Respond to two colleagues who shared a different perspective on whether the protective factors could have changed Chase’s diagnosis and outcome. Explain whether your colleagues’ stances on the relevance of these protective factors have any influence on your position.
Colleague 1: Tyisha
Working with Children and Adolescents: The Case of Chase
Chase is a 12-year-old male who was brought in for services by his adoptive mother. He is very small in stature, appearing to be only 8 years old. Chase was adopted at age 3, from an orphanage in Russia. The adoptive parents are upper middle class and have three biological children (ages 9, 7, and 5). Autism spectrum disorder and attention-deficit hyperactivity disorder, is the diagnosis I would give. According to the DSM-5 “neurodevelopmental disorders frequently co-occur; for example, individuals with autism spectrum disorder often have intellectual disability (intellectual developmental disorder), and many children with attention-deficit/hyperactivity disorder (ADHD) also have a specific learning disorder. Due to him having to learn to speak English late, he could be delayed in school, causing him to feel left out and unable to function in the classroom. Predisposing and risk factors that led to the outcome of this case are: being abandoned by his birth parents, moving to another country where he did not speak the language, and his adoptive parents not seeking help sooner. The school also dropped the ball, they should have spoken with the mother sooner about making modification sooner. The past trauma suffered by the child should have been treated by a physiatrist. I believe these steps could have helped the child to adjust better, but I also believe the child still would have challenges to face.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Plummer, S.-B., Makris, S., Brocksen S. (Eds.). (2014). Sessions: Case histories.
Colleague 2: Jennifer
Upon reviewing the case of Chase, a 12 year adopted boy, it is reasonable to presume that his original diagnosis of Pervasive Developmental Disorder NOS and Transient Tic Disorder would currently be classified as an Autism Spectrum Disorder (ASD) (Plummer, Makris, and Brocksen, 2014; APA, 2013).
Chase meets the following diagnostic criteria for ASD: persistent deficits in social communication and social interaction – including deficits in developing and maintaining relationships, and failure to respond to social interaction; restricted, repetitive patterns of behavior, interests or activities – including inflexible adherence to routine and ritualized behaviors, fixated interests of abnormal intensity, repetitive use of objects; symptoms were exhibited during early developmental periods; symptoms cause significant impairment in social and educational areas of functioning and are not better explained by an intellectual disability (APA, 2013). Chase’s ASD diagnosis would be accompanied by intellectual impairment due to decreased functioning typical of children his chronological age (Plummer et al., 2014; APA, 2013). Based on information from Chase’s case, current symptomology would be rated at a Level 1, indicating that additional supports are necessary to increase functioning across the social and behavioral domains (APA, 2013). ASD diagnosis is established based on exhibiting factors including: difficulties transitioning from one task to another, inability to focus, frequent meltdowns, speech and language issues, facial tics, inability to sit still, overly focused on details of WWII, inability to make friends and/or successfully interact with family members, disrupted sleep patterns, and noted intellectual impairments or delays. Z-Codes which would be applicable to his diagnosis would include Z55.9 – academic or educational issues, Z60.4 – social isolation, Z62.890 – parental-child relational problem, Z62.891 – sibling relational problem, Z65.9 unspecified problem related to unspecified psychosocial circumstances, Z72.810 child antisocial behavior, and Z91.5 personal history of self-harm.
Risk and prognostic factors include gender-related diagnostic issues – males are four times more likely to be diagnosed with ASD; and functional consequences associated with ASD – lack of social and communication abilities may have hindered growth and development in educational settings or in settings with peers (APA, 2013). Additional considerations regarding his behaviors would include gathering a history of the experiences Chase had prior to and during his stay at the orphanage.
Functional consequences of ASD include: hindered learning and development of relationships, insistence on routines interferes with sleeping and routine care, decreased coping and adaptive skills, and difficulties establishing adulthood independence, social isolation and communication issues, and reduced help-seeking behaviors (APA, 2013).
