Art and Esther live in Washington, DC. They have been
married for 12 years having met through a mutual friend when Esther was
finishing her Master’s degree in Fine Art. Art is now 45 years of age, and
Esther is 41. Art had owned his own construction company for several years, and
his marriage to Esther was his second. He did not have any children with his
first wife. Recently, Art’s business has barely been scraping by, and their
middle to upper-middle class lifestyle has been threatened. Art and Esther
consider themselves Caucasian, and both were raised in the Jewish tradition. At
this point, their religious life is not of the utmost importance for them, much
to the disappointment of Art’s parents. Esther’s parents were killed in an auto
accident when she was 19, and she has been on her own ever since. Esther has a
sister in Philadelphia and a brother in prison. Art was an only child, and his
parents live in California; they meet up about once a year.
Now as a four-year
old, Kendra’s behavior and temper hasn’t gotten any better. Esther has been
quietly laying the groundwork to move out; she is planning to go to her
sister’s house in Philadelphia where she thinks she has secured a job at a
museum. She is not yet sure but hopes to be able to take both of the kids and
leave.
For his part, Art’s
company got a large contract for a new shopping center, so he, thankfully, hasn’t
been around that much in the last year and a half. When he has been at home, he
has mostly been exhausted or has been on the phone with subcontractors.
Kendra is, at
times, inconsolable. She kicks, scratches, and bites Esther for no apparent
reason, and Esther thinks there is really something seriously wrong with her.
She can’t explain it any other way. She has heard that some kids get bipolar
disorder, and she really thinks that is what is happening with Kendra. She has
talked with her pediatrician and is planning to take Kendra to see a child
psychiatrist.
1) Research the
diagnosis of pediatric bipolar disorder. Be certain to include the views of the
psychiatric establishment as well as the views of those who would critique such
a diagnosis for children. Compare the symptoms of pediatric bipolar to those of
avoidant and/or resistant attachment. Based on what you know of Kendra’s
family, is an organic, biochemical imbalance more likely or is an attachment
difficulty more likely?
2) Of all of the
mental health providers available, why do you think Esther would take Kendra to
a child psychiatrist? What are the potential risks and benefits to such a
choice? Are there other options that Esther might consider?
3) Given the family’s
limited disposable income, if Esther had wanted some kind of intervention for
Kendra starting at age two, what would her options have been for both
outpatient and (perhaps) in-home services? Remember that the Kleinman’s live in
a big city (we are using DC as our big city).
4) Describe typical
developmental milestones for a four year old. How unusual is Kendra’s behavior?
DECISION POINT :::
Does Esther take Kendra to a child psychiatrist? If so, what is the outcome of
the visit?
1) According to The Balanced Mind Foundation (2010), the DSM-IV describes four types of bipolar disorder, all of which a child can be diagnosed with. The four types are Bipolar I, Bipolar II, Bipolar Disorder NOS (not otherwise specified), and Cyclothymia. In Bipolar Type I disorder, a person is diagnosed by experiencing one or more episodes of mania; depression does not need to be experienced to be diagnosed under this type (The Balanced Mind Foundation, 2010). Symptoms of mania typically include euphoria, grandiosity, flight of ideas or racing thoughts, more talkative than usual or pressure to keep talking, irritability or hostility when demands are not met, excessive distractibility, decreased need for sleep without daytime fatigue, excessive involvement in pleasurable but risky activities, poor judgment, hallucinations and psychosis (2010). To be diagnosed as having Bipolar Type II disorder, a person experiences periodic episodes of depression with episodes of a normal mood or hypomania (elevated or irritable mood with increased physical/mental activity). The symptoms of depression typically include lack of joy in life, withdrawal from activities formerly enjoyed, agitation and irritability, pervasive sadness, sleeping too much or inability to sleep, drop in grades or inability to concentrate, thoughts of death or suicide, fatigue or loss of energy, feelings of worthlessness, or significant weight loss or weight gain (2010). Bipolar Disorder NOS is used when a person is having impairment from serious mood dysregulation but it is unclear which type of bipolar disorder they are experiencing. Cyclothymia is a less severe form of bipolar disorder that impairs one’s life with less severe mood swings. Those not in a medical profession may see this behavior more as a lack of discipline based problem and not as a chemical imbalance disorder.
ReplyDeleteThe Balanced Mind Foundation (2010) claims that if a child is having more than a few of the following symptoms, they may have a form of the bipolar disorder. Symptoms to look out for are severe and recurring depression, explosive rages, extreme sadness, lack of interest in play, severe separation anxiety, talk of wanting to die or kill themselves or others, dangerous behaviors, grandiose belief in own abilities that defy the laws of logic, sexualized behavior unusual for the child’s age, impulsive aggression, delusional beliefs and hallucinations, extreme hostility, persistent irritability, telling teachers how to teach the class, compulsive creativity, compulsive craving for certain objects or foods, hearing voices telling them to take harmful action, sleep disturbances, and drawings or stories with extremely graphic violence (2010).
ReplyDeleteIt seems that a child can have attachment problems through many different stages of life. There are three main types of attachment styles a child may go through. About one half of children experience the attachment style of being securely attached. The other half of children are divided into the styles of being insecure avoidant attached and insecure resistant attached. Insecure resistant children experience symptoms such as showing signs of intense distress when mother leaves, avoiding strangers and showing fears towards them, approaching mother while resistant contact or pushing her away during reunion, and crying more instead of exploring a new environment (McLeod, 2008). Insecure avoidant children experience symptoms such as showing no sign of distress when mother leaves, shows no signs of bother when meeting a stranger by playing normally when they are present, showing little interest when reuniting with mother, and being able to be equally comforted by mother and stranger (2008).
