment and treatment plan for Sophie, I will also need to address any ethical concerns that may apply. This is because following ethical standards will help ensure that her rights are protected throughout the overall process. Four specific ethical codes that may also apply to her individual case include:

1. Informed Consent – According to this standard, professionals must inform participants of all features which might affect his or her willingness to participate. This is important because clients will be informed about the overall purpose and it gives them an option to participate or withdraw. I will also implement this by having Sophie sign a written document that identifies the overall content and purpose of the assessment and treatment plan.   

2. Debriefing – This states that all professionals should debrief each client before, during and after the process. This is important because it can ensure that clients are aware of all beginning, ongoing, and final results that may be obtained. This can also allow the opportunity to address any misconceptions that clients may have during the overall process. I could also implement this by ensuring that Sophie was kept informed about all important findings.

3. Protection From Harm – This means that I will need to get permission from Sophie prior to treatment and if any aspects of treatment may be harmful to her I will avoid using them.

4. Confidentiality – This standard protects the rights of clients by mandating that personal information can only be released under specific circumstances. Following this law is important because it can ensure that no harm occurs to the client due to personal information being released in a malicious or damaging manner to third party members. However, according to (BACB Guidelines For Responsible Conduct), a behavior analyst can “disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose, such as (1) to provide needed professional services to the individual or organizational client, (2) to obtain appropriate professional consultations, (3) to protect the client or others from harm, or (4) to obtain payment for services, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose” (p.4). Since, this is the case I may be required to report some of Sophie’s personal information to specific third parties that can further assist her. This is because she is a victim of domestic violence which is a crime and she may also be a danger to herself due to an unstable psychological state and/or mental disorder.

Client Name: Nathan

Background Information

Nathan is 29 years of age and from a Jewish descent. He currently lives in Brooklyn with his girlfriend Sophie and states that he is a biologist but his brother says that he actually works at a library. He claims that he graduated from Harvard University but his brother dispels that lie as well by saying that Nathan has no college education and is regularly abusing cocaine. Furthermore, he was diagnosed with Paranoid Schizophrenia at the age of 10 and has been in and out of mental institutions. The symptoms that are associated with this particular disorder are also still present.

Behavioral Observations

Nathan is an extremely intelligent man who often wears nice suits and is well groomed. He interacts well with others unless he experiences a psychotic episode. This is when his mood changes and he becomes extremely agitated, angry, paranoid, and delusional. During this time, he also psychologically and physically abuses Sophie on a severe level. Furthermore, he also has delusions of grandeur which make him believe that he is a brilliant biologist and almost every aspect of his daily life is consumed by this fabricated way of thinking. 

Diagnosis

295.30 (Schizophrenia) Paranoid Type - This type of schizophrenia involves a preoccupation with delusions or auditory hallucinations. In order to diagnose a client with this disorder, he or she must also still have organized speech and non-catatonic behavior.

Other Conditions That May Be a Focus of Clinical Attention:

Substance Abuse and possible Bi-Polar Disorder 

Findings

After reviewing Nathan’s background information and long-term behavior, I diagnosed him with Paranoid Schizophrenia because he meets the criteria for that disorder. This is because he exhibits the following symptoms and/or behavior:

1. Clinically significant distress – He feels bad after he hurts Sophie due to his disorder.

2. Mood changes with periodic hypomania – He becomes agitated and physically abuses Sophie.

3. Anger that is dealt with by using repression, denial or paranoid projections – He often psychologically attacks Sophie by calling her names and accusing her of cheating on him.

4. Delusions of grandeur or auditory hallucinations – He believes that he graduated from Harvard University and is a brilliant biologist who is working on groundbreaking research.

Treatment Recommendations

When reviewing Nathan’s case, there are major issues that need to be immediately addressed. The first one will be to try and reduce the overall level of symptoms that are related to Paranoid Schizophrenia. According to (Butcher., Mineka & Hooley. 2010), an individual with this type of schizophrenia “shows a history of increasing suspiciousness and of severe difficulties in interpersonal relationships” (p. 463). The symptoms that seem to be most relevant with Nathan are his mood changes with hypomania, paranoid projections, anger, and delusions of grandeur. 

The main reason that these symptoms should be treated as soon as possible is because he is causing psychological and physical harm to Sophie when they appear. These symptoms are also preventing him from being able to live in a normal state of reality. I would begin treating his disorder by verbally teaching him certain coping skills that can be used to manage these symptoms and prescribe an antipsychotic medication to try and reduce the intensity of symptoms and number of episodes. 

