Disruptive Behavior-Angry Adolescent Childs

The adolescent population is often referred to as “young adults,” but in some ways, this is a misrepresentation. Adolescents are not children, but they are not yet adults either. This transition from childhood to adulthood often poses many unique challenges to working with adolescent clients, particularly in terms of disruptive behavior. In your role, you must overcome these behaviors to effectively counsel clients. For this Discussion, as you examine the Disruptive Behaviors media in this week’s Learning Resources, consider how you might assess and treat adolescent clients presenting with disruptive behavior Disruptive Behavior-Angry Adolescent Childs .
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Learning Objectives
Students will:
Assess clients presenting with disruptive behavior
Analyze therapeutic approaches for treating clients presenting with disruptive behavior
Evaluate outcomes for clients presenting with disruptive behavior
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide.
View the media, Disruptive Behaviors. Select one of the four case studies and assess the client.
For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.
Note: To complete this Discussion, you must assess the client, but you are not required to submit a formal Comprehensive Client Assessment.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the \”Post to Discussion Question\” link and then select \”Create Thread\” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
Post an explanation of your observations of the client in the case study you selected, including behaviors that align to the criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.
Read a selection of your colleagues\’ responses.
Learning Resources
Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 17, “Psychotherapy With Children” (pp. 597–624)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: You will access this text from the Walden Library databases.
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International Journal of Behavioral Consultation and Therapy, 9(2), 4–8. doi:10.1037/h0100991
Note: You will access this article from the Walden Library databases.
Koocher, G. P. (2003). Ethical issues in psychotherapy with adolescents. Journal of Clinical Psychology, 59(11), 1247–1256. PMID:14566959 Disruptive Behavior-Angry Adolescent Childs.
Note: You will access this article from the Walden Library databases.
McLeod, B. D., Jensen-Doss, A., Tully, C. B., Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2016). The role of setting versus treatment type in alliance within youth therapy. Journal of Consulting and Clinical Psychology, 84(5), 453–464. doi:10.1037/ccp0000081
Note: You will access this article from the Walden Library databases.
Zilberstein, K. (2014). The use and limitations of attachment theory in child psychotherapy. Psychotherapy, 51(1), 93–103. doi:10.1037/a0030930
Note: You will access this article from the Walden Library databases.

Required Media
Laureate Education (Producer). (2013a). Disruptive behaviors – Part 1 [Multimedia file]. Baltimore, MD: Author.
Laureate Education (Producer). (2013a). Disruptive behaviors – Part 2 [Multimedia file]. Baltimore, MD: Author.
Walker, R. (n.d.). Making child therapy work [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 95 minutes.
Optional Resources
Bruce, T., & Jongsma, A. (2010a). Evidence-based treatment planning for disruptive child and adolescent behavior [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 63 minutes.
Childhood disruptive behavior disorders form a major part of outpatient adolescent mental health referrals in the United States. Aggression and anger outburst leads the way in this respect. According to studies, childhood disruptive disorders impact the performance of patients in school as well as their interactions with other people. In other words, the social aspect of an adolescent’s life is severely impacted by these conditions. In the present case, an angry adolescent child will form the basis of the discussion. Specifically, a DMS-5 tool will be utilized to diagnose the particular childhood disruptive disorder. The condition will need to be accurately diagnosed owing to the fact that it shares characteristics with other conditions. Moreover, such a diagnosis precedes the formulation of an intervention strategy.

Assessment

The young adolescent client presents with symptoms of anger issues. She is disrespectful and has issues with following instructions. In addition, she has a “don’t care” attitude which may lead to financial loss or sometimes legal consequences for her parents. Further, the client displays lack of control over her anger, which is indicative of her inability to control her anger. The interview also reveals that the client’s outbursts are not premeditated and they do not serve any premeditated purpose. According to the DMS-5, the client’s symptoms are consistent with criterion E, C, and D of the Intermittent Explosive Disorder (Gresham, 2015). The differential diagnosis was buttressed by the fact that the client is 6 years old and that they demonstrate unique symptoms of the IED disorder Disruptive Behavior-Angry Adolescent Childs.

