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Nursing assignment 659

   The Assignment: Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.  In APA Format, provide at least 2 references no more five year old. Colleagues Respond# 1  Counseling Adolescents with ODD The case study I choose to write on involved the blaming adolescent. The age is not disclosed in the video, but client appears to be a middle age adolescent male. Base on the case, the adolescent has stolen a car, and he justify why he has taken the car, he placed the blame on the owner of the car because he left the keys in the car. He also stated that if the other student had not told on him, they won’t even be in counseling. He is blaming everyone for his action and doesn’t seem to see anything wrong with his behavior. He also stated that his parents are the people who need counseling, but not him.  Unfortunately, he is not taking full responsibility for his bad actions but blaming others for it. He appears to believe he is innocent, and others are to blame for his actions. Diagnosis The client behavior may be as a result of uncontrolled emotions such as anger.  According American Psychiatric Association. (2013), Disruptive, impulse-control, and conduct disorders include conditions involving problems in the self-control of emotions and behaviors. The disruptive, impulse-control, and conduct disorders are a group of psychiatric conditions that affect the self-regulation of emotions and behaviors that begin in childhood or adolescence (Amboss, 2018). The differential diagnosis for the client presented will be oppositional defiant disorder. The oppositional defiant disorder is classified as a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months, and often blames others for his or her mistakes or misbehavior. Most essentially, it is best to investigate the possible causes of ODD. This is because defiant behavior in children can be triggered by issues such as other family abuse, unstable home environment, or sudden change in family structure.   Therapeutic Approaches The therapy of choice would be cognitive behavioral therapy (CBT) approach as we can see from the clip which involves the psychotherapist collaborating with the client. Cognitive behavior therapy helps the patient understand that they are not bad, but the behavior may be (Wheeler, 2014).  Using CBT, clients learn to cope effectively their negative emotions by developing new cognitive and behavioral skills. To change an emotion, one must change how they behave or act. Another therapeutic approach that have been found very beneficial for client with ODD is the Dialectical behavioral therapy (DBT), which is a research-based therapy. The client presents with impulse control, poor insight, and defiance. This therapeutic approach focuses on the client’s overall behavior. Clients with difficulty managing the emotional challenges of their lives may be because of lack behavioral coping skills. using this therapy, the client will openly discuss their feelings, display insight into their decision process while judgment is not portrayed. A strong commitment to change must be displayed. Studies have shown that, DBT treatment is most effective when it includes individual therapy, a weekly skills training group, and assistance with skills application by phone with the client own therapist between sessions (Mindfulness Therapy Associates, 2019).  According to Bass, van Nevel, and Swart, (2014), dialectical behavioral therapy has been shown to improve behavior in three strong areas that disordered adolescents typically need help in improving: lack of the needed behavioral coping skills, accepting reality as it is, and maintaining strong commitment to change. Psychotropic Medications Many researches have concluded that psychotropic medications are not recommended to treat ODD in children and that no drugs have been specifically approved. ODD should be treated as an emotional and behavior challenge that requires individual and family therapy changes in a person’s environment and support to develop better social skills (Good Therapy, 2019). Since medication alone generally aren’t used for ODD unless your child also has another mental health disorder such as ADHD, anxiety or depression, medications may help improve the symptoms. Research shows that most children diagnosed with ODD are often diagnosed with ADHD, stimulant medications (methylphenidate) can be used as a source of treatment. Expected Outcomes Using the two therapeutic approaches such as cognitive-behavioral therapy and dialectical behavior therapy, clients will be empowered to make their own decisions. In doing so, they will have a greater understanding that there are responsible to all decisions and are held accountable for their own actions. Other mental health disorders, such as ADHD or conduct disorder, need to be examined to determine if they are associated with ODD. With an understanding and managing of feelings of defeasance and opposition, clients will maintain happy relationships and tend to excel at work and school.    Colleagues Respond# 2  Observations and Aligning Behaviors The case study I selected was the hyperactive child. According to the DSM 5 (American Psychiatric Association, 2013), this child has many different behaviors that align with an attention deficit/hyperactivity disorder (ADHD) diagnosis. Danielson et al. (2018) explains that “attention deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder diagnosed in childhood”. The DSM 5 notes that in order to qualify for a diagnosis, the individual must exhibit 6 or more of certain symptoms. Upon assessment, this young girl appears to have difficulty “sustaining attention in tasks or play activities”, is definitely easily distracted by stimuli, squirms in her seat, seems to be “driven by a motor”, talks excessively, and often blurts out answers. This patient appears extremely excited and on “overdrive” in a sense. She bounces back and forth from topic to topic and is very tangential. I would assume that she has an extreme difficulty in a school or other structured setting, where she needs to sit and concentrate for extended periods of time. Therapeutic Approached and Medications            Austerman (2015) explains that “treatment of ADHD relies on a combination of psychopharmacologic, academic, and behavioral interventions, which produce response rates up to 80%”. This tells us that while medications are extremely important in treating children with ADHD, it is also important to come up with plans and interventions for academic settings as these children will struggle with concentrating and ultimately, behaving, at school. Behavioral therapy would ideally help the child to replace any negative behaviors with positive ones.            Medications that are commonly prescribed for ADHD include ritalin, adderall, metadate, concerta, focalin, and vyvanse, among others. It is important to remember to start slow with these medications and to watch for increased aggression/rage as that can be a common side effect of these types of medications, which would make things worse rather than make them better. It is also important to watch that the child’s appetite remains good. Expected Outcomes            Overall, my goal with this client would be to help her take it down a notch and feel that she is not going 100 miles per hour all the time. She would ideally be put on a medication that helps her to calm down and concentrate. She will no longer be as tangential and distracted, and hopefully, relationships and her performance at school would show significant improvements.

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