For my project for this semester I have chosen to work with my individual client. My client is a five-year-old boy with behavioral issues. I have been working with him for about three months at this point. In order to make this evaluation different we have started to focus on different and more specific issues. There are many different things that him and I have been focusing on throughout the semester. For this project I have decided to work on strategies in order to help him focus more during class.
My client was brought in last semester by his mother because of behavior problems that he was having at school. He is very impulsive and has a hard time focusing in class. He also has a very difficult time in the lunchroom because of the overly stimulating environment. He has a history of biting and hitting other children. The biting has stopped and the hitting is no longer and issue. He tends to threaten children but doesn’t hit them anymore. He tends to disrupt other children while in school, which has caused the teacher to isolate him during class. Because of the issues that he was having in school his mother decided to get him evaluated by a developmental psychologist. After going through the testing with the psychologist, he was diagnosed with sensory integration issues as well as ADHD. The specialist recommended that he get occupational therapy as well as social therapy. He will be starting with all these services later in the year or possibly the beginning of next year. This history/baseline phase involved both my individual client and his mother. (Bloom e.t, 39, 2006).
The behavior that I have chosen to help my client modify is the ability to focus. My client has a really hard time sitting still even for just a few seconds. Since he has a hard time sitting still it makes it very difficult for him to focus during class. The goal that we have made for him is to increase the amount of time that he is able to sit still in order to help figure out how we can increase his attention during class. This is an observable action. During previous sessions we have had together I notice how hard it is for him to sit still. When he sits in a chair that spins in my office he is constantly moving it through the entire session. I am able to measure the exact time that my client engages in attempting to focus during a specific activity in my office. Since he is so young the easiest way to perform the measurements is for me to do it myself while we are in session together.
My client is very excited to participate in this evaluation. Although he does not completely understand what the evaluation is he is excited to get to play a new game each session. He knows that we will be doing an activity in order to help him focus more during class. My client is very aware that he has a hard time sitting still and concentrating during class. He has stated it to me before saying that he has a hard time remaining in one position. When I explained to him that we would be playing a game during each session he got even more excited. He is excited to be working towards a prize that I have promised him if he follows the therapy rules that we have. Every week if he plays the game and participates in therapy he receives a sticker on his sticker chart. When he reaches eleven stickers he gets a robot toy that he chose earlier in the semester.
After discussing this project with my field advisor I was initially going to be doing this project with my individual clients mother who is also one of my clients. I had problems with this because she has been very inconsistent with attending her sessions. Although her son comes regularly she does not. Because of this I was very worried about being able to do the measurements with her. Therefore I decided to switch the client to do the evaluation with. Since switching the client I have not had an opportunity to speak with my advisor and discuss the evaluation directly. Previously though my supervisor and myself have discussed doing these freezing activities with my client in order to help with focusing and attention. My supervisor helped give me the initial idea of doing this activity with my client in order to make it both fun and helpful for him.
My next blog for this class will discuss the specifics of my intervention.
Reference List
Bloom, M., Fischer, J, Orme, J.G. (2006.) Evaluation Practice: Guidelines For The
Accountable Professional. Boston: Pearson.
Rebecca--
ReplyDeleteYou are off to a good beginning. You described the client's age and his behavioral problems. You should also include his ethnicity, his socio-economic status, and a brief family history. Is there a history of ADHD in his family? Is there alcohol or substance abuse, or trauma? This is important diagnostically. Also, please check if there is a Connor's questionnaire in the psychologist's report. This will help you understand just how serious the problem is. The teacher and the parent should have both filled out a Connor's (our Achenbach child behavior checklist, or similar questionnaire.)
I am curious about why his mother won't continue treatment. Was she receiving psychoeducational material about ADHD, or was she seeing you about another issue?
You have figured out an intervention which we might call "freezing."
"The goal that we have made for him is to increase the amount of time that he is able to sit still in order to help figure out how we can increase his attention during class. This is an observable action. During previous sessions we have had together I notice how hard it is for him to sit still."
This might be a good intervention in the classroom, but it is not going to help much in your office. Behavioral therapy is best done in vivo--in the actual setting where the behavior will be tested. I am sending you an article about behavioral therapy and ADHD, so you can work from a theoretical base. You can use this as the basis for your literature review assignment.
Thanks for double-spacing and including a reference. Good use of APA style.
I don't know how the teacher is isolating him in the classroom, but this is usually not as good idea. Please see how this is being done. Because he is your client, it is your job to advocate for him.
By now there is pretty much universal agreement in this country that ADHD is best treated with medication. Has he been to see a psychiatrist? Is he being medicated?
Is there some reason why his occupational therapy is not beginning immediately? Why wait seven months? A child who needs treatment should receive it immediately.