Obsessive Compulsive Disorder or Social Anxiety Disorder or Major

Full Answer Section

Etiology:

1. Parenting Style: Michael's parents report inconsistent discipline and difficulty setting clear boundaries. His father is described as authoritarian, and his mother as permissive, creating confusion and frustration for Michael.
2. Temperamental Factors: Michael has a history of being a difficult child, showing early signs of irritability and impulsivity. This indicates a possible biological predisposition.
3. Environmental Stressors: The transition to a new school, coupled with academic difficulties, has created significant stress for Michael.

Functioning:

• Personal: Michael experiences frequent emotional outbursts and struggles to regulate his emotions. He has low self-esteem and feelings of isolation.
• Peers: He has difficulty maintaining friendships due to his argumentative and defiant behavior. He is often rejected by his peers.
• Academic: His academic performance has declined due to his refusal to comply with teachers' instructions and complete assignments.
• Social: Michael's social interactions are limited, and he often engages in conflicts with others.
• Family: Family relationships are strained, with frequent arguments and power struggles.

Treatment:

• Treatment of Choice: Parent Management Training (PMT) combined with Cognitive Problem-Solving Skills Training (CPSST).
  • Rationale: PMT aims to teach parents effective strategies for managing their child's behavior, including consistent discipline, positive reinforcement, and improved communication. CPSST helps Michael develop problem-solving skills, anger management techniques, and social skills.
• Advantages:
  • PMT has strong empirical support for treating ODD.
  • CPSST addresses the cognitive and emotional factors that contribute to ODD.
  • These treatments focus on improving family dynamics and teaching the child new skills.
• Disadvantages:
  • PMT requires significant parental involvement and commitment, which may be challenging for some families.
  • CPSST can be time-consuming and requires the child's active participation.
  • It can be difficult to get the child to participate in therapy.
  • If the parents are not willing to change their parenting styles, then the therapy will be less effective.

Sample Answer

General Description:

• Michael is a 10-year-old male. He presents as a slightly disheveled child, with a sullen expression. He avoids eye contact and speaks in a defiant tone. His mood is generally irritable and angry, and his affect is restricted, showing little variation.

Behaviors/Symptoms Indicative of ODD:

1. Persistent Argumentativeness: Michael frequently argues with adults, particularly his parents and teachers, often about trivial matters.
2. Defiance and Non-Compliance: He actively refuses to comply with rules and requests from authority figures.
3. Deliberate Annoyance of Others: He seems to enjoy deliberately provoking and annoying his peers and adults.
4. Blaming Others: Michael consistently blames others for his mistakes or misbehavior.
5. Angry and Resentful Mood: He displays a pervasive pattern of anger, resentment, and irritability.
6. Spiteful and Vindictive Behavior: He has shown a pattern of being spiteful or vindictive at least twice within the past six months.

Developmental Course:

• Onset: Michael's oppositional behavior began to escalate around age 7, coinciding with his transition to a new school.
• Developmental Appropriateness: While some degree of defiance is normal in children, Michael's pattern of behavior is excessive and persistent, exceeding developmentally appropriate limits.
• Changes Throughout Development: H