Child and Adolescent Psychopathology Assignment

Name(s):

 

Child and Adolescent Psychopathology Assignment for 2/1/19

This assignment should be completed after reading Case 3: Neesha Wilson in the Wilmshurst book.

 

 

1. A) Identify which aspects of Bronfenbrenner’s model (figure above) are factors in Neesha’s case.

 

 

 

 

 

 

 

B) Also indicate which factors interact with each other and briefly explain how they might interact with each other.

 

 

 

 

 

 

 

2. Which of the items you identified for Q1 are risk factors?

 

 

 

 

 

3. Which of the items you identified for Q1 are protective factors?

 

4. Identify at least 3 ways in which Neesha’s mother’s depression has impacted her daughter.

 

 

 

 

 

 

5. Describe one strategy/intervention that you would recommend for Neesha’s mother to try at home.

 

 

 

 

 

 

 

6. Describe one strategy/intervention that you would recommend for Neesha’s teacher to try at school.

Case 3 Neesha Wilson Phoenix Rising Risks, Protective Factors, and Psychological Well-Being

Neesha Wilson, a 10-year-old African American girl, was referred for assessment to the school psychologist as a result of a child study team meeting held at the school in May. Presenting problems included poor school progress and escalating behavioral concerns. It was the school’s impression that Neesha might qualify for special education assistance as a child with an emotional disorder. Currently, Neesha has an older brother, Tyrone, who is attending an alternate school program for children and youth with severe emotional disturbance.

Developmental History/Family Background

The school social worker completed Neesha’s initial work-up just prior to the end of the academic term; intake information is summarized as follows:

Neesha lives with her 15-year-old brother, Tyrone, and her mother in a two-bedroom apartment. The social worker described the apartment as tiny but very well kept. Neesha has her own bedroom, and Tyrone sleeps on the couch, which folds out into a bed. The social worker noted that it was difficult to book an appointment with Mrs. Wilson, who was reportedly working two jobs: cleaning offices and working as a hairstylist. Mrs. Wilson graduated from hairstylist classes last year. Although her career as a hairstylist has a lot of potential, she is only beginning to develop clientele. She also works part time cleaning offices. Despite the lack of financial resources, the children were clean, well dressed, and did not miss any meals. The children were on the free-lunch program at the schools. According to Mrs. Wilson, Neesha’s early history was unremarkable and motor and language milestones developed on schedule.

An immediate concern of the social worker’s centered on who cared for the children when their mother, Tanya, had to work evenings cleaning offices. Tanya stated that it was not a problem for her because she would either send the children to her sister’s apartment a few blocks away, or have a cousin who lived in the building check in on the kids. Also, Tyrone was 15, so he was capable of watching his sister, although she preferred to have an adult nearby, given Tyrone’s behavior problems.

Neesha’s mother described her as an easy baby and said that she never really had any problems with her. She added that it was Tyrone who was giving her all the problems, not Neesha. The family had struggled since her husband, Walt, left the family about 3 years ago, when Neesha was in Grade 1. In the past two years, Walt has had virtually no contact with the children. He moved in with his girlfriend and their one-year-old baby and recently moved to another state. Neesha was very upset with the marriage breakdown and misses her father very much. Neesha visited with her dad and his new family, initially, but was very disappointed that the visits were neither consistent nor more frequent. Neesha did not like Walt’s girlfriend and felt that her father was more interested in the new baby than her. According to Tanya, Neesha often talks about wanting to visit her father and continues to set herself up for disappointment. Tanya blames Walt’s lack of involvement with the children for Tyrone’s problems, which became more severe after Walt left.

