Seven Clinical Problem Modules

Seven Clinical Problem Modules

Social-Emotional Modules or Patterns of Behavior Addressing
Familiar Parent/Teacher Health, Social, and Psychological Concerns

1. Physical Health and Bodily System Problems
2. A Child’s Mal Temperament and Poor Goodness of Fit
3. Acting-out Behaviors
4. Acting-in Behaviors
5. Cycles of Acting In and Out
6. Disorganized Information Processing Affecting Learning, Memory, Language and Development
7. Regulation of Social, Emotional and Sensory Communication

The following behavioral modules can be used as steps toward sorting out confusing symptoms and behaviors, and in establishing a formal diagnoses. Effort here has been made to condense multiple conditions, as well as to separate them into several areas. A multi-risk child’s problems may fit under more than one area or module. The screeners are designed to help organize the direction of inquiry not necessarily to establish formal diagnoses. If conditions are responded to before there is a diagnosis, then more everyday sorts of solution may be started. There is a screener for most areas included along with favorite web sites and other literature to help in the exploration.

Although a diagnosis may be required either for services or a treatment course at a later time, it is believed that these several unifying patterns establish an empirical cause and effect on a continuum or spectrum and overlap. They thus require a multi-modal approach, which differs from the medical model in its single treatment management. This affords early intervention as well as ways to build protective factors promoting contextual resources such as have been developed in the Family Health Promotion Plan discussed under Our Practices – Part III. Many of these behaviors can be screened for early detection, using the Pediatric Screening Checklist available on public domain at http://www2.massgeneral.org/allpsych/psc/psc_home.htm. Other conditions can be screened from both of these sites: www.schoolpsychiatry.org and www.smhp.psych.ucla.edu.

ORGANIZING MY THINKING ABOUT THE CHILD’S BEHAVIOR

1. Physical Health and Bodily System Problems: Conditions, such as poor sleeping, eating, toileting, low stamina, and sensory/motor sensitivities are some of these bodily system problems. It is likely that these biological and physiological features actually combine with environmental events that are conditioned by sensory and emotional features to form some of the problem behaviors below.

Health Screener Forms:
Combined Health/Risk Checklist for Parents
The Daily Child Strength Scale for Child

Websites:
www.Medscape.com

Books:
Caring for Children with Disabilities and Chronic Conditions by Robert Nickel

2. A Child’s Mal Temperament and Poor Goodness of Fit: Before a clinical condition should be pursued, one should check if there are constitutional or familial factors present which may determine biological styles of perceiving and responding which may become maladaptive when demands of the environment exceed the ability of the child. Understanding the temperament of the slow to warm child can take guilt away from the parent and offer a source of clarity to match with the child’s style.

Temperament Screeners:
A useful multi sensory rating of under and over sensitivities  reported by the care giver.
A practical questionnaire for all age kids is in the preface of Stanley Tureckii’s book, The Difficult Child.

Websites:
ohioline.osu.edu/flm02/FS05.html (temperament of school-age children)

Books:
The Difficult Child, by Stanley Turecki, is a great parent book with lots of encouragement and suggestions, and deals with the borderline child between normal and emerging clinical areas.
Sensory Checklist.pdf

3. Acting-out Behaviors: Such dys-regulatory and disruptive behaviors as tantrums, being mad or defiant, not paying attention, and hyperactivity are all forms of acting-out behaviors. Some of these have a strong genetic and neurobiological basis, while others may represent social and emotional expressions. Regardless, there are psychological and social impacts of these externalized adaptations that must also be managed. We believe that ADHD represents a prototype for disruptive behaviors, even though hyperactive, impulse and inattention can stem from a variety of such causes as medical sources, sleep apnea, mood, anxiety, environmental stress and abuse, and temperament. (Surprisingly, many children who may present with ADHD are predominantly the inattentive type.) We believe that by defining these behaviors, it’s possible to structure an early response including differentiating these other possibilities which may lead to further diagnosis later on, if necessary.

Screeners:
A screening instrument for these behaviors, namely Vanderbilt, is suggested for both parent and teacher and can be found at the following website:

For Parents – http://www.vanderbiltchildrens.com/uploads/
documents/ccdr_adhd_scale.pdf

For Teachers – http://www.brightfutures.org/mentalhealth/pdf/
professionals/bridges/adhd.pdf

Websites:
http://www.medhomeportal.org/diag/diagnosis.cfm?diag_id=94&.
http://www.updc.org/behavior/ for description of behavioral disruption.

Books:
The Explosive Child, by Ross Greene
Taking Charge of ADHD, by Russell Barkley

4. Acting-in Behaviors: Turning feelings inward, being worried, scared, sad, anxious, in despair, or crying: These hypersensitivities are most common in our species, and can be situational, or may be a genetic trait. Feelings may be expressed overtly or they may lie dormant and are apart of all of these dimensions and need to be sorted out. Those children who are more nonverbal from language and cognitive delays may express themselves more emotionally.

