Psychology report written on me.

People Participating

(People have fake names)

James - John

Rachel - Robyn

Brent - Braden

Frances - Mum

Peter - Dad

Lena - Arlene

Cherry - Scarlett

Referral

Cherry was referred by her Home base LA and her mother as a result of her IEP meeting in March 2009. They were concerned about her attendance at school and her apparent lack of achievement. The intern sought and was given consent to use this case as part of her university work from Cherry, her parents, her LAs and the school. A referral form was given to her Home base LA. This was to help refine the referral issues. Cherry had been not attending school regularly for over twelve months. When she was at school, she did not always attend class. It was logical that her academic process would be poor because she was not at school enough.

Background

Frances reported that Cherry had always been a difficult child. Cherry was a fiddly fingers and prickly when Frances tried to cuddle her. Cherry had to have what she wanted and caused significant embarrassment to the family when they went or had visitors at home. Cherry used toileting, eating and sleeping to control her parents. They could never rely on Cherry to behave. Cherry had a particularly difficult time at Intermediate School. Her parents were concerned for her in transitioning to secondary school. As a result she was assessed at Seabrook McKenzie. The referral for testing was because of behavioral and social difficulties (Seabrook McKenzie Report, 1 December 2007). That assessment indicated that Scarlett's intellectual functioning was in the average range. Her scores varied from superior (Digit span and coding) to Low Average (picture concepts). The Conner's Rating Scale was also administered. Several categories were very elevated including: oppositional, hyperactivity, social problems, psychosomatic, emotional liability, restless-impulsive, DSM-IV inattentive and hyperactive-impulsive. A further assessment with a pediatric psychiatrist, which took place in December 2007, Dr Colin Watts, resulted in a diagnosis of Oppositional Defiance Disorder (ODD) and borderline Attention Deficit Hyperactivity Disorder (ADHD). She was given quetapel fumurate, an anti-psychotic medication, to "improve mood stability and assist with sleep onset" (Children's Special Centre, 19 Feb 2009). This had followed an unsuccessful trial of clonidine. The psychiatrist also noted "significant parent child relationship difficulty" (Children's Special Centre, 19 Feb 2009).

Cherry was truant for a substantial part of Year 9. She found it very difficult to get out of bed in the morning. She felt this was due to the medication that left her feeling tired and 'spaced out' in the mornings. She reduced the medication to 1 tablet and this had a marked effect on her ability to get up and to school. Her academic progress was limited because of this. She did not connect with her Home base Learning Advisor (HBLA) and this was a factor in her attendance.

Assessment Plan

Although the WISC assessment report was available, it was decided to administer the WJ-III Achievement and Cognitive Assessments. These would provide confirmation of Cherry's potential and also her level of academic functioning, which may have been impacted by her Intermediate schooling and her truancy. Additional assessments in literacy and numeracy would also be carried out if required.

The Achenbach Assessment was administered to assess Cherry's behavioral situation. In addition, selected questionnaires from Measuring Violence-Related Attitudes, Behaviors, and Influences Among Youths: A compendium of Assessment Tools (Second Edition) were administered to assess the areas of behavior, motivation, self-esteem and family functioning.

Interviews would be carried out with Cherry, her parents, her teachers and Lena, a person Cherry described as her second mother.

Assessment

1. Woodcock Johnson III - Tests of Cognitive Abilities

Woodcock Johnson III - Tests of Achievement

Cherry's overall intellectual ability is in the range of standard scores. Her verbal activity is in the low average range of standard scores compared with others her age. Her thinking ability is in the average range and her cognitive efficiency showed significant strength. Her working memory is in the very superior range and is significantly higher than predicted by her general ability. Cherry's ability to recall and relearn previously presented material is low average. Her oral language skills are high average and her academic skills are within the high average range. Her fluency with academic tasks is within the low range. Cherry scored in the superior range for brief writing and in the high average range for broad written language and written expression. Her standard scores are low average in broad reading and maths calculation skills. Overall, Cherry is performing at or above predicted levels in reading, mathematics, written language and oral language. The area of concern is broad reading where Cherry's achievement was significantly lower than predicted.

2. Achenbach System of Empirically Based Assessment (AESBA).

This is an individual assessment of adaptive and maladaptive functioning. Cherry's behavior had been described as difficult and she had been diagnosed with ODD and borderline ADHD. This assessment used multiple informant - teacher, parent and child report forms to capture information about an individuals behavior at home and school.