Furthermore, I would also refer Nathan for an additional assessment to address possible Bi-Polar Disorder and to agencies that help with domestic violence and substance abuse. This is because he may be able to receive beneficial services like further counseling, a neutral place for discussion, and group therapy with others who are experiencing the same issues.

Prognosis

When reviewing all of the details of Nathan’s case, I don’t believe that he will do well in treatment and that his overall prognosis is poor. This is because if he continues to live in his current environment, further abuse to Sophie will most likely occur when mood changes with hypomania and/or paranoia are present. Therefore, he won’t have the positive support system that is needed to combat symptoms that are associated with his severe level of long-term Paranoid Schizophrenia. Having a positive support system and acquiring treatment are also major requirements for people who develop this disorder because it may reduce these symptoms. 

However, up to this point he has been in and out of several mental institutions and has not improved. I am also confident that he will never acquire the motivation that is needed to end his relationship with Sophie due to his growing obsession and skewed belief that he is her grand savior. Therefore, his symptoms will probably only get worse and he may also begin to experience issues like self-hate and depression due to his continuous psychologically and physically abuse toward Sophie.

Ethical/Legal Considerations

When conducting an assessment and treatment plan for Nathan, I would also need to address any ethical concerns that may apply. This is because following ethical standards would help ensure that his rights were protected throughout the overall process. Five specific ethical codes that may apply to her individual case include:

1. Informed Consent – This means that I will need to inform Nathan about all features that might affect his willingness to participate. I will also implement this by asking him to sign a document that identifies the content and purpose of the assessment and treatment plan.  

3. Debriefing – This means that I will need to debrief Nathan before, during and after the assessment and treatment process. This is important because it will ensure that he’s aware of all beginning, ongoing, and final results that are obtained. This will also allow the opportunity to address any misconceptions that he may have during the overall process.

4. Protection From Harm – This means that I will need to acquire permission before treating Nathan and if any aspects of treatment may harmful, I will avoid using them.  

5. Confidentiality – This states that personal information can only be released under specific circumstances. The BACB Guidelines For Responsible Conduct also state that a professional can disclose confidential information without a client’s consent to protect the client or others from harm. In Nathan’s case, I would be forced to release some of his personal information to third parties. This is because he carries weapons, has threatened others safety and has already caused severe psychological and physical harm to Sophie. Since he is experiencing delusions of grandeur about who he is and what he has become, I also don’t believe that he is competent enough to make important decisions so involuntary hospitalization may be required in the future.  

Summary

This was written after watching a movie called “Sophie’s Choice” which includes two main characters named Sophie and Nathan. There are several scenes in the movie that depict different behaviors which may be associated with individualized mental illness. These behaviors and/or symptoms also negatively affect how Sophie and Nathan are able to interact as a couple and with others in various social settings. Therefore, the overall purpose of this work was to first provide a case evaluation for each character that confirms which mental disorder/s they may have. I then followed each diagnosis with any pertinent findings, treatment recommendations and ethical considerations that may apply to each case. 

References:

American Psychiatric Association. (2000). BehaveNet: APA Diagnostic Classification DSM-IV-TR. Retrieved on February 1 2013 via the World Wide Web at http://behavenet.com/apa-diagnostic-classification-dsm-iv-tr 

Behavior Analyst Certification Board. (2004). Guidelines for responsible conduct for behavior analysts. Retrieved on February 2 2012 via Kaplan Online at http://content-asc.kaplan.edu.edgesuite.net/PS502_1004A/images/product/Guidelines%20for%20Responsible%20Conduct.pdf

Butcher, J. N., Mineka, S., & Hooley, J. M. (2010). Abnormal Psychology (14^th Ed.). Boston, MA. Allyn & Bacon, Pearson Higher Education.

