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Case Study of Emotional DisorderS Case Study of Emotional DisorderS. PSY308 Abnormal Child and Adolescent Psychology. Nadif is a 7 year old Somali American boy. He lives with his family, here in America. He and his family moved here from Somalia, after living in a refugee camp, as war ravaged theircountry. Nadif’s family has been increasingly worried about his emotional and psychological wellbeing, since they moved to the refugee camp. Their concerns are mounting as Nadif’s anxieties are now stifling his physical and social development. Case Study: Nadif. Before moving to the refugee camp, Nadif had normal eating and sleep patterns for a child his age. Now, Nadif often complains about a stomachache and he frequently has a loss of appetite. Also, he has been experiencing sleep disturbances as well. He wakes in the middle of the night often due to nightmares about getting lost or separated from his mother. Nadif’s family describe him as nervous and his anxiety is escalated when his mother is away. Although his nervousness and nightmares are associated with being lost, he has never actually experienced anything similar, not even during his stay in the refugee camp. Even there, he was not exposed to any “intensely traumatic events” (Argosy University, 2015). This is imaad perfumes bangalore university confusing to his parents. Interestingly, Nadif claims that he doesn’t even remember much of his experience in Somalia. Nadif’s anxiety surrounding being separated from his family has forced his mother to homeschool him. He is very fearful of going to school and being away from his mother. Nadif does not seem to experience any stress or anxiety when going other public imaad perfumes bangalore university, as long as his family accompanies him. It is his parents’ hope that therapy will help Nadif become more comfortable with being away from his family “so that he can attend school, develop friendships, and become increasingly more independent” (Argosy University, 2015). DSM Diagnoses. Nadif is demonstrating some specific symptoms and characteristics, such as, loss of appetite, complaints of stomachaches, sleep disturbance, nightmares, excessive anxiety about being apart from family, and nervousness. By examining his symptoms, we can determine which DSM diagnoses best coincide with what he is experiencing. There are two sets of criterion that correlate with Nadif’s case; separation anxiety disorder and parasomnia. Let’s discuss these emotional disorders and what aspects of this case study reflect the DSM criteria of each disorder. Separation Anxiety Disorder. It is possible that Nadif is suffering from separation anxiety disorder. Separation anxiety disorder or SAD is characterized by an excessive fear of being separated from their parents or caregiver. This fear or anxiety of separation from those who take care of you, is a normal and necessary characteristic, during very early childhood (Mash & Wolfe, p. 206, 2012). “Children with separation anxiety disorder (SAD) display age-inappropriate, excessive, and disabling anxiety about being apart from their parents or away from home” (Mash & Wolfe, p. 206, 2012). This is true for Nadif. He is 7 years old and beyond the age that it is normal to experience these intense fears of separation from his parents. Some children may experience this type of anxiety occasionally, with minimal interferences in their daily functioning. However, “The symptoms of SAD need to be severe enough to cause significant impairment in the child or adolescent’s ability to function in at least two settings, which may include school, work, home, or other settings” (Argosy University, 2015). Nadif’s anxiety keeps him from going to school and he is only comfortable going other public places if his family is with him. The symptoms must “occur frequently” and they must be ongoing “for at least 6 months before a diagnosis can be made” (Argosy University, 2015). Nadif’s mother reports that he has been having trouble for a few years. Some children with SAD have trouble going to school, due to the anxiety of being away from the parent or family or complain of physical ailments or illness, such as headaches or stomachaches (Mash & Wolfe, p. 206, 2012). Nadif should have begun going to school about 2 years ago, but instead, is homeschooled by his mother due to his fears. Also, he often complains of a stomachache and loss of appetite. In addition, many children with SAD have “specific fears” associated with “getting lost” (Mash & Wolfe, p. 207, 2012). This is true for Nadif, as well. REM Parasomnia. Parasomnias are disorders that effect a person during their sleep (Mash & Wolfe, p. 387, 2012). These are not to be confused with Dyssomnias, which are disorders that impede sleep (Mash & Wolfe, p. 387, 2012). It