Two forms were completed and analysed at the time of writing - the Youth Report Form (YRF) and the Teacher Report Form (TRF). Cherry's parents had been given a copy of the Child Behavior Checklist (CBCL) but had not returned it to the intern. A summary of the results was complied (see attatched). There was general agreement between the YRF and TRF. Cherry scored in the normal range for most items on both scales and in social competency. In the syndrome scales she scored within borderline clinical range for Rule Breaking on both reports. In the DSM IV Orientation Scales Cherry was in the borderline clinical range for Affective Problems and Attention Deficit/Hyperactivity Problems (ADHD). This was consistent across both report forms. In the area of ADHD there were more problems in the hyperactive-impulsive part of the sub-scale.

3. Measuring Violence-Related Attitudes, Behaviors, and Influences Among Youths: A Compendium of Assessment Tools (Second Edition)

A selection of measures were chosen that focused on aspects that had become apparent during resting and interviews. These were used to explore possible dimensions.

A. Children's Desire for Control

This scale measures the desire for control and the endorsement of aggressive strategies for gaining control. On a four point scale where 1 is low desire for self control and 4 is strong desire for self control, Cherry scored 2.4. This is at the midpoint of the scale and indicates a balanced desire for self control.

B. Seattle Personality Questionnaire

This scales measures self-reported psychological symptomology. There are four subscales: Anxiety, Conduct Problems, Somatisation, and Depression. The lowest score is 1 and the highest score is 3. Cherry's scores were: Anxiety 1.57, Conduct Problems 1.28, Somatisation 1.2, and Depression 2.0. These results were at variance with the AESBA results.

C. Attitude Toward Delinquency - Pittsburgh Youth Study

This scale measures the acceptance of engaging in delinquent behavior. Cherry scored 5 out of a possible 33 indicating low acceptance of delinquent behavior.

D. Commitment to School - Seattle Social Development Project

This scale measures feelings about the importance of school and course work. Cherry scored 16 out of 30 indicating some difficulties regarding her commitment and involvement in school.

E. Stressful Urban Life Events Scale

This scale measures stressful life events. There were five subscales: hassles, life transitions, circumscribed events, violence, and school problems. The highest score was 1.0 and the lowest possible score was 0. Cherry scored 0.2 for hassles, 0 for life transitions, 0.67 for circumscribed events indicated exposure to a number of discrete events that Cherry would have found stressful, such as injury or death of someone close to her.

F. Parental Child Attachment - Rochester Youth Study

The items on this scale indicate the degree of warmth and lack of hostility in the parent-child relationship. There are two questionnaires: one for the parent and the other for the child. The child questionnaire was administered. The range for the result is 1-4, with the higher score indicating a higher level of attachment. Cherry scored 2.45.

Analysis

Dimensions

1. School Achievement

2. Attendance at School

3. Diagnosis and Treatment of ODD and ADHD

4. Relationship with Parents

5. Running Away From Home

1. School Achievement

Cherry has made minimal progress at school over the last eighteen months. In most instances this has not been due to a lack of ability or to difficulties with learning. Cherry does not attend classes often enough to grasp what is being taught and to have a continuity in her education. Her AsTTle results from the beginning of 2008 show that she was functioning at level 4 of the curriculum in reading, writing and mathematics.

2. Attendance at School

Cherry's attendance at school in 2008 was bad. This included... half days absent with no explanation, days absent with an unjustified reason and half days absent for medical reasons. Cherry was adamant that her attendance was affected by the medication she was taking to help her sleep. She reduced the dosage by half towards the end of 2008 and she reported an improvement in her ability to get up and function the next day. She said the drug made her feel remote and spaced out. She has now changed to an anti-depressant. Cherry reported that she still had problems getting to sleep and this often leaves her feeling out of sorts, tired and lacking in energy during the day.

In term one 2009, Cherry attended school for 69 half days out of 76 that were marked. She was absent for 2 and a half days for illness, and there were five half days where there was no explanation of her absence. This was a significant improvement on the previous year. However, attendance at school is only part of the picture. Cherry's attendance in class was also explored. In both blocks, Cherry was enrolled in a full schedule of six classes, the Wednesday morning Inspire progamme and Sport. These included Enligh, Maths, Health, Philosophy and arts courses.