Pakula, Alan (Director and Producer). (1982). Sophie’s Choice. (DVD). Lions Gate

Schub, T., Jaffe, S. (2012). Post-traumatic stress disorder. Retrieved on February 3 2013 via the Kaplan Library at http://ehis.ebscohost.com.lib.kaplan.edu/eds/pdfviewer/pdfviewer?sid=b008d357-ffce-4487-b4b6-7d2bd37572c9%40sessionmgr11&vid=9&hid=2

COGNITIVE NEUROSCIENCE: HOW SPECIFIC BRAIN STRUCTURES CAUSE CERTAIN BEHAVIOR/S

             After reviewing several different articles and books about cognitive neuroscience, I chose to discuss one that addressed how specific brain structures cause certain behavior/s. According to (Lezak, Howieson & Loring. 2004), “the brain is an intricately patterned complex of small and delicate structures. Three major anatomical divisions of the brain succeed one another along the brain stem: the hindbrain, the midbrain, and the forebrain” (p. 42). Behavior can then be determined based on how information is processed and flows through structures within these divisions. Some of these structures are also as follows:

RAS - This is known as the reticular activating system and it is located in the midbrain. Its function is to control one’s level of wakefulness and alertness so an individual has the ability to react to certain stimuli.  

Thalamus - This is located at the top of the brain stem and it is responsible for relaying sensory messages and motor signals to the cerebral cortex, while also regulating ones consciousness, alertness, and sleep.

Hypothalamus - This is located under the thalamus. Its main function is to regulate things like emotions, hunger, sex drive, thirst and many other major drives.

Amygdala - This includes two almond-shaped masses of neurons that are located on each side of the thalamus. Their primary function is associated with regulation of certain emotions, like anger or fear. This is also a very important part of individual brain structure because if people and animals didn’t have these, they may not be affected by certain stimuli that would normally be frightening, personally threatening or dangerous.

Cerebellum - This is located at the base of the brain, directly behind the brainstem. Its main function is to maintain balance and coordination of complex movements, along with controlling certain responses associated with perception and cognition, like pleasure and fear.

Somatosensory Cortex - This is located in the midbrain and it processes information when affected by various systems in the body that are sensitive to touch. This sensitivity can include pain, temperature, and the proprioception system. It is also highly sensitive which allows people to detect and interpret a large variety of sensations.

Frontal Lobes - The main function of these is to receive and coordinate messages from other lobes, regulate motor control, speech and other higher functions.

What Does This Tell Us About Brain Structures and Human Behavior/s?

After reading this previous research, one thing that I have learned is that all behaviors are exhibited based on different structures within our brain. A second thing is that the brain is way more complex than I had initially realized. While, a third thing that I have learned is that several psychological/physical behaviors would not occur if it wasn’t for these structures and that they can diminish or be altered when these structures are damaged.

Conclusion

Although, this article was very thorough and extremely informative, I believe that further research should be conducted. This is because the article could not determine all of the affects that individual brain structures have on human behavior/s. Therefore, I am confident that further research may uncover even more evidence to prove how brain structures and human behavior/s are related. This process can also be completed by identifying further correlations among these two factors.   

Reference:

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

UNDERSTANDING THE CONNECTION BETWEEN BELIEF PERSEVERANCE, CRITICAL THINKING & COMMON SENSE

According to (Douglas. 2000), belief perseverance is “when people form a belief based on initial evidence, the belief will be resistant to contradictory evidence, and when people form a theory based on erroneous evidence and later discover that the evidence is false, the belief often survives such discrediting” (p. 134). There are also different strategies that can be used to overcome belief perseverance. Two of these strategies include the use of:

1. Critical Thinking – This is when someone will choose to believe a certain thought because it is based on observations through environmental factors, specific data, or other factual evidence. Critical thinking usually lacks the bias that may normally be present within average home, school and/or social beliefs.

2. Common Sense – This is based on factual opinions of average people about a specific phenomenon. Normally, these opinions are considered factual because they are thought to be common knowledge among most members of a society, population or culture. This thought process is also not usually extremely jeopardized by prejudice or biased thinking.

There are also several times when people are unable to overcome belief perseverance. Two examples could include prejudice and religious beliefs that have been conditioned by respected loved ones or those that have been acquired through a lack of critical thinking and/or common sense. The negative consequences of this skewed belief system can create further issues and will depend on each individual situation. One example is if a Caucasian person chose to be prejudice against an Afro American by starting a physical fight with that person. The initial victim could then end up killing the person who chose to act out based on his or her prejudice beliefs. Therefore, the consequence of prejudice thinking in this particular situation would be premature death of the Caucasian.   

