Lisa is an 11 year old girl, who was evaluated due to aggressive…

Question Answered step-by-step Lisa is an 11 year old girl, who was evaluated due to aggressive… Lisa is an 11 year old girl, who was evaluated due to aggressive and oppositional behavior, frequent tantrums and mood swings. During the evaluation, Lisa separated easily from her parents and readily accompanied the examiner to the testing room during both sessions.  Although her grooming was initially neat and appropriate, Lisa took on a more “disheveled” appearance during the course of each day.  As a part of the evaluation process, Lisa was engaged in a structured play and communication assessment.   During play with the examiner, Lisa frequently attempted to redirect the examiner to a more preferred task, rather than engage in the required activities.  She became frustrated quickly (e.g., irritable) when she was “pushed” to participate in the more structured play tasks.  At such times, she would become withdrawn and pout.  If that approach was unsuccessful, Lisa attempted to change the activity.  She did not respond well to limits or to attempts by the examiner to compromise, such as “We can play with that after we finish doing this.”  Lisa would frequently refuse to complete the task and sit silently staring at the examiner with her arms crossed and a scowl on her face. On other occasions, Lisa would attempt to bargain with the examiner, requesting to play with her desired item first, or to take “one more turn” with a toy that she was playing with. However, even when allowed to do so, Lisa had difficulty moving on to the requested task.  She would often repeat the above strategies in order to continue her preferred activity. When the examiner continued to stand firm, Lisa would argue with the examiner and lose her temper. Further, her parents confirm that this pattern of behaviors has been long-standing (since early childhood) and occur at home and at school.   Specifically, Lisa exhibits a consistent pattern of oppositionality, frequent tantrums and aggressive behavior toward others which started in preschool.  Lisa may tantrum 2-3 times a day (or more) typically occurring when she does not get her way.  These tantrums have become more severe over the past year; during these behavioral outbursts, Lisa may curse, hit or spit at others, and scream.  However, even when Lisa does not tantrum, she still frequently refuses to follow adult requests.  Lisa will often say “no” to her parents, or may simply ignore them (“pretendinh” that she does not hear them).  In addition, Lisa will often continue do things she is not supposed to, even after her parents tell her to stop.  Her parents further report that Lisa can be vindictive toward her twin sister as well.  They note that the children are very competitive with one another, and are constantly arguing over who will get a certain privilege (such as sitting in the front seat, or playing with a certain game).  They feel that the level of sibling rivalry between Lisa and her sister goes well beyond that of most siblings.  Lisa will often yell at her, and may hit or scratch her, when she perceives her sister has “won,” and often tattles and even makes up stories to try and get her sister in trouble. Further, Lisa’s parents describe her as generally overactive and impulsive since preschool; she is “always on the go,” is extremely noisy when playing (even when playing alone), blurts out answers without waiting to be called on, interrupts other children’s play by trying to join games already in progress, and uses others’ belongings without asking permission. Her teacher also often has to reprimand her for continually wandering around the room to chat with her friends in the middle of lessons. In addition, Lisa often fails to finish classroom assignments and homework and forgets to turn in her classroom assignments, leaving them half-completed in her desk. Lisa’s parents also repoted that she has had problems with regulating her mood and activity level since she was a baby and toddler.  She was described as a fussy, moody and overactive infant, who did not sleep or eat on a regular timetable.  She was very active as a toddler and preschooler, often running about and even scaling the counters and bookcase to obtain items she wanted, without regard for the danger she faced. Nonetheless, Lisa’s parents reported new concerns about her dramatic changes in mood over the past 6 months. For the past 6 months, Lisa’s mood has been observed to change several times over the course of a day.  In addition, these mood changes are often very rapid and can even change several times within a few minutes.  For example, Lisa is frequently extremely happy one moment and very angry the next.  Her mood will change from happy/excited/ socially motivated/interactive to irritable and/or withdrawn.  These mood changes have been accompanied by periods of increased sociability; during such times, she becomes so focused on interacting with others that she can not be redirected.  She is often intrusive and goal directed in pursuing social interactions; she will persist until others respond to her regardless of the appropriateness of the situation.  During such interactions, Lisa will also talk much more loudly and quickly, rapidly asking a series of seemingly unrelated questions of others (while barely pausing to hear the answers), and will frequently ignore others’ personal space.  During these same time periods, Lisa will becomes even more distractible than usual, often moving quickly from one activity to another without completing the initial activity, leaving a string of uncompleted tasks and activities in her wake.  Lisa’s parents also report that during these times, she requires little sleep, frequently waking up during the early morning hours “raring to go.”; she is often awake when they come in to wake her for school, and seems agitated while pacing about the room.  They indicated that they need to lock her door at night to ensure she does not wander throughout the house.  On several occasions during these episodes, Lisa has climbed out her 2nd story  window onto a tree to go play in the backyard. These episodes happen infrequently (2 episodes in total), but generally last 2 to 3 weeks before they subside. Nonetheless, during these periods, Lisa’s ability to function at school is significantly compromised (e.g., her grades decline, her parents are called to take her home) and her parents have to take additional measures to keep her safe at home.Her parents report that they have tried many different strategies in order to improve Lisa’s compliance with parental requests, such as time-outs, taking away privileges, and a “level-based” behavioral system.  However, these techniques have not been as effective as her parents had wished.  They report that it is often difficult for them to be consistent in disciplining Lisa, as her behavioral difficulties can be very frequent.  In addition, her parents report that they respond to her problem behaviors in different ways.  Her mother reportedly reserves her energy for major offenses, and ignores more minor behaviors.  When her mother feels that Lisa’s behavior has crossed the “line,” she is quick to act and has resorted to physical punishment on a number of occasions (although the level of punishment would not meet definitions of physical abuse). In contrast, her father gets easily frustrated with Lisa’s behavior and reportedly responds to most of Lisa’s negative behaviors, often trying to bargin with her or will nag her to behave until she either complies or her behavior escalates.  In such cases, her father usually withdraws the command and tries to get Lisa in a more positive mood by joking around with her.   The stress within the family resulting from her parents’ disagreement over parenting strategies has led to a high level of marital discord, and Lisa’s parents have separated and reconciled on several occasions.  Use the above case example to answer the next set of questions (24 total). 1. Describe the diagnosis or diagnoses for Lisa, including a discussion of the other disorders (that were NOT diagnosed) that you considered in the differential diagnosis.  Be sure to provide a rationale to support your diagnosis/diagnoses including which specific DSM criteria she meets for any disorder that you give, and why she does not meet criteria for disorders you included in the differential diagnosis but did not give.  2. (a) Describe Patterson’s Coercion Model (what are the 4 main aspects).  (b) apply this model to Lisa’s case: how does it help us understand the development of Lisa’s difficulties, as well as how we might treat her difficulities?  Social Science Psychology PSY 210 Share QuestionEmailCopy link Comments (0)