It was clear the next step for Cherry was to choose courses that she wanted to learn something from to encourage attendance. She may also benefit from some goal setting so she can tie the relevance of the courses to her own personal goals. Cherry can see the link between what she does at school and her future. She needs help to make the connection at the day to day level.

3. Diagnosis and Treatment of ODD and ADHD

Cherry discussed the diagnosis openly. She does not think that she has ADHD at all but can see that she is oppositional in some ways. She hates her medication and would rather not take anything.
Cherry showed that she was self aware and that she could manage her behavior at school. She showed some insight into the motives and reactions of other people. During assessment she was compliant, responsive and worked hard. This may have been due to the one to one setting and the structured nature of the tasks.

4. Absent from Home

Cherry asked me to talk with another parent, Lena, whom she regarded as her second mother. Lena had done the initial tests with Cherry. Cherry often stayed with the family who lived around the corner from her house. She was friendly with the boys who went to the same school.

Cherry talked about running away from home and staying away from home several times. Lena indicated that Cherry would just turn up, sometimes late in the evening, and stay over. Sometimes this was arranged, especially at the weekends. Lena made sure that Cherry's parents knew where she was. Cherry was often reluctant to go home and had said she would rather live at Lena's house.

Lena said that Cherry sometimes stayed at other places. She was concerned because she though some of these places were unsupervised and unsafe for a 14 year old. Lena had found Cherry wandering in the nearby park late at night after she had left home.

Frances said Cherry was very difficult. She would 'get in their faces' and yell at them. She used the cellphone to keep track of where Cherry was. Frances said Cherry was unpredictable and she never knew when she was going to fly off the handle. It was difficult to plan meals and family things because Cherry would often not turn up. This was clearly a frustration for Cherry's family.

5. Relationship with Parents

As indicated in the psychiatrist's letter, there was significant difficulty in the relationship between Cherry and her parents. Cherry has a younger brother who gets on well with his parents. Cherry does not like him and thinks her parents favour him because he is clever. Frances finds her son easier to manage and to be close to.

Frances said that they found Cherry very difficult. She was embarrassing and they had lost friends because of what she would do and say in front of them. She could not take Cherry to a playgroup when she was little because she kicked the other children. Cherry was obviously a very difficult child to manage an this had created huge stressed on the family.

Cherry expressed a range of feelings about her parents. She was angry because she did not like the way they lived. She felt sorry for her mother who was going blind. She was jealous of her brother. She felt guilty about the way she behaved at home and was sorry she caused so much trouble. She wanted to have a better relationship with them but did not know how to make it right. Cherry desperately wanted to feel loved by her parents.

Cherry disclosed to the psychologist that her parents had been hitting her. She showed a bruise on her upper arm and that had been caused when her father had pushed her onto the couch. She said he had hit her in the head. Cherry said her mother had burned her leg with the hair straighteners and she still had the scars. She said this had been going on for as long as she could remember. She said her mother kicked her when she was about four.

It was apparent that the difficulties with Cherry's behavior, attendance at school and academic progress were all linked to the situation with her parents. The first concern was for her safety. There was also a concern for her family because of the stress they must have been under looking after Cherry.

6. Intervention

With Cherry's permission, the psychologist discussed the disclosure with the school counselor who had also been working with Cherry. In a meeting with Cherry, safety plans were put into place to ensure she would be okay until a notification could be made to CFY. The intern took Cherry to Lena's home to ensure they were aware of the situation and to ensure they were prepared to look after Cherry in the meantime.

The school procedures for a disclosure of abuse were followed. A meeting was held with the Director and a notification made to CYF. A follow up phone call was made to Lena.

What I think is wrong with this

For starters, I was never diagnosed with ADHD, only elements of ADD, and I'm sick of getting all these fucking labels stuck on me, its complete and utter bullshit. No body ever found me walking through a park late at night, and I'm not 'academically underachieving'. Back then I had 50 level 1 credits in year 10, not even supposed to have any at that stage, yet the report makes me out to be some 'rule breaking' little bitch. I never kicked another baby at playcentre, and I never made a statement saying I was jealous of my brother.

There are also a lot of spelling errors, and I do not think this report sums me up in any good way what so ever. It doesn't make sense, lacks in the truth, and needs to be rewritten.

Being diagnosed with having a mind is fucked up. Everyone is fucking insane.