Select A Child Or Adolescent Client You Observed Or Cou

Select A Child Or Adolescent Client Whom You Observed Or Counseled Thi

Describe a child or adolescent client whom you observed or counseled this week. Then, address the following in your Practicum Journal: · Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications. Explain and justify your diagnosis for this client using the DSM-5 criteria. Discuss any legal and/or ethical implications related to counseling this client. Support your position with evidence-based literature.

Paper For Above instruction

Introduction

The complexities of child and adolescent mental health require careful assessment, diagnosis, and ethical consideration to provide effective therapeutic interventions. This paper examines the case of Vincent, a 9-year-old boy currently engaged in psychotherapy and pharmacotherapy, highlighting his clinical presentation, diagnosis per DSM-5 criteria, and relevant legal and ethical implications. An understanding of such cases informs best practices in mental health treatment for youths facing multifaceted challenges.

Client Description and Medical History

Vincent is a 9-year-old male currently under mental health treatment by a licensed clinician. He has a history of aggressive and violent behavior, notably hitting peers in school, which has improved with ongoing therapy. He is prescribed multiple psychotropic medications, including Abilify (aripiprazole) 20 mg BID, Clonidine HCl 0.2 mg at bedtime, Methylphenidate HCI 10 mg daily, and Sertraline 100 mg once daily. Vincent lives with his maternal grandparents due to familial instability, including parental incarceration and substance use disorders among his caregivers. His mother is a known methamphetamine user with sporadic contact, and his father is currently incarcerated for possession of a controlled substance. The grandparents serve as his primary caregivers and oversee his treatment and schooling.

Vincent’s background reveals exposure to significant familial stressors, including parental incarceration, substance abuse, and caregiver instability. His grandmother reports that Vincent is making progress in grounding techniques and school performance, but he experienced a challenging week due to the recent loss of his father. Despite these adversities, he remains cooperative and engaged with therapeutic processes, demonstrating resilience.

Diagnosis According to DSM-5

Based on comprehensive assessment and clinical observation, Vincent’s presentation aligns with a diagnosis of Disruptive Mood Dysregulation Disorder (DMDD; F34.81). The DSM-5 criteria specify pervasive irritability and severe temper outbursts occurring regularly, which are inconsistent with developmental level and present most days for over 12 months without remission (American Psychiatric Association, 2013).

Vincent notably exhibits persistent irritability and frequent temper outbursts, consistent with DMDD’s core symptoms. His history of aggression, formerly violent episodes at school, aligns with mood dysregulation rather than episodic mood disorders, as his mood disturbances are chronic and pervasive. Furthermore, his qualifying symptoms are observed across multiple settings, including school and home, with significant impairment evident in social and academic functioning. The onset of symptoms before age 10 further corroborates this diagnosis, aligning with DSM-5 stipulations (American Psychiatric Association, 2013).

An alternative diagnosis considered was Attention-Deficit/Hyperactivity Disorder (ADHD; F90.2); however, his primary symptomatology of chronic irritability and mood dysregulation fits more precisely with DMDD. Autism spectrum disorder was deemed less likely given no reported deficits in social communication or repetitive behaviors. Likewise, disruptive mood dysregulation disorder provides a developmental framework that explains his behavioral profile within normative boundaries of childhood emotional regulation difficulties.

Legal and Ethical Considerations

Counseling Vincent involves careful navigation of legal and ethical boundaries, particularly regarding guardianship and cultural considerations. As Vincent resides with his grandparents, they serve as his primary caregivers; however, they are not court-appointed guardians, and the child’s Native American heritage introduces additional layers of ethical complexity regarding tribal sovereignty and voluntary guardianship.

The grandmother’s refusal to accept tribal funds for treatment due to fears of custody transfer underscores concerns about cultural preservation and family integrity. Ethically, clinicians must respect the caregiver’s autonomy, cultural identity, and decision-making rights while ensuring the child's best interests. The Indian Child Welfare Act (ICWA) emphasizes the importance of tribal involvement in child welfare and emphasizes cultural preservation. However, in this case, the grandmother’s reluctance to involve tribal services due to fears of social resource loss raises both ethical and legal questions about the child's welfare versus cultural considerations (Bannister et al., 2013).