When Walt moved out, Tanya could no longer afford to live in the apartment they were living in. Tanya described the previous 2 years as very difficult for her and the kids. As Tanya spoke, the social worker noted in the file that the mother’s affect was very flat. She also seemed preoccupied with her financial situation and said that at times she just wasn’t sure how she would make the rent. They have struggled to survive financially, and Tanya often gets depressed and—if she isn’t working the evening—either goes to bed early or cries herself to sleep. On these occasions, Neesha is very quiet and tries to comfort her mother. Tanya said that when she woke up the other morning, Neesha had placed a handmade card on her pillow. The card was decorated with hearts and bows and huge letters: “I love you, Mom. Neesha.” Tanya said she didn’t understand why Neesha was doing so poorly in school because she seemed to love to “play school” on the weekends and in the evening. When asked whether Neesha has demonstrated any behavior problems at home, Tanya said she is more like a little mother than a kid and has no behavior problems at all. Her brother is the problem; Neesha is more like a little adult. She described Neesha as a sweet and loving child who always tries to please.

The social worker expressed her concern to Tanya about her own symptoms of depression and fatigue and wondered if Tanya might see her physician for a referral to talk to a counselor. The social worker stated that she was concerned because Tanya seemed overwhelmed by all the financial stresses the family faced that seemed to be taking their toll on her emotionally. However, Tanya was quick to say that the extended family was very supportive and that her two sisters were always there for her to talk to when she needed it. She also said that her church was a continued source of comfort and support for herself and the children. In addition to information obtained from the clinical interview, the social worker also had Tanya complete the Behavioral Assessment System for Children (BASC-2).

In August, at the beginning of the new term, the school psychologist completed a review of Neesha’s cumulative school record and obtained teacher ratings (BASC-2) from her previous years’ teachers, which were on file in the guidance office. Neesha’s school record contained the following additional information. Neesha began her formal schooling at Franklin Elementary School but transferred schools midway through the Grade 1 program. She completed Grade 1 and Grade 2 at Vista Springs Elementary. She has been attending Heartfield Elementary since her enrollment in the Grade 3 program. Neesha is currently repeating the fourth grade. Neesha’s records reveal that her Grade 3 teacher was concerned because Neesha was repeatedly falling asleep in class. Because Neesha seemed overly fatigued, her mother took her to the family physician to check out any possible physical causes; however, no medical reason was evident to explain her fatigue. Last year, Neesha was absent 15 days. On the days she attended school, Neesha was late more than one third of the time (51 days). The school counselor had written a summary report based on her observations of Neesha in the classroom, toward the end of the Grade 4 program, when the paperwork was being collected for her assessment in the fall. The notes indicated that Neesha was off task (daydreaming, looking out the window, staring out into space) for the majority of time that she was observed. The observation supported teacher comments that Neesha often failed to complete her seatwork and handed in assignments unfinished. During another observation session, the counselor recorded that during a 25-minute seatwork session, Neesha completed only 2 out of 8 comprehension questions for a story read aloud in class. Her teacher also reported that, at times, Neesha’s lack of attention to task could also result in class-disturbing behaviors such as humming, playing with articles on her desk, and socializing.

As part of the referral process, in addition to notes on classroom observations, the teacher also was asked to record what interventions were attempted and to comment on the success of these attempts. Interventions included sending a daily agenda regarding Neesha’s behavior for home signature, providing extra time for task completion, and seating her closer to the teacher’s desk. However, the daily agenda often was returned unsigned, since her mother was sleeping, and providing extra time did not increase her productivity. In all, the interventions generally were not successful. Ultimately, the decision was made to have Neesha repeat the Grade 4 program, since she had not completed any assigned tasks during her Grade 4 year, and to place her on high priority for a comprehensive assessment early in the fall term.

The school psychologist saw Neesha for an initial assessment session, early in the fall term. Neesha was very well groomed, with matching accessories and her hair stylishly braided in a way that must have taken hours to complete. When asked about her hair, Neesha was very proud to say that her mother had done it for her, and that her mother was a very good hairdresser. Neesha was very polite and cooperative. Neesha’s responses and demeanor suggested a precocious maturity for her 10 years. The psychologist felt that Neesha tried her best on all tasks presented but questioned the validity of overall intellectual scores.

Reason for Referral

The school requested assessment due to Neesha’s escalating academic difficulties and increased behavioral problems (irritability, moodiness, and beginning to strike out at other children). There were concerns that Neesha might warrant placement in a program for children with emotional problems.

