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Thursday, May 31, 2012

Case Study: Ricky R.

Today's case study will be about 8 year old boy who has a Dx of ADHD and how he is currently being treated.

Disclaimer: Certain information has been changed to protect the identity of this patient and is in accordance with the rules and regulations of HIPPA. To learn more about HIPPA, please click the link HIPPA.

Ricky is an 8 year old white Jewish male who resides in his parents home with two younger siblings 6 year old boy and 2 year old girl. He attends school in his community. He enjoys sports, history, and is in the school choir. Additionally, Ricky does have Dx of a learning disability which compounds the issue of him having ADHD. I have been seeing him for the past 2 years. He was brought in by his parents because he was unable to control his behaviors in school and at home. Ricky has been on medication from the psychiatrist to help him treat his ADHD. While working with Ricky, we would utilize play therapy,  learn coping skills to reduce ADHD, and behavior modification techniques to help him focus more on tasks that needed to be completed. During sessions he would have a finite amount of time to finish a task with a reward at the end of session. His parents and myself meet monthly to track his progress at home and school. At the end of last school year Ricky was assessed by the Jewish day school he was attending, which showed that he was not up to grade level on any of his subjects. Ricky's behavior continued to deteriorate socially and academically in school , but had improved at home with his parents. He was disrupting the other children which in turn Ricky started to be ostracized from his classmates.  In a meeting with Ricky's parents I had suggested that it might be a good idea for them to explore moving him from Jewish day school which has a double curriculum(learning bible, Jewish heritage, and Hebrew) to a public school and be in a special education classroom, may improve socially with peer like him, a shorter day and single curriculum. Initially, Ricky's parents had a lot of trepidation in switching him, but after explaining that at this point in his life he needs to feel that he is confident that he can succeed in school and have good peer interactions rather than him spiraling down academically just so he can be with Jewish kids and having the extra curriculum. I continued to explain that very often when you can eliminate one negative element from a child it has a positive effect on other areas of his life. 

That was 10 months ago...

Fast forward to his current functioning. Ricky will be completing his first year public school, not only has he caught up to grade level, he was mainstreamed for 2 classes in January. As reported by his parents he will be taken out of the special education class for the fall and put into a mainstream class. Parents reported that he is doing great socially, and he has not had any out of range problems (meaning no significant problems for A)a child and B) a child with ADHD)with his attention at home or in school. Parents reported that when an incident does occur they have been able to redirect him and he has been able to calm himself down and focus on using his coping skills.

In this case, it had more to do with the child and his needs academically and socially rather than the coping skills for his ADHD emotionally. While learning those skills were and are important for him, it was being able to recognize that although patients can be taught coping skills and other techniques, sometimes a change of scenery or in this case school had a trickle effect on his emotional and social needs.

Happy Thursday!

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