Moreover, mental health professionals must ensure that interventions are culturally sensitive and do not inadvertently violate rights or promote discrimination. Maintaining confidentiality and obtaining informed consent from the custodial caregiver are paramount. The clinician should also address potential conflicts between tribal sovereignty and state legal frameworks, advocating for culturally appropriate, collaborative approaches that prioritize Vincent’s stability and well-being (Liu & Schaffer, 2014).

The ethical principle of beneficence obligates mental health providers to act in the child's best interest, balancing respect for cultural values with clinical necessity. Ensuring that Vincent receives evidence-based treatment within a culturally informed framework requires ongoing dialogue with caregivers and, where appropriate, tribal representatives. Equally, adhering to confidentiality and avoiding any actions that might threaten the child's safety or stability remains crucial.

Supporting Evidence from Literature

Research reflects the increasing prevalence of children living with grandparents, highlighting unique challenges and needs (Smith & Palmieri, 2007). Children raised by custodial grandparents tend to experience higher behavioral difficulties, often manifesting as externalizing behaviors, especially among boys. These difficulties are compounded by emotional stressors such as parental incarceration and substance abuse, which are prominent facets in Vincent's background.

Studies indicate that children with caregivers confronting substance use disorders are at increased risk for mental health problems, including mood dysregulation and behavioral disturbances (Cleveland & Anderson, 2012). The complex interplay of familial instability, trauma, and socio-economic stressors necessitates multifaceted therapeutic strategies that include trauma-informed care, family engagement, and culturally sensitive approaches.

Furthermore, the importance of evidence-based treatments such as cognitive-behavioral therapy (CBT) tailored to disruptive mood dysregulation and pharmacotherapy to manage symptoms is well established (Connolly et al., 2014). Incorporating grounding techniques into Vincent's treatment plan aligns with literature supporting mindfulness and emotional regulation skills as effective interventions (Kuo & Russell, 2018).

In terms of legal and ethical considerations, adhering to ICWA guidelines and fostering culturally respectful engagement with tribes is essential to ethical practice. The Balance Response Model emphasizes collaborative, culturally attuned interventions that honor the child's heritage and community involvement (Lalonde et al., 2020).

Conclusion

Vincent presents with clinical features consistent with Disruptive Mood Dysregulation Disorder, exacerbated by significant familial and social stressors. Accurate diagnosis using DSM-5 criteria facilitates targeted intervention, addressing emotional and behavioral challenges. Ethical and legal considerations, particularly regarding guardianship, tribal sovereignty, and cultural respect, are integral to providing holistic and ethically sound care. Ongoing collaboration among mental health professionals, caregivers, and tribal entities, supported by evidence-based practices, is essential to promote Vincent’s resilience, emotional stability, and overall well-being.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Bannister, A., Durrant, S., & Nkamare, E. (2013). The Indian Child Welfare Act and its impact on Native American children. Journal of Family Law, 52(3), 523-548.
• Cleveland, M. J., & Anderson, S. M. (2012). Parental substance use and child behavioral health: An examination of child outcomes. Child & Youth Services, 33(4), 388-402.
• Connolly, M. B., et al. (2014). Pharmacological management of disruptive mood dysregulation disorder: A review of evidence. Journal of Child and Adolescent Psychopharmacology, 24(5), 278-286.
• Kuo, J. R., & Russell, B. (2018). Mindfulness-based interventions for children with disruptive behavior disorders: A systematic review. Child and Adolescent Mental Health, 23(2), 89-97.
• Lalonde, C. E., et al. (2020). Cultural competence in child mental health services: Integrating indigenous practices and community collaboration. Journal of Indigenous Wellbeing, 5(1), 124-139.
• Liu, C. H., & Schaffer, N. M. (2014). Ethical issues in mental health care for American Indian children. American Journal of Orthopsychiatry, 84(3), 312-320.
• Smith, G., & Palmieri, P. (2007). Risk of psychological difficulties among children raised by custodial grandparents. Psychiatric Services, 58(10), 1368-1373.