Assessment Results

Information concerning specific assessment instruments and the interpretation of standard scores and T scores can be found in Appendix C.

Responses to the Wechsler Intelligence Scale for Children (WISC-V) revealed Neesha’s overall intellectual score of 92, which was within the average range (IQ range 87–98). However, there were several indicators to suggest that this score was likely an underestimate of her “true potential.” Neesha’s mature conversational tone, insight, and academic levels obtained on standardized testing suggested intellectual functioning more appropriately suited to the upper average to high average range. Based on her overall obtained score, Neesha performed in the average range of ability at the 30th percentile when compared with children her age. There was minimal difference in her scores for the Verbal Comprehension Index (VCI, standard score of 90), the Visual Spatial Index (VSI, standard score of 95), and the Fluid Reasoning Index (FRI, standard score of 93). Based on these scores, it would be anticipated that Neesha should be performing approximately at grade level academically. An analysis of the individual pattern of test results indicated that Neesha had relative strengths in the areas of the Working Memory Index (WMI = 100), which involves the manipulation of mental information and short-term working memory, and Processing Speed Index (PSI = 103), which measures speed of copying and scanning information. An analysis of the individual pattern of subtest scores indicated that Neesha had relative strengths in the area of visual analysis and reasoning (picture concepts) and recall for letter and number sequences. Weaknesses were noted in vocabulary development, social judgment, and part-to-whole visual organization (block design).

Academically, according to the Woodcock Johnson Test of Achievement, Neesha’s current functioning levels were far in excess of her current grade placement and also exceeded predicted levels according to the WISC-V (which was considered as an underestimate of her intellectual potential). Overall, Neesha was performing at a Grade 7.2 level in Broad Reading (age score of 12.7), Grade 5.8 level in Broad Math (age score 11.4), and Grade 7.9 level in Broad Written Expression (age score 13.2). Overall, Neesha was achieving in the high average range when scores were compared with those of other children her age who would be enrolled in a regular Grade 5 program. When compared with other children enrolled in a regular Grade 4 program (which Neesha was currently repeating), her scores represented functioning in the superior range.

Neesha was cooperative during the clinical interview and provided thoughtful and conscientious responses to the interviewer’s questions. When asked what types of things or situations made her feel happy, sad, angry, or frightened, Neesha provided the following information. Neesha stated that “compliments, surprises, and visits with her Dad” were all things that could make her “happy.” She said she felt “sad” when kids threaten her or people say bad things about her or her family. She also stated that she gets very sad when her mother cries because she doesn’t know how to make it better.

Neesha looked sad as she spoke about her mother, and her voice trailed off as she swallowed hard. Neesha admitted to feeling angry and upset when her older brother (15 years of age) hits her, and she is “frightened” when she visits her aunt’s neighborhood, because the kids are loud and scary. In response to what worries her presently, Neesha said that she is worried that she won’t be able to advance to the fifth grade this year. She said that she asked her mother to talk to the principal because she is working very hard and wants to go to Grade 5. She said she did not want to be in Grade 4 again, and she is very afraid that the kids will start being mean again and call her names like they did last year. She said she did not want to get into trouble this year like she did last year.

When asked why she was falling asleep in class, Neesha said that in the past she had lots of problems falling asleep but added that was 2 years ago and things were different then. She said that at that time she would come home from school very tired and fall asleep after dinner. Then she would wake up at night and not be able to go to sleep again. She said that she has stopped taking naps in the afternoon and now she doesn’t wake up at night anymore. Neesha volunteered that she also worried a lot about things and that sometimes when she worries she has a hard time falling asleep. Not so much now, but it was bad then because she missed her dad and wanted him to come home. She said that last year she got in trouble for being late so many times, but it was hard to wake up. Neesha said that she was tired and had trouble getting herself ready for school. Her mom was sleeping late because she was working more nights cleaning the offices. Neesha said it was a very hard year. She was tired and cranky and just couldn’t seem to concentrate on her work. She said she would read a page and then not remember what she read. Neesha said she got so far behind that she just gave up. She was also having problems with the other girls in the class, who were starting to tease her about sleeping in class and not doing her work. She said they called her names like “Sleepy” and “Dummy.” She said that at first it made her very sad, and then it made her very mad. That’s when she started to hit them to make them stop. When I asked what made the difference this year, Neesha said, for one, she now has an alarm clock. She sets the clock and lets her mom sleep in. The school bus picks the kids up on the corner, so she just goes and waits with the other kids who live in the apartment building. When asked about schoolwork, Neesha stated that she was very proud of her reading ability and said that she is now concentrating on finishing her work and that keeps her going.