Further evaluations would be necessary to determine the extent of Chase’s diagnosis; involvement with Chase’s school as well as his parents would be necessary to determine the range of his abilities and to pinpoint the areas in which his disorder was causing the greatest impact. Consistency between the home and school is necessary for success, while an IEP or placement into special education programming would be necessary to meet his educational needs, applied behavioral analysis therapy may also prove effective in modifying some of Chase’s behaviors and promoting effective coping mechanisms.
While ASD is a lifelong neurodevelopmental disorder, research suggests that early intervention is key to increased success rates of those with ASD (Autism Speaks, 2009). Although early intervention has proven successful, increased parental involvement and the use of the relationship-based approaches within the home additionally aid in increasing the success and outcomes of a child’s progress (Autism Speaks, 2009).
Respond to a colleague who chose a case different from yours by addressing the following:
- Describe another way the identified problem can be defined.
- What policy advocacy skills do you think should be used to address the identified problem?
- What makes a social problem a social work problem?
Background: Levy Case
Jake Levy is a veteran who suffers from trauma and depression. Jake was deployed and during that time, his humvee was attacked., killing his Sargent. Jakes drinks alcohol in excessive amounts to cope with his loss and transition into civilian life. He reports fighting with his wife, loss of interests and suffers from nightmares. During this video, Jake recalls receiving an email about a fellow soldier who suffered from PTSD and committed suicide.
PTSD is common in soldiers and veterans’ due to the nature of their jobs. According to the U.S Department of Veterans Affairs (2016), “20 out of every 100 veterans (or between 11-20%) who served in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) have PTSD in a given year” (para. 6). Many soldiers have a difficult time transitioning back into civilian lives, are in denial or are not educated in PTSD symptoms, therefore seeking treatment may not be the first thing on their minds. The problem is when PTSD is present but not treated for whatever reason. Jake shares that the Veterans Affairs (VA) does not offer any help with suicide prevention (Laureate Education, 2013).
Jansson (2018) suggests that prevention is a significant part of advocacy, as it is just as important to prevent social problems as fix existing ones. Although PTSD in veterans often go untreated for many different reasons, we have to consider the barriers that get in the way of treatment. For starters, the fact that suicide prevention programs amongst veterans do not exist is a problem. As social workers, we have the obligation to “promote the well-being of clients, consumers, and citizens by shaping human services system to conform to evidence-based policies such as ones confirmed by social science and medical research” (Jansson, 2018, p. 31). According to Erbes et al., (2012), PTSD can be accompanied by other disorders such as insomnia, loss of appetite, irritability, etc. Therefore, evidence-based practices should be the focus in prevention programs. Lobbying, taking proactive steps to involve policymakers and state officials in creating preventative programs is not only a big part of advocacy, but it is also reflecting in social work values.
Although we have the responsibility to ensure and promote individual’s well-being and safety, the lack of a suicide prevention program challenges that fact. As we are all aware of the dangers and violence that so many soldiers see during missions, it is even more important to safeguard individuals who are at-risk for PTSD. Evaluations for soldiers should be required before they are allowed to join or carryout missions. Most importantly, soldiers that come back from deployment should be screened, accessed and educated about PTSD to prevent and treat any signs of PTSD early.
Erbes, C. R., Meis, L. A., Polusny, M. A., Compton, J. S., & Wadsworth, S. M. (2012). An examination of PTSD symptoms and relationship functioning in U.S. soldiers of the Iraq war over time. Journal of Traumatic Stress, 25(2), 187-190. Retrieved from Walden Library databases.
Laureate Education. (Producer). (2013). Levy (Episode 7 of 42) [Video file]. In Sessions. Retrieved from https://class.waldenu.edu
Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice. (8th ed.). Pacific Grove, CA: Brooks/Cole Cengage Learning Series.
Plummer, S. -B., Makris, S., & Brocken, S. M. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
U.S Department of Veterans Affairs (2016). PTSD: National Center for PTSD. Retrieved from https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp
***Each response needs to be at least 1/2 page in length with 2 or more references****