This assignment is designed to help you aquire a better understanding of one of many processess parent(s) go through to aquire proper treatment for child(ren) with mental health disorders. You will be given an extensive case to read. Please view course schedule on D2L to know when the case will be made available to you. At the end of the case you will answer 8 questions. It is required that you find two additional resources to support your answers. Cite the resources (APA format) within your paper and reference page. Each question should be answered in paragraph form, double spaced, font 12, and APA format. CASE ON WHERE TO BEGIN Here is a mothers written story of two sons, John and his older brother. Both were students with attention deficit hyperactivity disorder (ADHD). John, however, had additional problems. The case raises many questions about where to beginhow an emotional or behavioral disorder (EBD) in its many manifestations might best be conceptualized and managed. John I always considered myself lucky. I had grown up in a very loving family. I always wanted to get married and be a mother and wife. I got married a year out of high school and had three children. Then I got pregnant with a fourth child, and somehow knew things would never be the same. My oldest and third children were delightful but very active girls, and my middle child was a boy who had been difficult to deal with behaviorally. He, however, was a wonderfully bright and loving child. I sought out help early on, and eventually he was diagnosed as having ADHD. He was on Ritalin by the time he entered kindergarten and was doing quite well in school. My pregnancy with John was miserable overall because I did not feel well, either physically or psychologically. John was born two days before Christmas by cesarean section. So, for the first time, I had to be away from my children and husband over the holidays. In utero, John was extraordinarily active, causing me a great deal of pain and discomfort. It did not take long to discover that he was a very different infant and child. Looking back on it, I can see now that he was born angry. Johns growth and development were relatively normal for the first couple of years. He reached his cognitive and motor milestones pretty much on target. He, however, was irritable and definitely hyperactive. There had been problems in my marriage before John was born, but another child with behavioral issues was the final blow. Johns father and I separated when John was about 18 months old. Johns irritability and hyperactivity were so difficult to deal with during this stressful time that I took him to see a pediatrician to see whether we could get the ADHD diagnosis and put him on Ritalin. With Ritalin, we could avoid a lot of the problems I had had with his older brother, Robert. After observing John for about four to five minutes, she declared that he was a normal child and the real problem was that I was not coping with the breakup of my marriage. She sent us to family therapy. The consensus at that time was that if there was a problem with a child, there was a problem with the family and with parenting techniques. Neighbors and relatives had been quick to advise me to take a firmer hand with my boys Take John to the shed for a whipping a couple of times and hell shape up, they suggested. I never believed in corporal punishment, but I did believe in setting firm limits. Indeed, I had learned a lot about parenting because of the problems I had with my oldest son. I read every book imaginable and went to many workshops and talks given about parenting children with behavioral problems. Many of the ideas were helpful with my other son but did little to improve things with John. My oldest boy was doing well enough with Ritalin, and I wanted the same for John. I was having great difficulty keeping daycare providers for John because of his behavior. Eventually, I took John to the same place I had taken his older brother when he was finally diagnosed with ADHD. There, I met with a team of peoplea couple of psychologists and a pediatric nurse practitioner, who were employed by the public-school district to evaluate children in the school district who were having behavioral and learning problems. It did not take them long to decide that John also had ADHD. Armed with their evaluation, I was able to get a different pediatrician to put John on Ritalin. The Ritalin did help somewhat, but not as much as it had helped his older brother. Johns birthday is in December, so he entered kindergarten just shy of his sixth birthday. He went to the same private K8 elementary school as his older siblings had attended. His teacher was older than most and very exacting. At the end of the year she decided it would be better for him if I kept him in kindergarten another year because of his behavior, even though he was functioning at grade level academically. I chose not to do this because I felt his self?esteem would suffer. The next year, his first?grade teacher was enthusiastic but not very experienced. She believed that he was not capable of keeping up with the other students academically and that he did have difficulty with peer relationships. According to national standards, however, Johns skills were still at grade level. At this school, most of the children operated substantially above grade level, which placed him near the bottom of his class. She would not pass him on to the next grade, and the principal stood behind her decision. I decided that rather than keeping him back I would send him to public school. The local public school was very different from the private school. He had a second?grade teacher who could not control her classroom at all. At the end of that year, according to the standardized tests, John had not gained any ground in his reading and math skills and so was a year behind where he should have been. I returned him to his former school the following year. There, the new principal assured me that we could all work together and achieve success for John. John started third