Neesha completed several self-report inventories. Overall response to the Revised Children’s Manifest Anxiety Scale (RCMAS-2) revealed total anxiety to be within normal limits. However, there was a significant elevation on the Physiological Indicator scale, and Neesha endorsed several items indicating a generalized heightened state of arousal often associated with stressful conditions, such as trouble getting her breath, feeling sick to her stomach, and hands feeling sweaty. She also admitted to worrying a lot of the time and having problems falling asleep. An elevated validity scale (the Lie scale on the RCMAS) was suggestive of Neesha’s tendency to try to project a good image and suggesting that perhaps her anxiety was more of an issue than Neesha was letting on.

Neesha’s responses to the Children’s Depression Inventory (CDI-2) revealed overall depression level to be within the norm when compared to girls of a similar age. However, the elevation on the Negative Mood scale was significant, indicating problems with sleeping, fatigue, and worry about aches and pains. Neesha also completed the Personality Inventory for Youth (PIY), a 270-item questionnaire that assesses emotional and behavioral adjustment and family characteristics and interactions, as well as school adjustment. The instrument also includes validity scales that identify a respondent’s level of consistency and defensiveness. Neesha’s scores on the validity scales suggested that her profile was an honest attempt to reflect her current emotional and behavioral concerns. Scores indicated normal concerns typical of girls her age in most areas. However, consistent with the RCMAS, Neesha endorsed a significant number of items indicating somatic concern (T = 73). Scores in this range suggest a large and varied number of somatic symptoms and health concerns, such as fatigue, headache, stomachache, back pain, dizzy spells, trouble breathing, and the like. Results of this kind are often seen in children who worry about and are preoccupied with illness and may become emotionally upset when they are sick. Often these symptoms represent the physical aspects of anxiety and tension. Neesha’s particular pattern of endorsement suggests that symptoms are likely connected to feelings of psychological distress within the home.

Projective assessment was also conducted using the Robert’s Apperception Test, a series of pictures that are used as prompts for children’s stories. The characters in Neesha’s stories revealed difficulties in the following areas: conflicts with siblings, fear of being punished for doing something wrong, fear of being ill, and concerns regarding school performance. Family matters included a mother having a new baby and a young girl being a bridesmaid for her parents’ wedding. Neesha’s drawings for the House–Tree–Person indicated a positive openness to communication and were generally free of suggested pathology.

Two of Neesha’s teachers from the fourth grade last year, her current teacher, and her mother completed the Behavioral Assessment System for Children (BASC-2). It should be noted that although the BASC-2 suggests that rating be conducted by individuals who have known the child for at least 6 months, the desire to have a current behavioral rating for comparison violated this suggestion since her current teacher has known Neesha only since the beginning of August (less than 2 months). Therefore, results should be interpreted with caution. The BASC-2 is a comprehensive measurement of common behavioral and emotional problems in children. Ratings of children are interpreted to indicate behavioral concerns that are normal, at risk, or clinical. Behaviors falling within the at-risk range represent an emerging problem area that needs attention but does not warrant a formal diagnosis, while behaviors within the clinical range are problems that warrant attention and intervention.

Ratings are based on the observations of informants in different situations, and it is not unusual for children to behave differently in various situations. Therefore, inconsistencies between informants are not unusual. According to Neesha’s teachers last year, there was agreement in several areas on the BASC-2 ratings. The two teachers rated her behaviors as clinically significant in the following areas: Aggression (physical and verbal), Conduct Problems (rule-breaking behaviors), and overall Externalizing Problems. They also agreed that the following behaviors were at risk: Attention Problems, Leadership, Social Skills, and Study Skills. At-risk or clinically significant elevations were also noted for Composite Adaptive Skills (Adaptability, Social Skills, Leadership, Study Skills). Neesha’s current teacher and Neesha’s mother have indicated all behaviors currently to be within the normal range.

