Case Study on Adolescent Sexual Abuse Essay

Elias is a five form old Mexi throw out American male who has recently been referred to the community counseling inwardness due to the characterization of knowledgeable ill-usage by his stepfather. Elias was a client of this community center approximately 18 months earlier. Elias had been referred for poor impulse control and hyperactivity. At that conviction he was diagnosed as having At cristaltion Deficit Hyperactivity Dis ready (hyperkinetic syndrome). He to a fault met with the agency psychiatrist who had prescribed Elias Focalin. His cased was closed after unaccompanied a fewer sessions due to the familys inconsistency and withdrawal from services.At this point in time Elias has been attending his sessions with his mother and baby brother. Stepfathers whereabouts ar unknown and he has not had any contact with the family since the twist was exposed. Elias has returned to taking Focalin, since he failed to continue taking his medication after withdrawing from services. However, in that respect shoot been no changes noted in his behavior since he has begun to draw the medication. The psychiatrist believes that this may be due to the low dosage he has prescribed Elias and because of such(prenominal), the psychiatrist has opted to slowly increase the dosage and closely varan any changes.The clinician notes that Elias is extremely hyperactive and exhibits minimal impulse control. Other than his elevated levels of restlessness, Elias shows no observable signs or symptoms of reaction to the intimate do by. When clinician has attempted to wreak with Elias about the abuse or his feelings about the abuse, Elias has changed the subject or ignored the clinician all together. Mother states that she has noticed no changes in his behavior since the abuse was discovered.Practice Effectiveness QuestionsThe special population in discussion is children, the cordial problems in focalise are sexual abuse and trouble famine hyperactivity disorder (hyperkine tic syndrome), which leads the target client group to be children who fork over see sexual abuse and get to been diagnosed with ADHD. Our client is Elias who is a child, who has experienced sexual abuse and is diagnosed with ADHD. For the purposes of this discussion our practice trenchantness questions are1) What are effective interventions for children who have been sexually abuse? and 2) What are effective interventions for children who have been diagnosed with ADHD? Search description Procedures The databases use for this search were Google Scholar, Social Work Abstracts, babe Welfare Information Gate trend, Academic Search Complete, Professional Development Collection, PsycARTICLES, PsycINFO, SocINDEX with rise Text Sociological Collection, Academic Search Premier, and JSTOR. It was also helpful to round off the journal empower Sexual Abuse A Journal of seek and word for relevant articles.While searching the aforementioned databases, the following keywords were util ized sexual abuse and ADHD, sexual abuse and interventions, sexual abuse and co-morbidity, ADHD and co-morbidity, children and sexual abuse, sexual abuse and interventions. any articles selected were helpmate reviewed, found in scholarly journals, and make within the last ten years. In searching for relevant articles regarding give-and-take of sexual abuse, most articles intercommunicate interventions designed to treat perpetrators of child sexual abuse a few articles were uncovered that discussed treating adult survivors of childhood sexual abuse.Fewer still were articles that set interventions for children who are recent or current victims of sexual abuse. In order to find information relevant to our target client group, we began pulling sources from beginning pages of relevant articles which provided more focused research relevant to discourse of children who have experienced sexual abuse. Results The result of our exhaustive search of available literary works led us to identify eight articles to focus on.Out of these articles, four-spot dealt ad hocally with children who have experienced sexual abuse, ii focused on abuse of children which overwhelmd physical abuse along with sexual abuse, cardinal were focused in general on ADHD, four focused on co-morbidity of all post-traumatic stress disorder (posttraumatic stress disorder) or ADHD and sexual abuse, and four specifically discussed treatments and interventions. Half of the selected articles were literature reviews time the remaining four were reporting from the vantage point of a primary source on research studies of treatments and interventions.The research studies change in their sampling and control or comparison groups only devil studies were able to utilize a true experimental design with stochastic assignment of subscribe participants to control and experimental groups. The literature reviews provided an extensive overview of relevant studies and interventions from a secondar y source standpoint. The eight identified sources provided an assortment of research- found perspectives as well as a sampling of evidence based on authority by those who reviewed the literature and discussed their findings in literature reviews. Research FindingsDescription of Articles In the article Sexually Abused Children Suffering from posttraumatic stress disorder legal opinion and interference Strategies by David Heyne, Neville J. King, Paul Mullen, Nicole Myerson, Thomas H. Ollendick, Stephanie Rollings, and Bruce T. Tonge states that sexual abuse of children is a major societal problem because of its high prevalence and devastating bear upon on the ill-used child. Children who have been sexually treat a lot express trouble, depressive moods, improper sexual behaviors, nightmares, complaisant withdrawal, sleep difficulties, anger, shame/guilt and educate problems.The authors did diagnostic interviewing with their participants. The authors interviewed thirty six chi ldren and sixty nine percent were primarily diagnosed with posttraumatic stress disorder. Within the thirty six children four of the children with full PTSD had no other diagnoses. Nine had one co morbid diagnoses, ten had ii co morbid diagnoses, and two had three co morbid diagnoses. PTSD is not always prevalent and at times other steamy and behavioural problems are prevalent. In fact, many studies confirm that on clinical evaluation a large proportion of sexually abused children march diagnostic criteria for PTSD (Heyne, at el. , 2003).This particular article showed that often there are other diagnoses that go along with PTSD but in an article by Peggy T. Ackerman, Roscoe A. Dykman, Jerry G. Jones, W. Brian McPherson, and Joseph E. O. Newton, did research on groups that have been affected sexual, physically abused, or some(prenominal). The article Prevalence of PTSD and Other Psychiatric diagnosing in Three Groups of Abused Children (Sexual, Physical, and Both) was a moot do ne with children that are sexually and or physically abused. Fortunately, many children who are victims of horrifying events do not develop PTSD or other psychiatric disorders (Ackerman at el. 