is possible that Nadif may be suffering from REM parasomnia. According to the DSM diagnostic criteria, this disorder is characterized by “Repeated awakenings with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem; generally occurs during the second half of the sleep period” (Mash & Wolfe, p. 388, 2012). Recall from the case study that Nadif experiences frequent nightmares that involve him being lost or somehow separated from his family. In addition, this disorder is most common in children “ages 3 to 8 ” and Nadif is 7 (Mash & Wolfe, p. 388, 2012. Most Appropriate DSM Diagnosis. After thoroughly assessing Nadif’s case and reviewing the diagnostic criteria for both, separation anxiety disorder and REM parasomnia disorder, it seems the SAD is the most appropriate DSM diagnosis in Nadif’s case. SAD accounts for Nadif’s appetite loss, complaints of stomachaches, nightmares, and his excessive anxiety associated with being away from his family. In contrast, REM parasomnia only accounts for his nightmares. Separation anxiety disorder’s DSM criteria requires that the child or adolescent demonstrate at least 3 of 8 symptoms, including, frequent, severe stress related to separation from parents or caregiver, frequent worrying about parent/caregiver, frequent worrying that something bad will happen that leads to separation from parent/caregiver, not wanting to go to school or other places without parent/caregiver, fear of being alone (without parent/caregiver), fear of sleeping alone (without parent/caregiver), frequent nightmares about separation, and frequent complaints of physical pain or illness (headache, stomachache, nausea) during or before separation (Mash & Wolfe, p. 207, 2012). Nadif demonstrates more than three of these symptoms. Also, the DSM diagnostic criteria requires that the symptoms be ongoing for at least 4 weeks (Mash & Wolfe, p. 207, 2012). According to Argosy University (2015) these symptoms must be recurrent for at least 6 months for the child or adolescent to be diagnosed with SAD. Nadif’s issue have been present for considerably longer than both of these time parameters. Finally, the DSM criteria for SAD requires that “The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder” (Mash & Wolfe, p. 207, 2012). There does not seem to be any evidence that Nadif suffers from these other types of disorders. (Note that this section fully describes the symptoms required for a diagnosis of SAD, as required.) It is not uncommon for children with SAD to fear, or refuse to, go to school. Recall that Nadif’s fear of being separated from his mother lead to her decision to homeschool him. REM parasomnia does not address Nadif’s nervousness about being away from his family, which is at the core of his symptoms. There are other gaping discrepancies associated with a REM diagnosis for children like Nadif. “DSM-IV-TR criteria for sleep disorders typically are not met in full by younger children because of the transitory nature of their sleep problems” (Mash & Wolfe, p 388, 2012). This is true for Nadif’s case. A DSM sleep disorder diagnosis, such as REM parasomnia disorder, requires that “(1) the presence of clinically significant distress or impairment in social, occupational, or other important areas of functioning; and (2) the requirement that the sleep disturbance cannot be better accounted for by another mental disorder, the direct physiological effects of a substance, or a general medical condition (other than a breathing-related disorder)” (Mash & Wolfe, p. 388, 2012). It cannot be determined that Nadif’s nightmares (REM parasomnia) is not caused by the distress of the migration to America or the emotional turbulence of living in compare and contrast essays need weed refugee camp. Also, it is not clear that his other symptoms that are not addressed by REM parasomnia are not the caused by a different mental disorder, such as SAD. Therefore, REM parasomnia disorder speaks to Nadif’s nightmares, it simply does not correlate with enough of his symptoms to be an accurate and appropriate DSM diagnosis. Possible Causes of SAD. Often separation anxiety disorder is caused by a stressful or pivotal event in a child or adolescent’s life (Mash & Wolfe, p. 208, 2012). In Nadif’s case, there are several examples of major stressors that may have contributed to his condition. For instance, having to move from one’s home and into a refugee camp, could bring on the symptoms of SAD. Major moves such Writing a scientific proposal besttopwriteessay.org change of city, region, or country, could cause significant enough emotional stress that the child begins to display symptoms of SAD. Thus, it is not unusual for a child Nadif’s age to have trouble adjusting to moving to a different continent. A drastic change of residence is one of the possible causes of SAD. In addition, if