According to previous research, there are also many similarities and differences between common sense and science that are based on which area of psychology is being considered. One particular area that common sense does not play a huge role in is that of neurophysiology. Although, common sense is considered an extremely valuable attribute when applied to the areas of social psychology and social cognition. Common sense is also categorized in three ways which include “a set of shared fundamental assumptions,” “a set of maxims or shared beliefs,” and “as a shared way of thinking” (Fletcher. 1984. p. 1). These are viewed as three major similarities between common sense and science because this thought process is shared by many within a specific population, culture or society. Furthermore, three differences between common sense and science are as follows:

1. Common sense is based on only preconceived ideas while science acquires factual data that can support or dispute those initial ideas.

2. Common sense can include prejudice or biased thinking but scientific theories are designed after attempting to eliminate these potentially harmful factors.

3. Common sense can lack validity but science tries to reduce or eliminate this possible issue before sharing any newly acquired information with the general public.

References:

Douglas, N. (2000). Enemies of critical thinking: Lessons from social psychology research. Reading Psychology. Retrieved on September 8 2011 via the World Wide Web at http://web.ebscohost.com.lib.kaplan.edu/ehost/pdfviewer/pdfviewer?sid=5040acc5-a3b0-42d6 911e-2250afb06064%40sessionmgr111&vid=2&hid=21

Fletcher, G. (1984). American Psychologist: Psychology and Common Sense. University of Waikalo Hamilton, New Zealand. Retrieved on September 8 2011 via the World Wide Web at http://contentasc.kaplan.edu.edgesuite.net/PS501_1004A/images/product/Psychology%20&%20Common%20Sense.pdf

THE DIFFERENCE BETWEEN INDUCTIVE & DEDUCTIVE REASONING IN COGNITIVE PSYCHOLOGY

According to (Anderson. 2010), researchers have been “investigating brain areas involved in reasoning, and it suggests that people can bring different systems to bear on different reasoning problems” (p. 273). There are also two well-established logical methods of reasoning that have been identified which are known as inductive and deductive. Trying to understand these reasoning methods may be difficult because the differences between them are subtle. Therefore, I have also provided a more in depth description and examples of each method below:

Inductive Reasoning – This is a process of reasoning that involves the use of specific observations to reach a general theory or logical conclusion. It can be categorized into different types which include: statistical syllogism, simple induction, generalization, false analogy, and casual inference. An inductive argument is also evaluated based on whether it is strong or weak and there are many times when the conclusion will be false even when the specific observations are true. This is because the conclusion is based on an individual’s educated prediction and/or bias thinking. Specific bias thinking that may occur with this type of reasoning could be confirmation bias, availability heuristic, and the predictable world bias.

Furthermore, when the specific observations that are used to acquire the conclusion are false, the argument will be considered “unsound.” Three examples of an inductive argument can also be as follows:

Example #1 – 100% of life forms on earth need water to survive. Since this is the case, if a new planet is discovered, then that life form will probably also need water to survive.

Example #2 – The neighbor’s dog has a high pitched bark. I hear a high pitched bark outside, so the neighbor’s dog must be barking.

Example #3 – Every time I eat dairy products, I get cramps in my stomach. Therefore I must get cramps in my stomach because I eat dairy products.

Deductive Reasoning – This is a process of reasoning that involves the use of a theory or general statements to reach a specific logical conclusion. A deductive argument is evaluated based on its overall level of validity and soundness. Since, this is the case there are times when a deductive argument may be considered valid but unsound. For example, when a specific conclusion is true, the argument may be valid, even though the general statements that were used are false. Since, a deductive argument is based on individual emotion and belief, there are also many times when it may contain a certain level of bias thinking. 

One example of bias thinking that can occur is when there may be differences in beliefs among varying cultures. Therefore, a deductive argument will only be considered sound if it is both valid and the general statements are true. Three examples of a deductive argument can also be as follows: 

Example #1 – All bachelors in the world are single. Joe is single. Joe is a bachelor.

Example #2 – The members of the Johnston family include Becky, Arnold and Larry. Becky is overweight. Arnold is overweight. Larry is overweight. Therefore, all members of the Johnston family are overweight.

Example #3 – Each day, I drive to work. This takes one hour. My job starts at nine o' clock in the morning. Therefore, if I leave at eight o' clock in the morning, I will get to work on time.

Reference:

Anderson, R. J. (2010). Cognitive Psychology and Its Implications (7th Edition). Worth Publishers. New York, NY.  

