Social History
What behaviors prompted Ken's referral? Where did they respectively occur?
Home: inappropriate behaviors at dinner, fighting with sister, tantrums, destructive/impulsive
School: getting out of seat, low achievement exam performance, easily distractible, low assignment completion, aggressive with peers
Which of Ken's symptoms fit with the different types of ADHD (inattentive v. hyperactive)?
Hyperactive: impulsivity, destructive tendencies, aggression with peers/sibling, getting out of seat
Inattentive: incomplete school assignments, school issue of not listening when directly spoken to
If you were Ken's therapist, what would you prioritize as target behaviors for his treatment in his plan?
Available behaviors observed: getting out of seat in school, aggression with sibling and peers, distractibility, inappropriate/disruptive dinner behaviors, tantrums, destructive/impulsive behaviors, incomplete assignments
What factors are important in successful parent training?
Family involvement in treatment, supportive family environment, open-minded parents, willing to learn/accept criticism, highly motivated, parent-to-parent communication/parent-to-therapist communication
How would Ken have been affected if he were in a different environment (think of family structure, financial status, etc.)
Family: parental training might not have been feasible with single parent household
How could the therapist's presence have affected the observation?
Ken could have been overly expressing behaviors for attention from the outside party
Mom could have also altered behaviors (might not have been as quick to react to bad behaviors)
What would be different if the therapist hadn't integrated praise from parents/teacher into his treatment?
Ken may have become frustrated with constant reprimanding with no positive regard, possibly losing motivation and not meeting treatment goals
What are the pros and cons of prescribing stimulant medication in an ADHD case?
Pros: less communication between significant figures (teachers, parents, etc.) involved, fairly straightforward
Cons: possible side effects, fosters dependence on medication
How did Ken's IQ compare to his achievement exam scores?
What factors explain the disconnect?
IQ of 120 but low achievement scores in math/reading
Context is important (where he took exams with how many people/possible distractions involved), time difference (timed vs. not)
What interventions could be beneficial to Ken's case?
Behavioral/reinforcement (actually used)
Social skils training
Play therapy
Medical intervention
What was most effective in Ken's treatment? What was least effective?
Most: rewards (both weekly and daily), praise
Least: time-outs (at first), adding more behaviors to the intervention under the initial chart system
How much leeway is there is parent training? Can parents add components as they see fit?
Because of how intricate the system is, it would be best for parental suggestions to be confirmed by the therapist first to prevent a possible negative reaction
Imagine that you know that Ken meets criteria for ADHD. How do you think his case would be affected if he had been previously diagnosed with another disability such as autism spectrum disorder or a physical disability?
Some of the primary behaviors in ADHD may have been attributed to the autism diagnosis (poor frustration tolerance/tantrums, difficulty in school, poor peer relations), with a physical disability he could be receiving accommodations that would also work to serve the symptoms of ADHD
What do you think the case outcome would be if the teacher's report hadn't been consistent with the parents'?
Therapist may not accept case for treatment, possibility of other diagnosis (just hyperactive type, conduct disorder), just intervention at home
What is the benefit of using the point system instead of the chart system? Or vice versa?
Points: Ken could excel in one area (e.g school behaviors) and still potentially earn a reward, even if he had difficulty in other areas. The chart would penalize him for not meeting all of his goals each day
Chart: simpler for Ken to understand
How do you think Ken's case would have differed if he were prescribed a stimulant medication?
No need for charts or rewards, less involvement from family and therapist