a child has developmental risk factors such as not mastering developmental tasks at a normal rate, the child may be more likely to develop SAD. For instance, if a child does not learn to eat, walk, play, and learn, independently, at rates similar to their peers, this may be indicatory of psychological disorders such as SAD. Also, a death in the family could also contribute to the onset of SAD (Mash & Wolfe, p. 208, 2012). This can be especially stressful for the child if the decedent is a parent or other adult figure in the family. Losing a parent or caregiver may cause the child to demonstrate excessive fear or worry about something happening to the other parent. In the war torn Somalian culture that Nadif is from, death of a family member is not uncommon. Also, “the symptoms of SAD may also fluctuate over the years as a function of stress and transitions in the child’s life” (Mash & Wolfe, p. 208, 2012). In addition, although SAD is usually associated with children and adolescents, this disorder “persists into adulthood for more than one third of children and adolescents” (Mash & Wolfe, p. 208, 2012). Treatment. One of the most effective treatments available for children and adolescents with separation anxiety disorder is cognitive-behavioral therapy or CBT (Argosy University, 2015). This method directly addressed the maladapted or distorted thought processes that are associated with the child or adolescent’s fear of separation (Mash & Wolfe, p. 238, 2012). “CBT teaches children to understand how thinking contributes to anxiety, and how to modify their maladaptive thoughts to decrease their symptoms” (Mash & Wolfe, p. 238, 2012). In Nadif’s case, a therapist or clinician may help him think through the scenarios that go through his head when he feel afraid to leave his mom. For instance, if Nadif is afraid he will get lost at school and not be able to find his way home, the therapist may point out that Dissertation binding service swindon admission essay of children go to school every day and make it back home. Resume cover letter education, he or she may help Nadif think of ways to ensure that he can find his mother after school, such as, asking his teacher where the pick-up area is, memorizing his school bus number, or getting the secretary in the office to call his mom. The therapist might also help Nadif think of all of the things that he misses out on by being homeschooled, such as, making friends, field trips, and playing sports. Another treatment option that SAD responds well to is behavioral therapy or BT (Mash & Wolfe, p. 237, 2012). Behavioral therapy is often used with CBT (Mash & Wolfe, p. 238, 2012). “The main technique of behavior therapy…is exposure, causing children to face what frightens them, while providing ways of coping other than escape and avoidance” (Mash & Wolfe, p. 237, 2012). Using this treatment technique, the therapist might get Nadif to go to school for the first 2 hours of the school day, while his mother is nearby in another room or waiting in the car. Nadif will be exposed to his fear of being there without his mother in sight, but have the assurance that she is close by. As time passes, and his confidence builds, he will stay longer each day. Perhaps, some of the days, his mother will run errands while he is inside the school. The ultimate goal is for Nadif to eventually stay a full school day, without his mother there. This exposure technique has proved successful with both genders, across multiple age groups and cultural backgrounds (Mash & Wolfe, p. 237, 2012). Also, family therapy can be an effective treatment option for children and adolescents with SAD, and their families. Often families do not completely understand why the child or adolescent has such excessive fear based reactions to being away from their parents, family, or caregiver. This can be especially confusing for the family and the child, if there are other children or adolescents that are reacting normally to similar stressors. A family therapist can help the child manage their symptoms while educating the parents and other family members on what separation anxiety Dissertation binding service swindon admission essay is and how they can be helpful. Often, family based therapy, coupled with behavioral or cognitive-behavioral therapy, is an optimal choice in SAD cases. Cultural Bias. It is important to understand and acknowledge any cultural biases that may be associated with emotional disorders such as SAD. “SAD may vary by culture depending on how much that culture values independence in its youth” (Argosy University, 2015). Western cultures such as the United States value the independence of thought and emotion, in their children. In American culture, it is considered an attribute for a child to be a leader and not a follower. However, other