The client was a seven year old male at the time of admission. He was active in therapy until about the age of eleven. He had poor socialization skills and was behind in school. The client’s level of social interaction and play was that of a five year old. At school he was seldom included in games with the other children his age. He was in a transitional first grade when he should have been in the second grade. The client parents separated shortly after he was born. The client lived with his mother and grandmother until the death of the grandmother.

There is a family history of alcoholism and drug abuse on the mother’s side. Little is know about the client’s father. After the death of the grandmother, the client and his mother lived in shared housing. The client experienced the death of his mother during this time. Her death was substance related. Finally the client’s adoptive parents also got a divorce. The following paper will review the diagnosis; therapies used, and provide alternative suggestions.

The client experienced a range of trauma at an early age. The therapists in this case believed the client suffered from Posttraumatic Stress Disorder. According to the DSM-IV-TR (2000), Posttraumatic Stress Disorder will typically occur in individuals who have experienced a traumatic event that directly threatens their sense of safety. To meet the criteria for this diagnosis the individual must relive the events through one of the following: thoughts, dreams, flashbacks or hallucinations, mental distress, or physiological reactions.

The individual will attempt to reduce or inhibit these stress symptoms. For example, using avoidance; this can mean avoiding the thought itself or avoiding entire activities, places, or people. In some cases an individual will suffer from blackout type response during the trauma. Individuals suffering from Posttraumatic Stress Disorder also tend to isolate, loose interest in activities, have difficulty expressing emotions, or feel a sense of pending doom. Finally, these individuals also may experience insomnia, uncontrolled anger, hypervigilance, or increased startle response.

With regard to this client, he presented with a number of these symptoms. Throughout his life he suffered from several traumatic events, including, witnessing his mother’s alcoholism and substance abuse, the death of his grandmother and eventually his mother, and not knowing his father. He also went through his adoptive parent’s separation and divorce shortly after the adoption. Due to these events in the client’s life, he also experienced nightmares, mental distress, and physiological reactions. In terms of mental distress, the client was behind in school. According to teacher reports and observations, the client wanted to learn but had difficulty concentrating.

The client would also become physically ill when he thought about or discussed certain topics. The client was also reportedly hypervigilant and overly emotional. He had a tendency to try to hold feelings in but would eventually explode into tears. This client also had difficulty with impulse control and was unable to verbally express his feelings. One therapist also reported that the client’s intensity of his reactions were often inappropriate. For example, his reactions for winning or losing when playing a game were either too excited or too frustrated, respectively.

While this client displays many of the symptoms related to Posttraumatic Stress Disorder, there are some concerns with this diagnosis. Posttraumatic Stress Disorder typically occurs after a trauma such as combat, severe physical or sexual abuse or a natural or man made disaster. Additionally, symptoms begin after a delay from the time of the event to the time when the individual begins reliving the event. These qualifiers do not necessarily apply to this client. For one, there was no report of this client experiencing any type of abuse trauma, nor any type of disaster trauma. There was no marked delay between one specific event and the onset of the symptoms. Although the client’s entire history is unknown, he seemed to experience symptoms in conjunction with these difficult events.

There are two other possible diagnoses for this client; Adjustment Disorder or a Learning Disability. For example, Adjustment Disorder could be an alternative diagnosis. To meet criteria for Adjustment Disorder the individual must develop emotional or behavioral problems within three months of the stressor. These symptoms also must cause significant stress that impairs the individual’s job, school or social functioning and is more intense then normal stress. Finally, these symptoms are not caused be bereavement and they do not last longer than six months. One argument for this disorder is the fact that this client seemed to display symptoms prior to his mother’s death, specifically his poor socialization skills.

Additionally, throughout the years this case was open, this client went through a number of environmental changes, suggesting the inconsistency as the root of the client’s symptoms. In the beginning he lived with his grandmother but had to move after her death. He again moved after the death of his mother where he stayed with family friends. The client moved again when placed with his adoptive parents. Finally, the client’s adoptive parents separated and again the client moved. Throughout this time, the client displayed academic and social problems in school, both criteria for Adjustment Disorder.

Another alternative diagnosis in this case is a Learning Disorder. While noted that this was a possibility, no assessment was completed. The therapist held to the diagnosis of Posttraumatic Stress Disorder to explain the client’s symptoms. There are a number of specific diagnoses that fall under this category, including disorders in reading, mathematics, or writing. It is difficult to determine if one of these diagnoses may be plausible because there is no mention of testing in the case study. In line with a Learning Disorder, Childhood Disintegrative Disorder could also be an explanation for the problems this client dealt with. The criterion for this disorder state that the child develops normally until about the age of two. Beginning around this time but before the child is ten years old; the child begins displaying maladaptive symptoms.

This includes a significant loss of skills such as language, behavior or social skills, bladder or bowel control, play skills, or motor skills. Also criteria for this disorder, the individual must display abnormal functioning in two of these skills: social, communication, or age appropriate activities and behaviors. As noted in the case study, the client’s history is unknown prior to the age four. Therefore, there is no direct evidence that a Learning Disorder can explain the client’s problems. However, the client did have difficulties in expressing himself and had poor socialization skills, further fitting the criterion for the Learning Disorder, Childhood Disintegrative Disorder.

The client saw two therapists due to the adoption and having to move schools. The therapy used was psychoanalytic in nature. The therapist felt this would be the best therapy to reveal the client’s deep rooted problems while at the same time begin to develop and maintain a consistent, nurturing environment. The therapists also used story telling, art, and play therapy to explore the issues that this client was dealing with. Additionally, the client attended special classes to address his academic underdevelopment. This therapeutic method helped this client in a number of ways. The play therapy taught the client basic cognitive skills he was lacking.

The client was also able to learn appropriate expressions of frustration when he lost the game and joy and happiness when he won. Additionally, the storytelling gave the client the opportunity to express himself and his feelings in an indirect way. As the therapist noted, most of the client’s stories were about other people or creatures, but all revolved around similar themes. Likewise, the art therapy also allowed the client to express himself visually when he could not do so verbally. During the client’s treatment, the therapist did not use any direct methods for increasing socialization. To address this issue, the therapist could have encouraged the client to participate in a school club or sport.

Reference

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.

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