Screeners:

Depression Module – Self Help Report – Reading age children for screen
Spence Children’s Anxiety Scale – Self Report ages 8-12 and parent report ages 3-7
intermountainhealthcare.org/hospitals/primarychildrens/childhealth/resources/Pages/home.aspx?Topic=Depression

Websites:
www.worrywisekids.org

Books:
Freeing Your Child from Anxiety, by Tamar Chansky
Lonely Sad and Angry-a Parents Guide to Depression in Children and Adolescents, by Barbara Ingersall and Sam Goldstein
What to do when you worry too much: A Kids Guide to Anxiety by Huebner,D
What to do When your scared and Worried: A Guide for Kids by Crist J
Be the Boss of your body kit with Stress Book, self Care for Kids

5. Cycles of Acting In and Out:

A. Mood Fluctuations or Emotionally-consolidated Mental States or pervasive emotional traits, which seems to be part of personality and may fluctuate through the day. They have disruptive effects like a roller coaster. The cause of these may include temperament, personality, and clinical conditions such as manic bipolar depression, trauma, extreme stress, and others discussed below.

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Screener:


For a daily mood tracking form –
http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=mooddiary

Websites:
www.dbsalliance.org/
http://www2.massgeneral.org/schoolpsychiatry/info_bipolar.asp

Books:
Raising a Moody Child, by Mary Fristad

B. Trauma, Disorganized Attachment, and Complicated Grief Behaviors.

Websites:
www.Trauma-pages.com

www.childrensgrief.net/info.htm

Books:
Rebuilding Attachments with Traumatized Children, by Richard Kagan
Real Life Heroes—a Life Storybook for Children, (a school-age book), by Richard Kagan

6. Disorganized Information Processing Affecting Learning, Memory, Language and Development: Severe learning disabilities and/or developmental retardation best describe this dimension. These atypical features of receiving information and processing it with a compromised adaptive response overlaps with normal variation often describing inter and intra-individual diversity and “goodness of fit” in determining the adaptive outcome. Families and society generally determine the acceptable limits and boundaries of social expectation. Richard L. Evans once qu oted, “Language is the dress of thought: every time you talk, your mind is on parade.” Although there are many categories, as with people, we generally feel that expressing life stories generally functions in achieving wants and needs through both cognitive reality processing and adequate language use, and that both require understanding and intervention. We also suggest that many of the above concerns regarding a child’s behaviors, feelings, moods and social expression will depend on these learning functions as well as determine his or her learning capacities. It’s important to see the impact of these styles on daily function to determine their severity. We use one of several adaptive behavior assessments. See “Assessment.”

Websites:
www.tr.wou.edu/bridges/ecelinks2.htm
www.internet4classrooms.com/
http://www.interventioncentral.com/

Books:
A Mind at a Time, by Mel Levine
Frames of Mind: Theories of Multiple Intelligences, by Howard Gardner

7. Regulation of Social, Emotional and Sensory Communication:

A. Eccentric and Sensory Different: Multi-system Developmental Disorder defined by Stanley Greenspan as those odd, autistic-like kids, many fall under the non-autistic PDD classification having greater language and sensory-motor processing sensitivities, who may have better outcomes from relationship-based and sensory and motor-planning interventions.

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Screener: (see above) An elementary school screening questionnaire is also present in the Out of Synch Child, compiled by Lynn Balzar-Martin, pp. 29-33.

Website:
www.nldline.com
www.floortime.org/
psychology.wikia.com/wiki/Multisystem_Developmental_Disorder
(some characteristics of autism spectrum, but primarily because
of impact of sensory motor and communication problems effecting
self regulation and relationships.)

Books:
The Child with Special Needs, by Stanley Greenspan and Serena Wieder
The Out of Synch Child, by Carol Kranowitz.

B. Aloof and Passive Children:Disorders of Social Relatedness and Interpersonal Contingency, which also include mindfulness, self and identity. Although we see these odd and quirky kids with challenges in this area as suggestive of the Autistic Spectrum, we choose to refer to them as having a developmental style which suggests a continuum. and range of adaptation.

Screener:
Informal Screening Questionnaire.
http://www.childbrain.com/pddassess.html

www.firstsigns.org/screening/tools/rec.htm (click on Autism Screening and checklists)

Websites:
www.autisminfo.com/

Books:
Quirky Kids by Perri Klass, M.D. and Eileen Costello, M.D.
A Parent’s Guide to Asperger’s Syndrome and High Functioming Autism, by Sally Ozonoff, G. Dawson and J. McFaPartland.

C. Active but Atypically Odd: Multiple Complex Developmental Disorders are further on the continuum, and include atypical development with excessive affective disturbance, ambivalent attachments, rage, regressive thinking with cognitive errors and poor reality testing. These multi-dimensionally impaired children whose over-sensitive receptive or perceptual challenges might include hallucinations, suspicious tendencies and undermining behaviors.

Websites:
www.mcdd.be/index_en.htm (a sub category of PDD NOS with borderline characteristics with anger)
http://en.wikipedia.org/wiki/Multiplex_developmental_disorder

http://wiki.healthhaven.com/Multiple-complex_Developmental_Disorder (more information about autism associated with some disordered thinking and extreme emotional regulation problems)

Books:
Borderline Features in Childhood Disorders, by M. Lewis, in Psychoses and Pervasive Developmental Disorders in Childhood and Adolescence, by Volkmar, FR (ed), APA Press, ’96

Transition Statement to Next Topic

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If the problem cannot be resolved, determine current teams that are operating and available, such as an IEP team, the Child Study Team, a DCFS Service Team, a Student Assistance Team, or a Child Guidance Team, and see if the child qualifies. A first-level problem-solving approach using many of the above ideas, will likely lead to more easily-resolved problems. Another level of awareness comes from combining knowledge already gained into the following context-based solution-findings in the World of the Child. This level is for more complex or unresolved situations requiring a greater understanding of both the breadth of challenges, as well as a possible multi-source range of solutions.

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