In the final assessment session, Neesha appeared very positive about her school successes this year and said that she was working very hard to go to the next grade level. When asked if she would like to meet with the school psychologist once in a while, just to talk about her worries, Neesha said that she would like that very much. As she left the office, she turned and thanked the psychologist for working with her, and added, “You know, sometimes, it’s hard being a kid.” When Neesha’s mother came to talk to the school psychologist about the test results, the psychologist mirrored the social worker’s earlier concerns about the mother being depressed and preoccupied. Affect was very flat despite the excellent news she was receiving regarding her daughter’s academic skills and behavioral turnaround. Her mother reported that what Neesha had accomplished, she had done on her own. She stated that Neesha had received no help from her. Mother appeared preoccupied with the interview making her late for work and asked if she could please leave quickly.

Postscript

Three weeks later, at 10:00 a.m., the school principal received a call from Neesha’s mother, who asked that her daughter not be sent home from school because she was going to kill herself. As she spoke on the telephone, she explained that she was holding a loaded gun to her head and that she had to do it, because she was not going to make this month’s rent. She could not take it any longer, but she did not want Neesha to come home and find her dead.

While the guidance counselor continued to keep the mother talking, the school principal contacted the police, who apprehended mom while she was talking on her cell phone from her car in the driveway of the apartment building. The loaded gun was on her lap. Mother was Baker Acted (taken into custody due to fears regarding danger to self) and taken to the local psychiatric facility. Currently, mother is on medication for depression.

Issues, Trends, and Treatment Alternatives

Considering Neesha’s case within the framework of developmental contexts and environmental influences, there are several risk factors that are affecting her development that are not within Neesha’s immediate control, including poverty, her mother’s mental illness (depression), and living with a sibling who has severe emotional disturbance.

Case Formulation

Unlike the other two cases presented in this introductory section, developing a case formulation for Neesha requires thinking outside the box. Neesha does not present with enough symptoms of depression or anxiety to meet criteria for any specific anxiety or depressive disorder. However, she does meet diagnostic criteria for an adjustment disorder with mixed anxiety and depressed mood. Adjustment disorders are evident as emotional or behavioral symptoms that develop in response to an identifiable stressor and occur within 3 months of the onset of the stressor. Although this stress-related disorder is considered to be a “temporary” condition that “lasts no longer than 6 months after the stressor or its consequences have ceased” (APA,2013, p. 287), in Neesha’s case, she is experiencing ongoing stress related to environmental influences that continue to be present. The DSM does specify that “if the stressor or its consequences persist, the adjustment disorder may continue to be present and become the persistent form.”

Risks, Protective Factors, and Resilience

Several researchers have focused on the role of protective factors in buffering some children living in high-risk environments. Emphasis has shifted from focusing on risks to determining environmental resources and adaptive strengths in children who do not show early signs of deviance (Richters & Weintraub, 1990). Rutter (1987) noted several years ago that instead of searching for broadly defined protective factors, emphasis needs to be placed on better understanding “why and how some individuals manage to maintain high self-esteem and self-efficacy in spite of facing the same adversities that lead other people to give up and lose hope” (p. 317). Further, Rutter (1990) suggests that we go beyond listing risk factors to looking at the underlying processes or mechanisms that are instrumental in producing the buffering effect. Rutter defines these processes as reducing risk impact, reducing negative chain reactions, increasing factors that promote self-esteem, and opening opportunities. The role of timing (life events) in changing the trajectory away from vulnerability is also discussed. In their discussion of risk and resilience, Werner and Smith (2001) concluded that certain environmental factors, such as positive emotional support from caregivers and mentors, could provide protection from negative outcomes, despite living in adverse conditions. Although resilience was once thought of as a trait, currently, resilience is thought of as “a process or phenomenon reflecting positive child adjustment despite conditions of risk” (Luthar & Zelazo, 2003, p. 510).

