COUC 546 Week 8 Case Study 3 Example

Case Study 3: An Eight-Year-Old Who Cannot Sit Still, Wets the Bed and Is Falling Behind, With a Family-Centered Treatment Plan

Case Summary

Jayden is an eight-year-old second grader whose household includes his mother, his father and a sister who is four. His mother sought counseling after his teacher reported that he rarely finishes classwork, leaves his seat several times an hour, blurts out answers, interrupts classmates and loses materials daily. His mother describes the same pattern since he was about four: he cannot sit through dinner or church, forgets instructions within minutes and runs or climbs where he should not. His kindergarten teacher had raised similar concerns. He is now reading below grade level, and he recently told his mother, "I'm the bad kid." He wets the bed two or three nights a week and has done so for as long as his parents remember; he has never had a sustained dry period. He is affectionate, eager to please and loves building with blocks, and his parents describe him as helpful at home when given one task at a time. Jayden's father was "the same way as a kid" and left school at sixteen. The family attends a Pentecostal church, and his mother worries that relatives see his behavior as a failure of discipline.

Key Issues

First, Jayden's self-esteem is suffering, and his statement that he is "the bad kid" signals a risk that needs attention now. Second, his academic progress is slipping, and the cause of his reading difficulty is unclear. Third, the bedwetting may add to his shame and limit activities such as sleepovers. Fourth, his parents feel judged and need accurate information. Fifth, coordinated support across home, school and medical care has not yet been arranged.

Diagnostic Impressions

Provisional diagnoses: attention-deficit/hyperactivity disorder, combined presentation, moderate (F90.2), and enuresis, nocturnal only (F98.0) (American Psychiatric Association, 2013).

Jayden shows at least six symptoms of inattention, including failing to finish work, losing materials, forgetfulness and difficulty following instructions, and at least six of hyperactivity and impulsivity, including leaving his seat, running and climbing inappropriately, blurting out answers and interrupting. Symptoms began before age 12, have lasted far longer than six months, appear at home, at school and in church, and clearly interfere with his learning and relationships. His father's similar history fits the strong heritability of ADHD described by Kring et al. (2016). The bedwetting meets criteria for enuresis because it occurs at least twice a week, has lasted well over three months and occurs in a child older than five, with a medical cause still to be excluded.

Oppositional defiant disorder was considered and ruled out for now: Jayden is not described as persistently angry, argumentative or vindictive, and his rule-breaking seems driven by impulsivity rather than defiance. A specific learning disorder in reading cannot be ruled out without psychoeducational testing, and anxiety and sleep problems should also be screened.

Treatment Recommendations

Biological

Jayden should be referred to his pediatrician for evaluation of ADHD and of the bedwetting, including tests to rule out a urinary or other medical cause. For children aged six to twelve, the American Academy of Pediatrics guideline pairs FDA-approved medication with behavioral help at home through parent training, in the classroom, or ideally in both places (Wolraich et al., 2019). In the MTA trial, carefully managed medication, alone or combined with intensive behavioral treatment, reduced core ADHD symptoms more than behavioral treatment alone or routine community care (MTA Cooperative Group, 1999). Decisions about medication belong to the physician and the family.

Psychological

The first goal of counseling is to help Jayden understand that he is not a bad kid but a child whose brain makes sitting still and remembering harder, and that adults are going to help him. Counseling can include simple psychoeducation, praise-based behavior plans and skills for waiting and asking for help. For the bedwetting, the counselor can support whatever plan the pediatrician recommends, such as a bedwetting alarm, and help the family respond without shame. Because bedwetting is common at his age and often runs in families, simply hearing that it is not his fault can relieve him.

Social

An evidence update by Evans et al. (2014) classed three behavioral approaches, training parents, managing the classroom and coaching peer interactions, as well established for ADHD. Jayden's parents should be enrolled in a parent training program, and the counselor should work with the school to develop a daily report card and classroom supports. With parental consent, the family can request an evaluation for special education or a Section 504 plan, including testing of his reading. Jayden's sister and both parents should be included, since family stress often rises around ADHD.

Spiritual

The family's faith can be a source of grace rather than blame. With their permission, the counselor can help Jayden's parents see his struggles as a condition to be treated, not a moral failure, and invite them to speak with their pastor about supporting him at church, for example by giving him a helper role during services. The psalmist praises God for knitting him together before birth and calls himself fearfully and wonderfully made (English Standard Version Bible, 2001/2016, Psalm 139:13-14), words that can help both Jayden and his parents see his worth apart from his behavior.

Collaboration

Once the parents sign releases, the counselor would work alongside the pediatrician, share teacher and parent rating scales, attend school planning meetings and review progress with the family monthly. Repeating the rating scales after any change in treatment would show the team whether the plan is working in each setting.

Conclusion

Jayden's case shows how ADHD affects a child's learning, self-image and family life. Treatment that combines medical evaluation, parent and classroom behavioral strategies, academic testing and a supportive faith community gives him the best chance to succeed in school and at home, and to see himself as the capable, loved child he is.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527-551. https://doi.org/10.1080/15374416.2013.850700

Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2016). Abnormal psychology: The science and treatment of psychological disorders (13th ed.). Wiley.

MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073-1086. https://doi.org/10.1001/archpsyc.56.12.1073

Wolraich, M. L., Hagan, J. F., Jr., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., Zurhellen, W., & Subcommittee on Children and Adolescents With Attention-Deficit/Hyperactive Disorder. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), Article e20192528. https://doi.org/10.1542/peds.2019-2528