grade with new resolve. Early on, I attempted to form a partnership with his teacher to help John be successful. She, however, made it abundantly clear to me that at this age she expected John to remember to go get his medications at lunchtime and to copy down and do his assignments without prompting from her. She told me that the only way to get him to act responsibly was to hold high expectations and punish him when he failed to meet those expectations. John was still having difficulty with peer relationships as well. He was very small for his age and looked immature. He had a very hot temper. The other children teased him endlessly, and he was frequently in trouble for fighting. One day on the playground, two children were teasing him, and he swung his backpack at them. His teacher saw him do it. During homeroom period, she took him out into the hallway and slapped him across the face, nearly knocking him over. This was witnessed by several of his fellow classmates, and I only heard about it later when several parents called to tell me. Their own children had come home from school and were very upset about their teachers behavior. Because there were only a couple of weeks left in the school year, I kept him home and did schoolwork with him there. The next year I was able to petition to get him into a different public school, one that was known for working well with children with ADHD. He did struggle, but he did relatively well that year despite some new problems. At this time, John was discovered to have a deficiency in growth hormone and began having daily growth hormone injections. Over the course of this year, there were weeks at a time when he would be a virtual recluse. He would come home from school, turn off all the lights, close the drapes, and sit two feet from the television, almost in a trance. He was particularly irritable at these times, and if friends called to ask him to come out and play, he would not even talk to them on the phone. He had difficulty getting to sleep at night, and it was difficult for him to get up for school in the morning. Eventually, he began to tell me how much he wanted to die because he hated his life. He began displaying some self?injurious behavior. We consulted a child psychiatrist, and John was eventually admitted to the childrens mental health unit at the local hospital. They tried some anticonvulsant medications (then the standard treatment for bipolar disorder), and his mood and behavior began to improve. Then he developed a severe allergic reaction to the drug he was taking and to other medications in that drug category. The psychiatrist would not diagnose bipolar disorder, which both Johns pediatrician and I now suspected was his problem. Instead, the psychiatrist diagnosed him as having oppositional defiant disorder (ODD) and ADHD. The psychiatrist told me that I simply could not allow John to behave this way and that I had to set firmer limits on his behavior. I must make John be responsible for his own behavior. He said I was looking for the magic pill and there was not one. In the fall of the next academic year, on one of the few occasions when he played outside, he jumped out of a tree about 20 feet off the ground and shattered his ankle. This required surgery to repair and casting that lasted three months. His behavior began to take on a different pattern. In the fall and spring, he had periods when he was extremely hyperactive and displayed a volatile temper. Then in the winter, he would be reclusive, generally irritable, and very emotional, with multiple episodes of uncontrollable sobbing. It was during these times that he would do things to injure himself. His endocrinologist thought he might have a seasonal affective disorder. Then Johns behavior pattern changed again. The periods of time with depressive?like symptoms and the hyperactivity seemed to occur during both winter and spring, which would be inconsistent with seasonal affective disorder. At the end of sixth grade, Johns teachers passed him on even though he really was nonfunctional in school. They told me that he needed to get into a special education program especially designed for children with behavioral problems. He went to the public junior high in the fall and was placed in a special education program. In this program, there were children who had behavior problems, but they were all very different problems from John. Many had been in trouble with the law. They had stolen cars, vandalized property, were truant from school, or had been in trouble with illegal drugs. Most had significant problems in their families. In order to fit in with the group, John had to become more like them. He began to be disrespectful to me, curse and swear, and be much more defiant to authority figures. When we found medications that would adequately quiet John, he became so sleepy that he could not stay awake at school. If we did not medicate him, he became volatile and was locked in the schools time?out room, which was basically a padded cell. We endured two more years of this. As before, he was passed to the next grade, even though he was getting next to nothing out of school. The junior high experience was also very isolating for John socially. I could not let him visit any of his friends from school at their homes because the environments were so bad. He was allowed to bring friends home, but his friends stole some of Johns prized possessions. John was crushed and didnt understand this. Of course, his behavior was too strange even for them, and they would beat him up. He had to learn to put on a very tough exterior and become even more like them just to survive. Senior high was even worse than junior high. That is when I began to realize that John was smoking marijuana and suspected there were other illegal drugs involved. School authorities expected more from him. They held the special education students to a much higher standard of behavior than the mainstream students. There were a million ways to get suspended from school, and John must have found at least half of