From the information provided, it seems Kendra is experiencing an attachment difficulty rather than a chemical imbalance. According to Saul McLeod (2008), a child with avoidant attachment usually has a caregiver who is insensitive and rejecting to their needs and is often unavailable during times of emotional distress. It seems this may be the case for Kendra, especially with her father. We do think Esther seems to pay attention to Kendra. However, how available is she to tend to Kendra when she is going through depression?
2) We think Esther would take Kendra to see a child psychiatrist because they are the most qualified for diagnosing Kendra’s behavior problems. Also, it seems that their pediatrician recommended that Esther take Kendra to see a child psychiatrist. We do not see any risks in Esther taking Kendra to see a child psychiatrist. By taking her, Esther can get a confirmation on what is really going on with Kendra and the reasons behind it. The sooner she takes her, the sooner an intervention plan can begin to improve her behavior. The only possible risks we can see is that it may be an expensive task to do; however, it would be very beneficial. We also feel that Esther does not have many other options to consider. Since it seems that Kendra is experiencing mental/behavior problems, a child psychiatrist is the most qualified individual for Kendra to be evaluated by. Esther could consider not taking Kendra to see a child psychiatrist and deciding Kendra does have pediatric bipolar disorder. However, this would not be beneficial in the sense of making a possible wrong diagnosis. A confirmed diagnosis needs to be established so Kendra can receive the most appropriate treatment for her behavior.
ReplyDelete3. If Esther had wanted some kind of intervention for Kendra starting at age two, there are many outpatient and in-home services available to her. The Early Childhood Mental Health Consultation Project, otherwise known as the Healthy Future Program, operates in 24 child development centers located throughout the Washington D.C. area. This program offers child and family-centered consultation services to care providers and family members that build their skills and capacity to promote social and emotional development, prevent escalation of challenging behaviors, and increase appropriate referrals for additional assessments and services (DC Department of Mental Health, n.d.). Another intervention service, The Parent Infant Early Childhood Enhancement Program, serves primarily children five years of age and younger. The program involves play and art therapy, infant observation, and Parent Child Interaction Therapies, and supports parenting groups (DC Department of Mental Health, n.d.). As far as in-home services go, The Children and Adolescent Mobile Psychiatric Service provides on-site immediate help to children facing a behavioral or mental health crisis, whether seen in the home, school, or community. The DC Department of Mental Health (n.d.) states that this program’s services are geared toward children and youth 6-21 years of age, however they will see children under the age of 6 as well. The on-call, mobile emergency service is available 24 hours a day, seven days a week. This program also makes follow up visits, and connects the family to needed support systems outside of their services.
ReplyDelete4. There are many typical milestones seen in a four year-old as a child develops. In terms of gross motor development, children’s running should be more controlled, they should be able to easily catch, throw, and bounce a ball, and wash and dress themselves with little assistance (Destefanis, 1998). In developing fine motor skills, children at the age of four should be able to cut along a line using scissors, print some letters, and use table utensils skillfully. According to Destefanis (1998), four year-olds typically take turns, share, and cooperate with others in terms of social and emotional development. They also enjoy pretending and engaging in make-believe play, as well as expressing anger verbally rather than physically. In terms of language and thinking development, children should be using a 1,500 word vocabulary and starting to think more literally, developing a more logical thought (Destefanis, 1998). Destefanis (1998) also states that children should understand number and space concepts, along with recognizing patterns among different objects by the age of four. Kendra’s behavior is seen as somewhat unusual for her age, however the problems that she has been facing at home could be a contributing factor towards her actions. As stated in a previous post, children can recognize stress in the home, which can ultimately affect his or her behavior. In the terms of emotional development, Kendra should have a little bit more control over her actions and is developmentally behind as compared to other children her age. However, we do not know much about Kendra’s progress in the other areas of development. We do not know anything about her language, cognitive, and physical skills, which could give us a skewed viewpoint in how she is developing as a whole.
ReplyDeleteDECISION POINT:
ReplyDeleteWe think that Esther should take Kendra to see a psychiatrist. Just because Esther is taking her daughter to a psychiatrist does not mean that there is necessarily something wrong with Kendra, it will just help Esther get a better sense of what is going through Kendra’s mind and causing her to act in such ways. The psychiatrist will ask what is happening at home, and Esther should tell her everything that her daughter has been exposed to. Kendra can sense the stress in the home, and the stress that Esther is feeling from her marriage, which may be the cause for some of her behavior. The psychiatrist can also give Esther some parenting tips on how to respond to Kendra’s behavior. Destefanis (1998) states, “4-year-olds crave for adult approval, so it is important that as a parent you provide your child with lots of positive encouragement” (para. 7). Also it is important that you provide your child with lots of play space and occasions to engage in play with others. By receiving positive encouragement and optimum space to play Kendra will develop a higher self-esteem, and also work on her social skills as she interacts with her peers.
References
ReplyDeleteDC Department of Mental Health. (n.d.). Children, youth and family services. Retrieved May 29, 2012, from http://dmh.dc.gov/dmh/cwp/view,a,3,q,515889,dmhnav,%7C31250%7C.asp
Destefanis, J. (1998). Developmental milestones: Age 4. Retrieved May 29, 2012, from http://www.greatschools.org/parenting/social-skills/1126-developmental-milestones-age-4.gs
McLeod, S. (2008). Mary ainsworth: Strange situation. Simple Psychology. Retrieved May 30, 2012 from http://www.simplypsychology.org/mary-ainsworth.html
The Balance Mind Foundation. (2010). About pediatric bipolar disorder. Retrieved May 29, 2012 from http://www.thebalancedmind.org/learn/library/about-pediatric-bipolar- disorder?page=all