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The Case Study of Angry Adolescent. The case study selected for the discussion included an adolescent female who appears to be extremely upset. The first video presented the client exhibiting extreme anger. The client as observed in the first video, appeared to be highly disrespectful towards the therapist and refuses to discuss anything. The client was also observed to have misbehaved with the therapist. In the second video, it was observed that the therapist succeeded to initiate a productive discussion with the client, which revealed significant points regarding the personality of the client. The client was identified to be a popular girl at her school; however, she reported having anger-related issues. The client’s behavior indicated that she is most likely to be suffering from oppositional defiant disorder (ODD). The ODD is a form of disruptive behavior disorder in which the client experiences irritable or angry mood, vindictiveness, and disobedient behavior (Cavanagh, et al., 2017). Clients experiencing ODD finds it difficult to keep their anger under control and exhibits a rebellious and noncompliant behavior (Cavanagh, et al., 2017).
DSM-5 Criteria
The DSM-5 criteria for the diagnosis of ODD require that the client experience a pattern of irritable mood or anger, aggressive or rebellious behavior, or vindictiveness for a minimum duration of six months (American Psychiatric Association, 2013). According to the American Psychiatric Association (2013), the DSM-5 criteria for ODD requires that the client must exhibit a minimum of four of the following symptoms:
Frequent loss of temper
Frequent anger and resentment
Frequently irritable or get annoyed easily
Frequent arguments with authoritative figures
Frequent denial to follow orders
Frequently upsets others
Frequently place blame on others for own mistakes
Remains mean or spiteful
Because the patient exhibited anger towards the therapist and behaved disrespectfully, it is suggested that the client is experiencing ODD. The client exhibited no fear of the consequences of her actions for being noncompliant.
Therapeutic Approach
The preferred therapeutic approach to be used with the client is child-based therapy and parent training. This is the preferred psychotherapies for the clients diagnosed with ODD (Katzmann, et al, 2018). Child-based therapy focuses on problem-solving whereas parent training supports parents to develop skills required for the management of troublesome behavior of their child (Goertz-Dorten, et al., 2019). This is accomplished by applying the technique of limiting involuntary positive reinforcement of troublesome behavior (Goertz-Dorten, et al., 2019). Cognitive-behavioral therapy (CBT) is identified to be effective psychotherapy for clients with ODD (Katzmann, et al, 2018). Therefore, the client would be referred to CBT and parent training would be referred for the parents.
Psychotropic medications appropriate for the treatment of ODD are second-generation antipsychotics (SGAs) (Arnold & Moody, 2018). Risperdal is the brand name of risperidone, which is considered the preferred psychopharmacological agent for the treatment of ODD because of its proven efficacy for adolescents (Arnold & Moody, 2018). Therefore, the appropriate psychotropic medication for the client would be Risperdal.
The expected outcome for the client based on selected therapeutic approaches will be that parents will be able to have a better understanding of their child’s behavior. The parents would gain the ability to manage the disruptive behavior of their child. It would also be expected that the client would be able to have a better understanding of herself, her thoughts, behavior, and pertinent actions. It is expected that the client would experience a decline in ODD symptoms and become capable of managing her disruptive behavior.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: Author.
Arnold, M. J., & Moody, A. L. (2018). Atypical Antipsychotics for Disruptive Behavior Disorders in Children and Adolescents. American Family Physician, 97(11), 5-6. Retrieved from https://www.aafp.org/afp/2018/0601/p715.html
Cavanagh, M., Quinn, D., Duncan, D., Graham, T., & Balbuena, L. (2017). Oppositional defiant disorder is better conceptualized as a disorder of emotional regulation. Journal of Attention Disorders, 21(5), 1-9. doi:10.1177/1087054713520221
Goertz-Dorten, A., Benesch, C., Berk-Pawlitzek, E., Faber, M., Hautmann, C., Hellmich, M., & Doepfner, M. (2019). Efficacy of individualized social competence training for children with oppositional defiant disorders/conduct disorders: A randomized controlled trial with an active control group. European Child & Adolescent Psychiatry, 28(2), 65-65. doi:10.1007/s00787-018-1144-x
Katzmann, J., Döpfner, M., & Görtz-Dorten, A. (2018). Child-based treatment of oppositional defiant disorder: Mediating effects on parental depression, anxiety and stress. European Child & Adolescent Psychiatry, 27(9), 81-92. doi:10.1007/s00787-018-1181-5
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