Durlak (1998) reviewed 1,200 outcome studies concerning prevention programs for children and identified several common risk and protective factors across seven major outcome areas: behavior problems, school failure, poor physical health, physical injury, pregnancy, drug use, and AIDS. Analysis of risk and protective factors linked each factor with the appropriate developmental context, including individual, immediate (family, school, peers), and community. Durlak found multiple factors playing a protective role for more than one outcome. For example, attending a “high quality school” protected against behavior problems, school failure, early pregnancy, drug use, and AIDS, and having “positive peer models” also protected across the same five areas. Having a good parent–child relationship and good personal and social skills protected across all seven major outcomes. High-risk factors included living in an impoverished neighborhood, low family SES, parental psychopathology, marital discord, and punitive parenting. Stress was considered to be a risk factor that crossed all levels of development, while social support was a protective factor that crossed all developmental levels.

When discussing risk and protective factors, the risks of being in an ethnic minority have rarely been addressed. Gibbs and Huang (2001) emphasize that when ethnic identity is combined with membership in a minority race, children are faced with a dual challenge. The authors also note that ethnic minority status has often been associated with restricted range of opportunities, and children growing up in minority families may be exposed to circumstances and experiences very different from the majority of the community. In addition, there is often an interaction among factors of ethnicity, race, and social class (SES), with higher status typically perceived for White, Anglo-Saxon, middle-class families, and lower status associated with non-White, ethnic minority, and lower class families (Hacker, 1992). In their study of child poverty rates, Lichtner, Quian, and Crowley (2005) found that whereas 9% of White children were living below the poverty line, one third of all Black children and 27% of Hispanic children were living at this level. According to the 2014 census, approximately 38% of African American youth under 18 years of age live below the poverty line, compared with 30% Hispanic, 9.6% Asian and 10.7% Whites (DeNavas-Walt & Proctor, 2014). Within this context, the role of the family has assumed a position of strength and resilience. One central value that is cultivated by African American families is the importance of being “independent” and the value of independence. In this manner, the family unit is sustained by members who are self-reliant. Other strong family values often include obedience, respect for elders, and emphasis on obtaining a good education. However, culture clash may be evident in the way in which family members or children whose sense of time is fluid and event oriented interact with largely White establishments where time is determined by the clock, calendar, or school agenda (Lynch & Hanson, 1998).

A growing body of research has revealed that maternal depression and depressive symptoms place children and adolescents at increased risk for negative social and emotional outcomes (Goodman & Gotlib, 2002). Recent studies have found that by adolescence, children and youth exposed to maternal depression demonstrate higher levels of internalizing and externalizing problems relative to peers whose mothers are not depressed (Foster, Garber, & Durlak, 2008; Nelson, Hammen, Brennan, & Ullman, 2003). Campbell, Morgan-Lopez, Cox, and McLoyd (2009) found that adolescents whose mothers reported chronic depressed symptoms across their childhood evidenced more symptoms of depression, dysphoria, and loneliness compared to peers whose mothers were without a history of depression. It has also been found that children living in stressful conditions surrounding maternal depression (parent–child conflict, less parental monitoring and supervision) are likely to engage in more risk taking and externalizing behaviors (Wiesner & Kim, 2006). Research has also demonstrated that boys and girls may respond differently to maternal distress, with boys being more inclined to react with externalizing problems, while with increasing age, girls are more likely to develop internalizing problems (Angold, Erklani, Silberg, Eaves, & Costello, 2002). In addition to trajectories that might be predicted by gender, the principles of equifinality and mulifinality provide different mechanisms to assist our understanding of the nature of different outcomes (Cicchetti & Rogosch, 1996). The principle of equifinality is used to explain how similar symptoms (depression) can result from different sources (e.g., two children may both suffer from depression; however, one child may be reacting to a parental divorce, and another child may be depressed because of peer rejection). The second principle of mulifinality is important in understanding how individuals who experience similar circumstances may be on different paths that will predict very different outcomes. For example, although Neesha shows many signs of distress due to her stressful living conditions, she also demonstrates qualities that suggest resilience in the face of adversity. However, her brother Tyrone, whom we will meet in greater depth in the case study of Tyrone Wilson, has moved further and further along a path of self-destructive behaviors, leading to his recent entry into the juvenile justice system. Therefore, despite living in the same stressful conditions, their outcomes are very different. Children who grow up in less-than-ideal conditions may accept these conditions as part of the “normalcy” of their life and learn to cope with what they have. Others may develop a sense of positive self-esteem and independence that may serve to buffer them from more negative outcomes (Cicchetti & Rogosch, 1997). Yet others, like Tyrone, will follow a path of aggression and retaliation and join others who are on a similar self-destructive trajectory.