HOW TO TREAT ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) (THE EXAMPLE CASE OF 8 YEAR OLD CHANTEL)

            According to (Hunt, Marshall, 2005), “attention deficit/hyperactivity disorder (ADHD) is a disorder that affects an individual’s ability to attend or focus on tasks and that may involve high levels of motoric activity. Between 3 and 5 percent of children in the United States are identified as having ADHD” (p. 256). Research has shown that many of these children are also diagnosed with a learning disability or possible conduct-related behavioral disorder. As a child development specialist, my current goal is to assist a young girl who has recently been diagnosed with ADHD. In order to successfully accomplish this goal, I will need to design an in-depth step-by-step treatment process. These steps will also be addressed within two written sections which are as follows:

1. Part I: Analysis

2. Part II: Intervention

PART I: ANALYSIS

             8 year old Chantel has recently been diagnosed with ADHD. She is exhibiting specified behavioral issues which may be devastating to her overall growth, functioning, and development. These issues are also affecting 5 specific domains which include cognitive, social/emotional, and physical, along with her home and school environments. Some of the specific issues within each domain are as follows: Chantel’s cognitive issues are hyperactivity, lack of focus, forgetfulness and/or poor memory skills. She may be experiencing social/emotional issues due to exile from fellow classmates. This constant isolation could also be causing inner feelings of inadequacy, loneliness and despair. Chantel’s major physical issue is that she’s sometimes aggressive toward classmates and does occasionally use excessive force. If this continues then she may eventually harm herself, a teacher, fellow classmate, family member or animal. It is also possible that she may be physically acting out in an attempt to communicate or manipulate an environment that she doesn’t fully understand. Although this is a major source of concern, she is also a fast runner, who is physically flexible, strong and athletic. Since she possesses these physical attributes, her peers usually pick her first in gym class. She is also experiencing issues within her home environment. Her parents have expressed a major concern about her level of hyperactivity, forgetfulness, impulsive behavior, late poor quality work, history with behavioral incidents, scapegoating occurrences and lack of social skill.

How Do These Behavioral Issues Affect Chantel’s School Environment?

Since, cognitive, social/emotional, physical and home environmental issues are occurring I believe that they are drastically affecting Chantel’s overall performance at school. Some of these issues may also coincide with her parent’s concerns, along with unique school related issues. These include difficulty retaining or remembering information, completing tasks, unsatisfactory work and some physical altercations with fellow classmates. She is also required to complete the same grade curriculum and time frames as “normal” peers who don’t have ADHD.

PART II: INTERVENTION

            Since several issues are present, implementing an intervention plan will be the next important step during this process. This step will also give me the opportunity to implement a treatment plan which is specifically designed to assist Chantel. The intervention plan that I have designed for Chantel is also “based on the principles of applied behavioral analysis; these programs involve the systematic instruction of discreet skills” (Hunt, Marshall, 2005. p. 309). An individualized ABA program plan is normally implemented to modify behaviors that may be viewed as undesirable to the client and/or society. There are also many cases when the undesirable behaviors are actually due to underlying symptoms of a disability, like ADHD. Since this is one of those cases, I have designed a 3 step process plan for Chantel, which includes early intervention, implementing specific techniques, and measuring and monitoring. This overall plan has also been designed to identify how to properly assist Chantel based on her individual needs and can be viewed below:

STEP 1. EARLY INTERVENTION

This first step is a key factor in order to properly assess and treat Chantel’s actual behavioral issues. This initial assessment is also when I will decide which techniques should be used to address the behaviors that are causing major distress.

STEP 2. IMPLEMENTING SPECIFIC TECHNIQUES

The second step is to implement techniques which can modify behaviors that are affecting specific domains. These 5 domains and recommended techniques are as follows:

Cognitive – She is experiencing hyperactivity, lack of focus, forgetfulness and/or poor memory skills within this area. Techniques that I can use which may improve cognitive development are individualized instruction programs and strategies. These can include a self management program and assistive technology.

Social/Emotional – Chantel wants to play with other children but she lacks proper social skill. Therefore, she will need techniques that build and/or develop these valuable skills. Once this process is completed, Chantel may also be able to interact with family members, teachers, and peers on a much healthier social and emotional level. Two techniques that I can use to help her develop these skills are implementation of monitored play dates and child counseling sessions. 
Physical - It‘s crucial that I provide a plan which can reduce Chantel’s desire to be aggressive. The techniques to address this issue will also first be implemented within her school environment.  