1998).Very little is known as to why some victimized children do and others do not develop psychiatric disorders. Even such basic variables as gender, ethnicity, socioeconomic status, intelligence, and age at time of trauma, have been inadequately studied. They were in a large childrens hospital in which sexual and or physically abused children were referred. The groups were divided into three, sexually and physically abused and both. Through the finding there were more boys who were physically abused and girls who were sexually abused. Anxiety and behavior disorders were more frequent than mood disorders.In concordance with clinical observation, abused boys, regardless of type abuse, had high rate of behavioral disorders and abused girls had higher rates of two internalizing disorders separa tion anxiety (caregiver reports) and phobic disorder (child report) (Ackerman at el. , 1998). Studies show most clearly that children who have been jointly physically and sexually abused are at great risk for psychiatric disturbance. There are many different treatment interventions one can go through to minimize PTSD and attention deficient disorders.Maryka Biaggio, Darlene Staffelbach, Dan Weinstein wrote the article ADHD and PTSD Differential Diagnosis in Childhood Sexual Abuse which shows different interventions used for victimized children. Treatment interventions for ADHD children predominantly consist of behavior management, social skills training, and stimulant or other medication. Treatment interventions for children with PTSD generally consist of management and respite of emotional distress using black market, psychodynamic and cognitive behavioral therapy modalities (Biaggio at el. 2000). residuum techniques and hypnosis have also been effective in treatment of PTSD in children.Misdiagnosis may lead clinicians to use malapropos interventions for PTSD. Side effects experienced by ADHD children on stimulant medication may intromit difficulty falling asleep, lack of appetite, irritability, headaches, stomachaches, nausea, dizziness, tachycardia, muscle tics or twitches, slowed physical growth, and bark rashes (Biaggio at el. , 2000). Another undesired onsequence of ADHD misdiagnosis in SAC (sexual abused children) is the failure to address and treat the trauma symptoms of children who actually have PTSD. tending(p) the risk of wrongly prescribing, untreated trauma, and negative impact on egotism for children misdiagnosed with ADHD, it is unfortunate little attention has been given to this issue (Biaggio at el. , 2000).increase attention to clinical decision-making in the differential diagnosis of ADHD and PTSD may lead to more appropriate, beneficial, and timely interventions. Darcie) Allison M. Briscoe-Smith and Stephen P. Henshaws article ent itled Linkages betwixt child abuse and attention-deficit/hyperactivity disorder in girls Behavioral and social correlates, was an excellent source to explore the relationship of sexual abuse and ADHD and begin to discuss the co-morbidity of these events for children. The article described a research study carried out with a sample of 228 females at a summer encampment for girls with ADHD over a three year span.Each year cohort groups were created to identify the prevalence of abuse among girls diagnosed with ADHD and those who had not true a diagnosis of ADHD. Out of the twenty-four identified cases of abuse histories, twenty of these girls were diagnosed with ADHD, and of those abuse histories ten were sexual in nature which is much higher than any other form of maltreatment documented by the researchers. All girls who had abuse histories had a co-morbid diagnosis of Oppositional Defiance Disorder.The study found that girls with both ADHD and abuse histories were more likely to display externalizing behaviors and be negatively received by their peers. The study also analyzed the relationship between the prevalence of an abuse history and the rejection from peers and found aggression to partially center(a) that relationship. The authors concluded that girls with ADHD were at increased risk of having abuse histories and questioned the absolute diagnosis of ADHD.It was suggested that the girls who had histories of abuse may more accurately be diagnosed with PTSD and/or share a co-morbid diagnosis with PTSD. Judith A. Cohen and Anthony P. Mannarino conducted a research study comparing two interventions to treat children who have been sexually abused their findings were published in the article entitled Interventions for Sexually Abused Children Initial Treatment Outcome Findings. This article was one of few that specifically addressed interventions for children with the focus being treatment of sexual abuse.The sample consisted of 49 children between the ag es of 7 and 14 who were randomly assigned to either sexual abuse specific cognitive behavioral therapy (SAS-CBT) or nondirective supportive therapy (NST) for a twelve calendar week duration. The study found that children in the SAS-CBT group improved significantly in social competence and in the reduction of feelings of depression. Also, substantially higher percentages of children abstruse in SAS-CBT experienced what is considered clinically significant improvements. In regards to deterioration while in therapy, higher rates were found in children who received NST.For the golosh of the other children in the groups, children who were consistently displaying repetitive extreme sexually inappropriate behaviors were removed from treatment groups seven NST participants were removed from the study as compared to two children participating in SAS-CBT. Parental satisfaction with treatment was high in both treatment groups which either treatment modality. The clinical impressions of the authors conclude that sexual abuse specific cognitive behavioral therapy is superior to nondirective supportive therapy in the reduction of depressive symptoms.SAS-CBT was also favored due to the benefit of including parents in treatment (NST did not formally include parents). The authors also concluded that there is think of and importance in providing a directive therapy technique in transaction with the effects of trauma caused by sexual abuse. Assessment of deduction Implications of Evidence Interventions for sexual abused victims trauma may include based cognitive behavioral therapy, play therapy, parental involvement- parent training, behavioral therapy, coping skills training, psycho-education, and prevention awareness.PTSD interventions may include trauma based cognitive behavioral therapy, and play therapy. Attention deficit disorder can also be treated with behavioral management techniques, medication, social skills training, play therapy, parent training, behavioral cla ssroom interventions and summer treatment programs. Many sexually abused children have other diagnosis along with PTSD and several(prenominal) possible co-morbid diagnosis are more than likely behavioral, but often can be confused with PTSD. When catching at interventions and treatments clinicians need to look at the clients cultural background so that way we do not intrude on their lives.