Case jim

• Engels
• Middelbare school
• vmbo b
• Leerjaar 1

Case Jim

Sofie Bernart, Ellen Fischer, Markéta Mickova

Case Jim

Name: Jim 

Age: 6 years 

Sex: male

Behavioural characteristics:

- Unfocused

- Impulsive

- Aggressive

Goal: enhance hiss wellbeing and behaviour

Conduct disorder	ADHD	Oppositional defiant disorder
-Bullying, threatening intimidating - Physical fights/ cruel to people and animals - Destroying property - Lying and deceiving - Stealing - Running away - Ignoring parental prohibitions	- Trouble holding attention - Careless mistakes - not listening or following instructions - Losing and forgetting things - Fidgeting and moving around - Difficulties staying quiet - interrupting others -	- Loses temper often - Often touchy and easily annoyed - Arguing with authority figures - Defying or refusing requests - Balling others for mistakes

DSM-5

What do we think?
(Hint: Ask questions to the parents!)

Conduct disorder

ADHD

ODD

Conduct disorder

- Psychiatric disorder

- Aggression, destruction, deceitfulness, theft and violation of rules

- More common in boys

- 2-16% has Conduct disorder

- Often starts as OOD 

- Can get worse 

--> Genetically and environmental causes

What do we think?
(Ask questions)

Environmental

Genetics

Genetics

- GABRA2, MAOA, SLC6A4, AVPR1A 

- 50% increased risk when parents have struggles

- GxE

Environmental

- Abusive upbringing

- Exposure to substance abuse

- Unpredictable environment 

Most likely to:
Develop CD

1. Authorian parents
2. Permissive parents

Most likely to:
Develop CD

1. Neglecting parents
2. Authorative parents

Most likely to:
Develop CD

1. Low socioeconomic status
2. High socioeconomic status

Most likely to:
Develop CD

1. Parents with a mental health disorder
2. Healthy parents

Feedback loop system

- Behavioural system - results in repetition/escalation/decrease/avoidance of behaviour

- Forming attachment

- more aspects: e.g., the way we view ourselves

Which feedback loop leads directly to avoidance of behaviour?

1. mother smiles -> infant smiles -> mother smiles even more
2. child relies on a parent -> parent does not fulfil what they have promised -> child learns not to trust the parent
3. Friend calls her bad names in an argument -> she responds in the same way -> the conversation becomes more hostile

What could be a reason for Jim to become more socially isolated in his school environment over time?

Feedback loops in Jim’s case: possible causes of isolation

- Jim mistrusts people -->  he relies on himself only --> ‘I delt with it well, I really do not need anybody’ -->  Jim becomes more separated

- Jim acts aggressively -->  people avoid Jim because he is aggressive --> Jim sees they do not want to be friends with him --> Jim becomes more aggressive

What do you think is the best reaction of a teacher to Jim having a tantrum because he does not want to write a test?

1. Relieve the pressure and agree that the test could be as well written on a different date
2. Rationally argument with Jim and try to explain to him why the test must be written now, in a discussion
3. Wait it out, stay calm, acknowledge his feeling by a neutral comment
4. Try to distract Jim by showing him nice pictures that are in a class

Suggestions for interventions regarding feedback loops

- Encourage Jim to rely on somebody and make him realize that he can rely on some people

- Creating different feedback loops: rewarding good behaviour  

- Make Jim realize that other children avoid him only because his expressed anger makes them uncomfortable

- anger management techniques 

- Not encouraging the bad existing loops 

- Teach him to communicate what he wants and feels in an assertive way

Jim is playing with a doll, a girl comes up to him and takes it from him. What do you expect him to do?

Aks the girls to give the doll back

Take the doll back from the girl

Hit the girl and react angry

Throw a tantrum

Self-fulfilling prophecies

Suggestions for interventions regarding self-fulfilling prophecies

Teaching Jim:

- Stress management, relaxation skills (exams)

- Positive thinking, self-talk, reinterpretation (cognitive therapy)

- Self-control & problem solution – ability to change the outcome of the situation

 

Making teachers & classmates aware of:

- Their bias (proven to help)

- The possibility of giving him space to change

- How their positive feedback on good behaviour can help him get back on track 

Take home message

Awareness & education - how to find the root of the problem of children, how to help them to make it easier for them

Fundamental attribution error: behaviour of others - result of their personality, not of outer influences --> 

excusing bad behaviour x being more

empathetic, taking into account unfair circumstances of the child

--> it can be changed