Home Environment – When a child is diagnosed with a behavioral disorder, this can cause many feelings within the family. Some of these include stress, guilt, helplessness and anger. It is important to implement techniques which will foster a positive and supportive home environment, while eliminating some of these family emotions. Chantel’s parents also revealing some of these feelings due to her ADHD. It is important that we support these concerns by keeping her parents informed through every step of the implementation/treatment process. They must also be informed about any plan changes or modifications so they can support and practice treatment consistency. If this is completed, then the level of stress and other feelings may decrease over time. Two techniques that I can implement which may initiate family support and consistency are effective communication skills and appropriate family intervention classes.

School Environment – Chantel needs comprehensive processes that may improve her issues with late homework, problems retraining or remembering information, unsatisfactory or incomplete work. She also tries to complete the same curriculum and time frames as “normal” peers even though she has ADHD. Below, there are 4 techniques that may address each one of these issues:

1. Proper Assessment - I will recommend that Chantel is immediately assessed by the appropriate staff members. This will determine if she should be completing the same curriculum as normally developed peers. If she is diagnosed with a learning disability due to her ADHD, then she may benefit greatly, from assistive technology or special education classes.

2. Weekly Reporting - The second technique that I will implement to address and/or modify these behaviors while at school is the addition of weekly reporting. Weekly reports can be used as a way to record how many issues occur and the details of each event. This process can also generate valuable information that may help with her treatment plan and possibly prevent any scapegoating issues that her parents are concerned about. 

3. Behavior Chaining/Differential Reinforcement of Alternative Behavior - The third technique that I will recommend is the implementation of behavior chaining. According to (Cooper, Heron, Heward, p. 435), “a behavior chain is a sequence of discrete responses, each associated with a particular stimulus condition. Each discrete response and the associated stimulus condition serve as an individual component of the chain. When individual components are linked together, the result is a behavior chain that produces a terminal outcome.”

Since, Chantel has ADHD she may require a world which is extremely routine and/ or structured. I believe that if she could slowly learn different chains of desirable behavior, she will begin to perform these rituals on a regular and permanent basis. Behavior chaining can also be conducted on a single individual our within a group setting. An alternate procedure that could also be used in Chantel’s classroom and recess settings is known as Differential Reinforcement of Alternative Behavior. According to (Cooper, Heron, Heward), this procedure “reinforces occurrences of behavior that provides a desirable alternative to the problem behavior but is not necessarily incompatible with it” (p. 471). An example of this process is as follows:

“When an incident begins to occur, the teacher will tell Chantel that it is unacceptable behavior. The teacher will than re-direct Chantel to hug her friend instead, and then go swing together.”

4. Parent/Teacher Conferences – I will also implement weekly parent/teacher conferences as a required technique. This will offer an opportunity to disclose all results or details which are pertinent to her treatment plan. These will include the weekly report and other factors. 

STEP 3. MEASURING AND MONITORING

This final step can be very exciting after implementing a program plan! This is because information will be shared which can determine if the implemented program plan and/or techniques are beneficial to Chantel’s treatment process. These results will also be gathered through weekly reports that identify any new behavioral changes or other issues.

CONCLUSION

               As stated in my initial introduction, according to (Hunt, Marshall, 2005), "attention deficit/hyperactivity disorder (ADHD) is a disorder that affects an individual’s ability to attend or focus on tasks and that may involve high levels of motoric activity. Between 3 and 5 percent of children in the United States are identified as having ADHD” (p. 256). Research has shown that many of these children are also diagnosed with a learning disability or possible conduct-related behavioral disorder.

As a child development specialist, my initial goal was to assist 8 year old Chantel, who has recently been diagnosed with ADHD. She was also exhibiting behaviors within 5 specific domains. In order to successfully accomplish this goal, I chose to address these behaviors within two specific sections. These included a lengthy analysis of observable details and creation of a final intervention and treatment plan.

I am confident that this overall process would modify some of Chantel’s undesirable behaviors. This is because my plan included the use of techniques that are based on principles of ABA to strengthen development within specified areas. The major domains of concern for Chantel’s case were cognitive, social/emotional, physical, and home and school environments. Some of my chosen techniques to modify behavior within these domains were the implementation of behavior chaining, differential alternative reinforcement, mandatory parent/teacher conferences, and parental communication to ensure plan consistency. The results of Chantel’s intervention and treatment plan would also be closely measured and monitored through weekly reporting. These results would also keep her “intervention/treatment team” informed about any new behavioral changes or other concerns. One example of this would be results that show where her undesirable aggressive behavior has been modified through “Differential Reinforcement of Alternative Behavior” to reflect desirable hugging behavior!