cultures, such as Asian cultures, value the family unit over individual independence. These cultural biases may greatly affect how SAD is viewed and which children are considered abnormal, thus maladjusted. In America, a child or adolescent who does not mind, or prefers, to be apart from the family unit, is considered a free spirit with leadership qualities. A child or adolescent with these identical attributes, in China, may be viewed as uncommitted, distracted, or even disloyal. It is essential that clinicians understand the multicultural factors and perspectives that may influence each case. Psychiatric Medications & Ethical Considerations. The mere mention of psychiatric medications being prescribed to children and adolescents can spark a heated debate on ethical practices and child endangerment. “As a mental health professional, it is controversial to prescribe psychiatric medication for children under the age of eighteen” (Argosy University, 2015). Some people argue that medicating a child who is already suffering from one or more psychological disorders is an unethical, abusive, and lazy approach to a solution. However, many children and adolescents annotated bibliography underground railroad in pennsylvania dramatic improvements in symptom management, using conservatively and conscientiously prescribed medications. There are a number of medications that are used to treat psychological disorders in children and adolescents. “Examples include the use of stimulant medications for the treatment of ADHD, anti-psychotic medications for the treatment of schizophrenia or serious aggressive and destructive behavior, and selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) for the treatment of depression and other disorders” (Mash & Wolfe, p. 115, 2012). Any clinician that prescribes psychiatric medications for children should practice caution and closely monitor the child or adolescent’s biological, emotional, and psychological reactions to the medications. In addition, other non-pharmacological treatment options should be utilized to avoid prescribing medications, if possible. There are various studies that support the use of medications for specific psychological disorders, like attention-deficit/hyperactivity disorder (ADHD) in some children and adolescents (Mash & Wolfe, 151, writing a letter of recommendation usf eye. For instance, “for about 80% of children with ADHD, stimulants produce dramatic increases in sustained attention, impulse control, and persistence of work effort, and decreases in task-irrelevant activity and noisy and disruptive behaviors” (Mash & Wolfe, A Link Between Womens Education and Their Right to Vote. 151, 2012). It is important to recognize that every child is different and it is essential that the child, parents, family member, educators, community resource workers, and mental health professionals, work together to design the most effective treatment plan for the child. It is the ethical duty of all clinician to first and foremost, do no harm to those they serve, be them children or adults. Conclusion. The assessment, diagnosis, and treatment, of psychological disorders in children and adolescents, is a very important and sensitive task in the mental health profession. It is important that professionals have multicultural competencies that allow them to not only observe their own biases and misconceptions, but observe and respect the cultural backgrounds of those they serve. Children and adolescents with psychological disorders are special clients and it is important to remember that their troubles are often compounded by their inexperience and their various stages of maturation. There are often biological, environmental, familial, developmental, and social risk factors and protective factors associated with child cases, that professionals should be aware of. There are various treatment options for psychological disorders in children and adolescents. Although “previously, SAD was treated primarily with medication or psychodynamic, family, or behavioral interventions…The addition of cognitive techniques can annotated bibliography underground railroad in pennsylvania cognitive distortions that keep the child from exhibiting behaviors in his or her repertoire, while also promoting generalization because of the reduced reliance on environmental contingencies to maintain behavioral change” (Dia, 2001). For young people, the world can be a scary and Dissertation binding service swindon admission essay place, at times. Those with mental illness are bombarded daily with obstacles that they may not even understand. We, as professionals, parents, family members, teachers, and neighbors, have to protect and aid those who desperately need a helping hand. Argosy University/Schreiner, G. (2015) PSY 308 Abnormal Child and Adolescent Psychology.