Post-Case Questions

1. In discussing the plight of resilient children, Luthar (1993) contrasts earlier concepts of the invulnerable child with present concepts of the resilient child. Luthar observed that children who survived difficult circumstances without developing maladaptive outcomes often presented with more subtle internalizing problems. In Luthar’s study, 85% of the resilient children had clinically significant symptoms of anxiety and depression. Similarly, longitudinal data from studies by Werner and Smith (1992) also noted that resilient children in adulthood were plagued with somatic complaints (headaches, backaches) and feelings of dissatisfaction. In the Introduction to this chapter, the topic of resilience and neurobiology was discussed. According to Karatoreos and McEwen (2013), initially an individual can withstand environmental challenges (stressful circumstances) by successful allostatic responses that can contribute to resilience, however, over the course of time, continued stressful circumstances can cause a system to go into “allostatic overload” resulting in overuse of the system and dysregulation (wearing down the system). Discuss Neesha’s current clinical profile in light of the information provided by these studies on resilience.

2. In a study of developmental response patterns to maternal depression, Solantaus-Simula (2002) found four response patterns: active empathy, emotional overinvolvement, indifference, and avoidance. Of the four types, children in the emotional overinvolvement and avoidance groups demonstrated the most internalizing and externalizing symptoms, independent of mother’s level of depression. Furthermore, children in the active empathy group fared best. They did not feel guilty about their parent’s depression and were able to discriminate their experiences from those of the depressed parent, supporting Beardslee’s theory (1989) of the protective function of self-understanding. The most common response to maternal depression in the active group was to make some effort to cheer up the parent. Discuss these findings in relation to Neesha’s case.

3. The way in which a child responds to distress can be strongly influenced by the cultural context in which the circumstance is embedded. Discuss this comment with respect to Neesha’s case.

4. Studies on resilience and maternal depression discussed in the Introduction to this chapter report a number of negative outcomes that can occur for children and youth who are raised by depressed mothers. Some of the reported risks include social withdrawal, inappropriate social skills, increased risk for psychopathology, and dysfunctional physiological systems associated with managing stress and regulating social engagement (e.g., cortisol responses and oxytocin production). Karatoreos and McEwen (2013) discuss how hyper or hypo cortisol reactivity in children of depressed mothers can influence a child’s tendency to withdraw socially or demonstrate behavioral inhibition. Describe how Neesha’s mother’s parenting behaviors may have influenced the development of these behaviors in Neesha.

5. Research regarding promoting resilience in children has focused on two important factors, individual characteristics and influences from family and parenting practices. Discuss possible interventions that would enhance Neesha’s opportunities for developing and sustaining resilience.

6. Suggested Individual or Group Presentation Activity: The guidance counselor has asked Neesha’s mother to attend a meeting at the school to address Neesha’s academic skills and social engagement. The school psychologist and social worker will be invited to attend the meeting, as well as Neesha’s teacher. Prepare a script for role-playing each of the player’s parts in the meeting and how they could potentially contribute information to assist with developing a case formulation and intervention plan. Who else would you want to invite to the meeting and why?

7. After reading the case of Neesha’s brother, Tyrone Wilson, discuss the concepts of mulitfinality and equifinality as they are related to the two case studies.

 
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"