     

REFERENCES:

Hunt, N., & Marshall, K. (2005). Exceptional children and youth (4th ed.). Belmont, CA: Wadsworth.

Cooper, J. O., Heron, T. E., Heward, W. L. (2007). Applied Behavior Analysis (2^nd ed). New Jersey: The Lehigh Press, Inc.

HOW ANXIETY, OBSESSIONS & COMPULSIONS RELATE TO OBSESSIVE-COMPULSIVE DISORDER (OCD)

     

            Obsessive-Compulsive Disorder also known as (OCD) occurs due to causes associated with genetics, brain physiology, childhood experience, and other environmental factors. Previous research has also provided evidence that supports a direct relationship between anxiety, obsessions and compulsions among those who have this disorder. This is because these factors appear to interact in the following way:

Obsessions occur when an individual repeatedly experiences uncontrollable obtrusive and unwanted thoughts or distressing images. Some examples of common obsessions may include excessive thoughts about contaminating or harming one’s self or others and forbidden or socially unacceptable sexual imagery. These thoughts can than lead to uncomfortable feelings of disgust, doubt, guilt or fear. The individual will then begin to experience an excessive level of anxiety due to not being able to control the thoughts, images and/or negative feelings from occurring. This will then lead the individual to believe that things should be done a certain way in order to prevent these thoughts, images and feelings from occurring. Eventually, the individual will feel uncontrollably driven to perform these things in a certain way and exhibit compulsive behavior/s. Some common compulsive behaviors that may also occur can include but are not limited to: repeatedly checking locks, washing hands, hoarding, silent prayer, or repeating certain words and phrases. 

When considering treatment options for OCD, some professionals use a technique that is known as "exposure and response prevention." According to (Butcher., Mineka., & Hooley. 2010), this is because “a behavioral treatment that combines exposure and response prevention seems to be the most effective approach to treating obsessive-compulsive disorders” (p. 212). This process also involves asking the client to design a hierarchy of upsetting stimuli that evokes distress, disgust or anxiety and is based on a scale from 0 to 100. However, after researching further information about this particular treatment technique, I do not believe that it should be used with clients if they are also taking an anti-anxiety medication. This is because that particular medication may reduce the overall level of distress, disgust and/or anxiety that would normally be measured when addressing the upsetting stimuli. Furthermore, the client also won’t get the opportunity to learn a new way of cognitive thinking and beneficial coping skills that can be used to address these issues properly. Therefore, since the results may be inaccurate and/or unreliable, the client will not receive treatment for OCD that may be best for his or her overall mental health needs.

Reference:

Butcher, J. N., Mineka, S., & Hooley, J. M. (2010). Abnormal Psychology (14^th Ed.). Boston, MA. Allyn & Bacon, Pearson Higher Education.

WHY PUNISHMENT MAY NOT ALWAYS WORK (THE EXAMPLE CASE OF 5 YEAR OLD BEN)

     For several years, researchers have been trying to determine whether certain consequences of behavior will have a positive or negative effect on overall learning. One particular case where this may be questioned concerns a 5 year old boy named Ben who was spanked after he was caught stealing from a store. After reviewing the details of this case, I do not agree that the consequence of spanking will teach this child that the behavior is wrong. This is because there are several other negative issues that can occur when using this method to shape behavior. Many of these may also have devastating effects on the quality of Ben’s overall psychological well-being. Therefore, the overall purpose of this paper will be to further discuss this issue by addressing the following two questions:

1. What could Ben learn from this punishment and why is it incompatible for the behavior?

2. What learning model and/or theory best provides supportive evidence for my position?

What could Ben learn from this punishment and why is it incompatible for the behavior?

     According to (Chance. 2009) “observational learning may be defined as a change in behavior due to the experience of observing a model” (p. 276). Many believe that this type of learning can occur within several different areas of our lives even without a model. When conducting observational learning, there are also two basic procedures that may be used during the process. The first process is called vicarious reinforcement and this is when an observer will see a model’s behavior produce reinforcement. While, the second process is called vicarious punishment and this is when an observer will see a model’s behavior get punished. 