them. In ninth grade, he spent more time suspended than he did attending school. Often, the school would only inform me of the suspension by mail several days after the fact rather than at the time it happened. In other words, he would be out running around during the day and I would think he was in school. It was during one of these many school suspensions that John jumped off the top of a bus stop and severely fractured both bones in his forearm. Life was constant turmoil. This senior high school also had a policeman assigned to the school full time. Whenever there was a possibility to get the law involved, the school did. It became very clear to me that John was being warehoused in a school system that had no idea what to do except call the police. They did not want these children, and the consensus was that if these children could not behave properly, the teachers or administrators would find a way to have them locked up and sent away. So, I decided to move out to a rural area. I was convinced that getting John out of the city and away from the influence of the gang members who were his classmates was crucial. We moved about 40 miles out of the city to a neighboring rural county and were able to get a mental health case manager through this county almost immediately (?John had been on a waiting list for three years in the county in which we had lived previously). I do believe that this social worker tried hard to be helpful, but I soon realized how limited those services were. She was able to get some assistance from an agency that provided after?school home care. By this time, Johns mood swings were very wide, with frequent fluctuations. I also found that kids in Johns special education program were not very different from the inner?city setting, except that they did not belong to gangs. John quickly became acquainted with drug?using friends. Actually, the drug?use problem in this rural county was far worse than in the large metropolitan school. Within a very short time, the school staff decided that John was simply not able to function in a classroom for very long periods of time. It was decided that he should only attend school half days. Every day when John got home from school, he was supposed to sit down with the after?school caregiver and do homework. The irony was that even though he could not sit still in school, the after?school caregivers believed that they could make him do it at home. It was a constant battle, and he was forever being sanctioned for one thing or another. John had a volatile temper, but he had never been violent to others. Mainly, he would scream and curse, trash his own belongings or his room, or do something to injure himself. He would attempt to leave, and the caregivers would call the police to have him picked up as a runaway who might harm himself. At school, the assistant principal tried to have John arrested for assault with a deadly weapon because he threw a paper clip across the room in the direction of one of his teachers. The paper clip hit the blackboard but not the teacher. The assistant principal decided that next year John should not be in a classroom with other children anymore. She was convinced that his behavior was attention seeking. She isolated him by placing him in a room with an aide who was to give him his schoolwork to do. The aide was there to watch him, keep him on track, and assist him if he had questions. He was not allowed to go to the lunchroom anymore or to interact with any of the other students attending the high school. His behavior became more and more bizarre. One minute he would be bouncing off the lockers that were in that room, and the next minute he would be rolling around on the floor crying. It became clear to me that he was rapid cycling from manic to depressed, then repeating this cycle, all in a matter of minutes. Still, the psychiatrists never witnessed these episodes and therefore would not diagnose bipolar disorder. At this point, he was on lithium and Ritalin, but it was clear that they were not working well for John. Eventually, John was expelled from that school. The school administrators felt he was a danger to himself and others. I had him schooled at home by a tutor for the remaining weeks of the school year. The teacher came to our home six hours per week. She was very good with John, and he did make some progress. She was willing to allow him to walk around during their lessons, and he was able to get some schoolwork done that way. Still, it was woefully inadequate. The next year, the local school district had set up a special school program for kids who had not been successful in the usual EBD programs. Johns mental health case manager thought that John would be appropriate for this program. They had a psychologist, in addition to the regular teaching staff, who would be there every day and spend time with each of the children daily. Additionally, Johns county mental health case manager would be a frequent and regular visitor to the school. The school psychologist and the county case manager became alarmed one day because John had burned and cut himself. The case manager came to our house and attempted to get my insurance to hospitalize him as injurious to himself. But the insurance company would not authorize it unless John stated that he was going to kill himself or someone else. John no longer felt that way. A few weeks later, the psychologist became convinced that John was using drugs and was chemically dependent. The psychologist decided to appeal to my insurance company to give him a chemical dependency assessment. They agreed to have him hospitalized for a day or two for a chemical use evaluation. When I brought him there, the hospital staff was convinced he was on something. John denied this, and I was sure that he had not had the recent opportunity to obtain any drugs. Nevertheless, the staff confronted him on this. I am not sure exactly what happened after that, but John became very volatile, and the staff placed him in seclusion, where he went totally out of control and became