Therapeutic Approaches to Treating IED

The management of the IED that the client presented depends on various factors. To treat the client effectively, there needs to be a combination of cognitive behavioral therapy and psychotropic medication. The cognitive behavioral therapy is particularly impressive as it will help the patient to identify their impulses (Fabiano, 2016). The methodology aids one to increase their awareness of the anger and modulate the outbursts. In more specific terms, the nurse will apply the anger control training form of therapy. According to studies, the aim of this kind of therapy is to enhance emotional regulation as well as the social cognitive deficits in the patient. In the technique, the patient will be taught to monitor the emotional arousal that they undergo and utilize other techniques to control them (Bresin & Robinson, 2013). Given the nature of the outbursts, the child will be subjected to cognitive relaxation and reappraisal so as to modulate the elevated anger levels. Further, the training will also encompass making the patient to practice socially apt response regarding anger-provoking circumstances. The situations may include teasing or reprimanded by parents.

The client will be re-evaluated after four weeks to assess the progress of the condition. If the IED symptoms have not undergone remission, a psychopharmacological intervention may be included. Accordingly, Zoloft 50mg will be prescribed to the patient. The mediation will be given to the patient in the evening during bedtime. After prescription, the client will be monitored for her response to Zoloft. In some cases, certain clients do not respond to medication and as such, interventions need to be undertaken. In this case, since the client is already undergoing therapy, a reassessment will be conducted after four weeks. Depending on the response from the client, the dosage will either be increased or reduced. The purpose of doing this will be to ensure that the client considers the therapy to be working.

Therapeutic Approaches

        Employing the use of CBT is expected to enhance the remission of the disruptive behavior symptoms. First of all, the client will be expected to control her temper and significantly reduce her outburst. To do this, the anger training program will do a host of things. According to studies conducted on human subjects, the utilization of anger control training has resulted in the reduction of the patient’s aggression. During the interview, aggressive symptoms were evident from the manner in which she was replying to my probing questions. In addition, the usage of the CBT will lead to the reduction of conduct problem that is one of the symptoms of the disruptive behavior as expressed by the patient (Lebel, 2017). Particularly, the instances of rude replies and sometimes outright abusiveness as displayed by the patient will be addressed by the therapy. Additionally, the frequency of the expression of anger will be significantly reduced by the CBT therapy. This is fundamental as the patient was show to lash out at her parents and teachers, as well as schoolmates.

Moreover, the pharmacological therapy will also produce the required effect on the patient. Zoloft, the drug used in this intervention, contains a molecule known as sertraline. According to studies, this molecule blocks the uptake of serotonin by the neurons. Studies have revealed that it does this by blocking the reuptake of serotonin to into human platelets (Kim et al., 2016). By doing this, balance is restored in the serotonin levels in the brain, thus reducing anger outbursts. Thus, by using the drug Zoloft, the frequency of anger outburst will reduce even further Disruptive Behavior-Angry Adolescent Childs.

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Conclusion

Therefore, the existence of disruptive behavior symptoms needs to be treated with the desired sensitivity. Given that most of the conditions thereof share many of their symptoms, differential diagnosis using tools such as the DMS-5 has proven fundamental. Accurately diagnosing the disruptive behavior will pave way for the formulation of an effective intervention strategy. In other words, the disruptive behavior conditions are manageable.

References

Bresin, K., & Robinson, M. D. (2013). Losing control, literally: Relations between anger control, trait anger, and motor control. Cognition & Emotion, 27(6), 995-1012. doi:10.1080/02699931.2012.755119

Fabiano, G. A. (2016). Interventions for disruptive behaviors: Reducing problems and building skills. New York, NY: The Guilford Press.

Gresham, F. M. (2015). Disruptive behavior disorders: Evidence-based practice forassessment and intervention. New York, NY: The Guilford Press.

Kim, H., Li, H., Kim, H., Shin, S., Choi, I., Firth, A., & … Park, W. (2016). Selective serotonin reuptake inhibitor sertraline inhibits voltage-dependent K channels in rabbit coronary arterial smooth muscle cells. Journal Of Biosciences, 41(4), 659-666. doi:10.1007/s12038-016-9645-6

LEBEL, R. D. (2017). MOVING BEYOND FIGHT AND FLIGHT: A CONTINGENT MODEL OF HOW THE EMOTIONAL REGULATION OF ANGER AND FEAR SPARKS PROACTIVITY. Academy Of Management Review, 42(2), 190-206. doi:10.5465/amr.2014.0368Disruptive Behavior-Angry Adolescent Childs.

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