Although, both of these procedures may acquire different results, they can still be responsible for shaping an observers behavior. Since, this is the case many may also question how an observer’s behavior can be shaped when using the procedures of observational learning. For instance, in Ben’s case, it was suggested that the model (his trusted caretaker) should use vicarious punishment to acquire the desired behavior of learning that stealing is wrong. However, I believe that vicarious punishment is an incompatible procedure to use in this case. One reason for this is because the punishment may be so psychologically and/or physically traumatizing that Ben will remember that, over the behavior that his caretaker was trying to shape. If this is the case, then there is a smaller chance that the desired behavior will be repeated in the future. A second reason that I do not think that spanking should be used is because that particular punishment may cause Ben to develop several psychological issues. Some of these may include low self-esteem, low self-worth, anxiety, depression, a desire for isolation, mistrust in others and/or, one specific social model learning behavior known as “Transmission of Aggression Through Imitation of Aggressive Models” (Chance. 2009).

What learning model and/or theory best provides supportive evidence for my position?

     Transmission of aggression through imitation of aggressive models can occur when an observer learns and imitates an aggressive behavior that was initially taught via a respected model. One specific theory that supports this idea is Bandura’s Social Cognitive Theory. In one particular experiment, he placed a group of young children in different scenarios with an adult and a doll. In the first part of the experiment, the children observed an adult spanking, yelling at and tossing the doll. In the second part of the experiment, a different group of children observed the adult playing with the doll in a non-violent manner. However, in the last part of the experiment, a third group of children observed no abuse or positive play among the adult and doll. The outcome of this overall experiment showed that only those children who observed aggressive behavior toward the doll became aggressive toward it themselves. Therefore, the results indicated that aggressive behaviors can be learned by direct observation through a model. In this case, the children also learned that the adult never received punishment for exhibiting aggressive behavior, so this may have encouraged them to exhibit the same undesirable behavior (Chance. 2009).

When considering this particular theory, Bandura also believed that observational learning may only occur when four specific factors are included. These are as follows:

1. The observer must give attention to the behavior - In Ben’s case there is a good chance that he will give full attention to the behavior because spanking is a painful physical punishment. Furthermore, he may be more attentive to this behavior because it could also cause major psychological distress during the overall process. 

2. The observer can retain the behavior that the model exhibited - If Ben can remember how the model completed the behavior of spanking, than it will be easier for him to imitate this at a later time. When considering spanking as a punishment, it may also be very easy to remember because the behavior is simple compared to other punishments that may be more complex.

3. The observer must have the motor skills required to carry out the models behavior - This is very important because it can greatly determine who might imitate certain behavior and who will not. In this case, if Ben has the cognitive ability to understand and process the behavior of spanking, then he will be able to carry out this punishment in the future.

4. The observer must possess the motivation needed to exhibit the models behavior - In this case, if Ben’s caretaker spanks him and he observes no negative consequence for her behavior, then he may begin to view it as acceptable and/or desired behavior. This skewed cognitive thinking may lead him to believe that punishment like spanking is acceptable reinforcement to use with his own children. If this occurs, he may then become motivated to try and shape their behavior by using spanking as a punishment. In this case, he will also initiate the next cycle of generational abuse and his children may experience similar psychological and/or physical issues.

Conclusion

     For many years, researchers have been studying how using punishment as reinforcement can have both positive and negative effects when used to shape behavior. After reviewing the case involving a five-year-old boy named Ben, I stated that I do not agree that spanking may be the best punishment technique to use in this case. One main reason for this belief is because when using this punishment, it may not shape Ben’s behavior to learn that stealing is wrong and could cause several different psychological issues during the overall process. These could include low self-esteem, low self-worth, anxiety, depression, a desire for isolation, mistrust in others.

A second thing that Ben could learn through this reinforcement procedure is aggression. Since, this is the case I also discussed one specific social model learning behavior known as “Transmission of Aggression Through Imitation of Aggressive Models. This theory explains and supports the idea that Ben could end up learning the aggressive behavior of spanking through direct observation of his respected model. I also provided supportive evidence of this by discussing a specific experiment that was conducted by Bandura. He analyzed a group of children and confirmed that they will repeat or imitate aggressive behaviors after direct observation of a model. Therefore, if this happens to Ben and these issues are not addressed accordingly they may greatly reduce the quality of Ben’s overall level of psychological well-being. He may also repeat this course of punishment to shape behavior within his own family environment in the future.   

Reference:

Chance, P. (2009). Learning and behavior. (6 ed.). Wadsworth: Cengage Learning.