Respond to your colleagues post by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients. Colleagues Post Disruptive behaviors can be difficult to diagnose and the etiology is unknown however temperamental, biological, and environmental factors are associated with increased risk (Karimy et al., 2018). In this week’s discussion video of disruptive behaviors, I choose to discuss an adolescent boy with withdrawn behaviors. Observation Withdrawn Behaviors On presentation, the child was withdrawn and his behavior was associated with constructs such as shyness, quiet, guarded, fearful, sadness, and passivity. His affect was flat and mood irritable. The adolescent seems reluctant to engage in conversation to express his thoughts, feelings, and views during the therapy session. However, there was not enough information regarding the client’s psychiatric, psychosocial, and medical history available. Behaviors (DSM-5) Social withdrawal is not a clinically defined behavioral, social, or emotional disorder for children. There is not a significant amount of data. However, emotionally withdrawn children showed limited social responsiveness, little positive affect, and emotion dysregulation, as well as failure to seek comfort when distressed. This behavioral phenotype is defined as Reactive attachment disorder (RAD), with a requirement that the signs result from pathogenic care (Gleason et al., 2011). According to the DSM-5, RAD is a trauma and stressor-related condition of early childhood caused by caregiver neglect and maltreatment. The children have difficulty forming emotional attachments, decreased ability to experience positive emotion, and seek or accept emotional closeness, may react violently when held or comforted. The child has episodes of unexplained irritability, sadness, or fearfulness that are evident during nonthreatening interactions with adult caregivers. The children tend to be unpredictable, difficult to console, and discipline (Association, n.d.). Therapeutic Approaches and Outcomes RAD is a rare attachment disorder that can be found in young children exposed to severe neglect before being placed into foster care or raised in institutions. However, less than 10% of these children experiencing severe neglect will develop the disorder. Children developing RAD most often experience severe social neglect within the first months of life. Symptoms of RAD develop at a young age, between the ages of 9 months and 5 years (Association, n.d.). Treatment involves incorporating parent/caregiver education and trauma-focused therapy. Children with RAD often have multiple issues, therapy and medical treatment may be advised to treat co-existing conditions. Therapy can help the child and parent/caregiver heal damaged family relationships and strengthen the parent-child bond. Also, medication may be considered when psychotherapy alone is not effective. The clinician will work with the caregiver, helping to manage the child’s behavior, as well as the caregiver/parent feelings of anxiety, frustration, or anger in dealing with the difficult-to-connect-with child. Psychopharmacological intervention is not indicated for RAD (Karimy et al., 2018). However, children with co-morbid disorders, such as ADHD, anxiety, or mood disorders, may benefit from medication to treat these disorders and symptoms like explosive anger, difficulty concentrating, and insomnia. In conclusion, the most important intervention for children diagnosed with RAD is ensuring a consistent, sensitive caregiver who is emotionally invested and emotionally available. Additionally, psychotherapies are important because they seek to change behaviors, thoughts, and emotions. Also, early identification and treatment are crucial for healing and developing healthy lifelong relationships. The PMHNP must tailored treatment for each client to appropriately manage the disorder and treat symptoms. References Association, A. P. (n.d.). Diagnostic and statistical manual of mental disorders, 5th edition: Dsm-5 (5th ed.). American Psychiatric Publishing. Gleason, M., Fox, N. A., Drury, S., Smyke, A., Egger, H. L., Nelson, C. A., Gregas, M. C., & Zeanah, C. H. (2011). Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. Journal of the American Academy of Child & Adolescent Psychiatry, 50(3), 216–231.e3. https://doi.org/10.1016/j.jaac.2010.12.012 Karimy, M., Fakhri, A., Vali, E., Vali, F., Veiga, F. H., Stein, L. R., & Araban, M. (2018). Disruptive behavior scale for adolescents (disba): Development and psychometric properties. Child and Adolescent Psychiatry and Mental Health, 12(1). https://doi.org/10.1186/s13034-018-0221-8
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