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Assessment and Practice with Adolescents and Children

1259 words | 5 page(s)

This case involves a short clip on the Dr. Phil show, where 10 year old boy gets into an argument with his mother and eventually slaps her in the face. This is a difficult case to assess because there is obviously a more complex family history at play than what is shown in the short, edited segment. From information found on the case history and the clues that are contained in the video, it is possible to glean some relevant facts that could help in the intervention. This case is complex and would require more time and information to understand the details. The following summarizes what is known about the case.

Noah is a 10 year old boy who appears on the show with his mother, Wendy. Wendy is a single mom who lost her daughter, Olivia, three year earlier to brain cancer. It was at that time when Wendy says that Noah’s behavior spiraled out of control. He has had numerous discipline problems at school, including striking Principal (eBaum’sWorld.com, 2014). CPS was involved at the time of the taping of the show. Throughout the course of the conversation it is revealed that Wendy grew up in a home with “real” abuse.

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Throughout the video, Noah tries to dominate the conversation, interrupting his mother and telling her to, “shut up” several times. A theme of feeling out of control runs throughout Noah’s dialogs. At one time he says she treats him like a “dog”. Noah feels that his mother does not pay attention to him. As the problems began soon after the death of Noah’s sister, it may be that they both have unresolved grief issues.

Noah accurses his mother other of physically abusing him numerous times. He claims to have a picture of a bloody nose given to him by his mother. Throughout the conversation Noah tries to paint himself as the “innocent” victim or an “evil” abusive mother. Once again, this fits in the theme of a feeling of a lack of control on Noah’s part.

Wendy complains that she does not like his lack of respect and challenging attitude. She feels that he tries to “one up” her with his verbal antics. It is apparent that he is trying to gain control and she feels that his violates her boundaries when he does. Wendy has several unresolved issues. The first is her grief over losing her daughter three years earlier. Even though it was not mentioned, there is grief or issues stemming from a broken marriage because she is single. It can only be assumed that this marriage break up occurred after Noah was born and depending on his age at the time, he may have issues that need to be resolved from that area of life. Wendy mentions being a child of abuse herself and as such, she may have learned maladaptive responses and coping patterns that she unintentionally carried into her own marriage and family. These may be subconscious learned patterns of which she is not aware.

Noah has self-esteem issues that are expressed by his attempts to gain control, meaning that he feels out of control. Wendy expresses remorse that she has not been the mother she once was before her daughter’s death. This further supports unresolved grief issues. The mother does not appear to be coping with the CPS case because she admits that she had said some things in anger since the case started. This may represent a coping pattern learned in her childhood home.

Throughout the video, Noah sits and leans forward in his chair. He sits with his legs wide apart, trying to make himself look bigger. Wendy addresses him directly and maintains eye contact the entire time. When Noah goes into his rants on control he looks around the room and does not meet her eyes, or anyone else’s eyes. When Noah wants to gain the sympathy of the other adults in the room, he uses a very sweet voice and softened body language. Noah lacks the ability to label and cope with his feelings. His slap of his mother was an attempt to gain control. Noah is overweight for his age, which may be a result of or contribute to his self-esteem issues. It may be noted that Noah slapped his mother hard, but when he recounted the scene and tried to justify his actions, he called it a “light tap” to show her how it feels. After the show when asked why he was glad he was in the intervention Noah replies “that he is glad that he is there so that “his Mom might finally be recognized for the abusive mother that she is.” Dr. Phil notes that the comment seems insincere and rehearsed. Noah tries to control and manipulate others.

Intervention Plan
The intervention plan must achieve two objectives. It must reduce risk and promote protection (Allen-Meares, & Fraser, 2004). One of the most difficult dimensions of adolescent aggression is determining when it is within the bounds of normal family dynamic and conflict, and when it is abusive. Abusive acts usually include aggressive behaviors in puberty (ages 6-11), a child that has difficult expressing emotions (especially love), a lack of remorse or guilty feelings for their actions, a child that shows a lack of social skills including empathy, and interactions that are based on an egocentric interest (Estevez & Gongora, 2009). The goal of intervention is to reduce the severity and frequency of the violence. Interventions that include the development of psychosocial skills, the development of emotional skills, interpersonal skills, and problem solving were found to be the most effective in reducing aggressive behavior (McGuire, 2008). Reducing parental stress was found to have a positive effect on reducing aggressive behaviors in adolescents (Fossum, Handegard, Martinussen, & Morch, 2008).

Intervention will include both group and individual therapies for both of them. Wendy will attend individual therapy to help her resolve early childhood abuse issues, grief over her daughter, and the loss of her former marriage. During the evaluation process, she will receive evaluation from a social worker to make certain that she has all of the necessary supports. She will also learn effective strategies for enforcing boundaries and to learn appropriate ways to respond to Noah’s behavior.

Noah will attend individual therapy to lean to lean to label and handle his emotions appropriately. Individual therapy will work on building self-esteem and resolving grief issues over his parent’s divorce and the loss of his sister. Noah will work on developing appropriate coping mechanisms and therapy to help him resolve his need to control. He will work on developing empathy for others and how to respect boundaries. Both Wendy and Noah will attend therapy together to work on communication and ways to respond to each other without escalating the behavior.

    References
  • Allen-Meares, P. & Fraser, M. (2004) Intervention with Children and Adolescents: An Interdisciplinary Perspective. Pearson Publishing.
  • EBaum’sWorld.com. (2014). Dr. Phil – Brat Camp – Out of Control Children! – Part 3. Video. Retrieved from http://www.ebaumsworld.com/video/watch/882930/
  • Estevez, E. & Gongora, J. (2009). Adolescent Aggression Towards Parents: Factors Associated and Intervention Proposals. In Quin, C. & Tawse, Scott (Eds). Handbook of Aggressive Behavior Research pp. 143-164. Retrieved from https://www.uv.es/lisis/estevez/nova.pdf
  • Fossum, S., Handegard, B., Martinussen, M. & Morch, W. (2008). Psychosocial interventions for Disruptive and aggressive behavior in children and adolescents: A Metaanalysis. European Child and Adolescent Psychiatry. 17: 438-451. Retrieved from http://uit.no/Content/242546/meta-analyse%20publ%20i%20ECAP.pdf
  • McGuire, J. (2008). A review of effective interventions for reducing aggression and violence. Philosophical Transactions of the Royal Society. 363 (1503): 2577- 2597. Retrieved from http://rstb.royalsocietypublishing.org/content/363/1503/2577.full

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