psychotic. The staff called the psychiatrist from the psychiatric ward to come and deal with him. The psychiatrist ordered a dose of Haldol, which quickly calmed him down. John spent a great deal of time talking with the psychiatrist. For the first time John admitted to hearing and seeing things. He said that the last medicine he was given made him feel calmer and think more clearly. The psychiatrist called me and explained that John had been admitted to the psychology ward and explained what had happened. The psychiatrist told me that he thought John was in acute mania. I told him that if he thought that was acute, he should have seen him during the previous month because I thought the mania was beginning to subside when I brought him in. The psychiatrist told me that he would like to put him on a different medication, similar to Haldol but with less severe side effects. John developed a severe allergic reaction to the first medication they tried but was placed on a different medication in the same atypical antipsychotic drug class. John really did seem much better on this medication, and for the first time I felt there was some hope for the future. The psychiatrist told me and the rest of the care team that it was clear to him that I had spent considerable time with John trying to reach him and help him to learn proper behavior. It had never mattered before that I had successfully raised three productive children before John. I was always blamed as one of the factors in Johns behavior problems. Now that John was able to think more clearly, he was able to reiterate what behaviors were expected of him. The challenge, however, would be that he was nearly 18 years old and had spent the last 10 years developing secondary behaviors in his attempt to cope with his mental illness and psychosis and now needed to eliminate these behaviors. Additionally, because John was so young when the beginning signs of his mental illness emerged, his social and emotional development was halted at a 3? to 4?year?old level. No one had any clear idea about how to help him catch up on his social and emotional development. But at least now we had the diagnosis that I thought would help people understand and stop blaming him and me for the behavior and really begin to help him. I was soon to find out how wrong that assumption was. During all these years, the stress had been nearly unbearable, and it was affecting my physical health. At the time John was discharged from the hospital, I was admitted to the hospital and had my sixth abdominal surgery. I was discharged from the hospital after three days, and the next day was visited by the county case manager and the psychologist from Johns school. They had decided to drop him from the program, and now it was determined he should go to the Alternative Learning Center (ALC) once per week to pick up assignments and then work at home on his own. I knew this would never work. I told them how incredibly unfair this was because he was not even given a chance to learn how to adapt and change since getting on better medications. But they had already made up their minds. He was discharged from the program, and someone else filled his spot just that quickly. After John left that program, I was able to get him into an inpatient state mental health hospital program. They had a psychiatrist on staff who spent time with my son more than once per week. She diagnosed John as schizoaffective bipolar. This program was the best I had seen to date, and John did get a lot out of the program. It was more successful than others were because they incorporated a behavior modification program that gave real incentives for desired behavior but was not so punitive for undesirable behavior. When children exhibited undesirable behavior, they did not lose all the credit they had built up with good behavior but were simply not able to earn merit points for a set period. Unfortunately, that program was time limited, and John was discharged back home to me about four months later. John spent the next three years trying to complete his high school diploma on a new Individualized Education Program (IEP), all while I was attempting to help him further his social and emotional development. With little to no help from the school or county, I pushed and prodded John until he was able to meet the goals set out by the IEP and get his high school diploma by the time he turned 21. Nevertheless, to this day he is barely literate and has few job skills. Currently, his social and emotional development is about that of a 15?year?old, which makes it incredibly difficult. People expect him to act his chronological age. Progress is occurring, but when it is two steps forward and one step backward it is very discouraging. I have been attempting unsuccessfully for the past year to get John in an assisted living situation because I no longer feel he is making progress living with me and I need some relief before my health really fails me. QUESTIONS ABOUT THE CASE How are the different responses of John and his older brother to the same drug for the same problem typical? How are the reactions of the neighbors and the pediatrician to the ADHD exhibited by John and his brother predictable? Why do you think school personnel were willing to see John as having ADHD when the pediatrician was not? If you had been Johns daycare provider or his teacher in preschool, how would you have attempted to help John? How would you respond to suggestions that Johns mother caused her son John to have EBD? What role, if any, do you think teachers had in Johns problems? How, if at all, do you see cultural factors as causing or contributing to Johns problems? What would lead you to the conclusion that Johns problems were primarily a result of biological factors? Imagine that at some point in the story told by Johns mother you were Johns teacher. What would have been the most important and helpful things you could have done as his teacher? * OUR CLASS BOOK IS ONE OF THE SOURCES
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