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Meier_Case Study


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PEDIATRIC CASE STUDY

Hailee Meier

BACKGROUND INFORMATION

• “7-year-old girl with anxiety disorder. Demonstrates difficulty remaining seated throughout the school day. Teacher reports constant feedback required to reassure the child of transitions and changes in the schedule. Slow to complete written work and often is watching her peers rather than focusing to task.”

Anxiety disorder- “Generalized anxiety disorder (GAD) causes kids to worry almost every day — and over lots of things. Kids with GAD worry over things that most kids worry about, like homework, tests, or making mistakes” (Lyness, 2018). Anxiety disorder makes it difficult for her to pay attention in class as she worries about others constantly.

REVIEW OF CASE STUDY

It is hard for her to sit still due to the anxiety disorder.

Requires constant reassurance of schedule changes as this is a contributing factor to her anxious feelings.

EVALUATION TOOLS

• Occupational profile of the child- interviews, likes and dislikes, things that make her feel anxious • Reports from teachers and caregivers • Observation & analysis of her behaviors in a typical school day during class • PROMIS Pediatric short form- this can assess anxiety in children • Consists of self-reports and parent-reports regarding mental health, physical health, and social health (Srlab, 2018).

THEORY: COGNITIVE-BEHAVIORAL THEORY The basis of this theory is if you change the distorted thoughts an individual experiences, the avoidant behavior can be changed (Case-Smith, 2020). Behaviors (fidgeting in class, inability to concentrate) can be a direct result from how/what an individuals perceives to be true. Gradual exposure to things that trigger anxiety can impact and change the thoughts the child has about those triggers (Bubrick, 2021). Interventions can be targeted for the child to unlearn the avoidant behavior that is causing the worrisome thoughts (Bubrick, 2021).

PROBLEM LIST AND REFERRALS



Problem list •

Child requires constant feedback of reassurance during transitions in the school day due to anxiety disorder.



Client is unable to stay seated throughout the school day due to inability to concentrate.



Worrying about what peers are doing results in slow completion of classwork.



Child is unable to participate in group activities with peers due to lack of attention and constant fidgeting.



Referrals: Psychologist/counselor to address anxious thoughts, summer camp to allow the child to gain confidence, increase social skills, and gain exposure to fears/triggers causing anxiety.

• LGT: Child will complete a full school day with minimal cues to stay attentive to tasks 4/5 opportunities within 6 months.

GOALS

• Objective 1: Child will stay seated for 1 hour requiring minimal cues while sitting on an exercise ball at her desk within 2 months. • Objective 2: Child will complete a worksheet within 15 minutes while being able to use a stress ball within 4 months. • Objective 3: Child will require a maximum of 4 verbal cues to stay attentive in class for an entire day within 4 months.

INTERVENTION PLAN •

Approach: MODIFY (adaptation)- change the context/environment to support performance of the individual by reducing anxiousness (American Occupational Therapy Association, 2020).



Prep-activities: Allow the child to play with a chosen toy by herself for 10 minutes before starting the intervention. This will help her desensitize to the environment before playing with peers.



The intervention plan will consist of child-centered play. During recess or a free period of the time, the therapist will have the child participate in a small group play session with peers. The group will be given toys of their liking, and the therapist will encourage creative play within the group. •



The child may require cues to stay focused within the group or may worry about her peers’ actions more than herself. The therapist will have an active role in the session to guide the child.

The purpose of this intervention will allow the child to find comfort in being in the classroom with peers. It will also allow her to increase her social skills.

• Title: ”Child-centered play therapy with young children who are anxious: A controlled trial”

EBP ARTICLE

• Summary: This article reports a trial for children ages 6-8 with anxiety symptoms. The purpose was to explore the effectiveness of child-centered play in young children (Stulmaker & Ray, 2015). The children receiving the intervention participated in 1216 sessions, lasting 30 minutes over an 8week course (Stulmaker & Ray, 2015). The results showed the the child-centered play reduced the overall worry in the children and increased their overall functional performance (Stulmaker & Ray, 2015).

REFERENCES • American Occupational Therapy Association. (2020). Occupational therapy practice framework (4th ed.). American Occupational Therapy. • Jerry Bubrick, P. (2020, June 16). Treating anxiety in children: Behavioral treatment. Retrieved April 06, 2021, from https://childmind.org/article/behavioral-treatment-kids-anxiety/ • Lyness, D. (Ed.). (2018, October). Anxiety disorders (for parents) - nemours kidshealth. Retrieved April 06, 2021, from https://kidshealth.org/en/parents/anxiety-disorders.html • O’Brien, J. C. & Kuhaneck, H. (2020). Occupational therapy for children and adolescents. St. Louis: Elsevier, Mosby. • PROMIS pediatric - anxiety. (n.d.). Retrieved April 06, 2021, from https://www.sralab.org/rehabilitationmeasures/promis-pediatric-anxiety • Stulmaker, H. L., & Ray, D. C. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127-133. doi:10.1016/j.childyouth.2015.08.005 • What is cognitive behavioral therapy? (n.d.). Retrieved April 06, 2021, from https://www.apa.org/ptsdguideline/patients-and-families/cognitive-behavioral