PRAC 6541 Journal Entry #2

Journal Entry #2

Describe an interesting case or a case that you have never seen before.

This is a pediatric case of a child with attention-deficit/hyperactivity disorder (ADHD), one of the most common mental disorders affecting children. John (pseudonym) is ten years old, in 5^th grade, and lives with his mother in a single-family home. He has an older brother. His parents are divorced. He spends most weekends with his father, who lives in a different part of town.

John’s strengths are his love of board games and dogs, watching mixed-martial arts programs with his father and brother, good math skills, and humor.

At school, John has challenges with not losing work, completing class tasks, organization, and material management. He has social difficulties and is impulsive. His teacher describes him as having short-lived relationships with others. He makes friends with his peers, but the friendship is suddenly over. In addition, the teacher reports that John lacks self-control, underperforms, and is messy. Besides that, the teacher feels he seems lost most of the time. The teacher may explain something or give instructions in class, but John would look confused while trying to figure out what was happening.

The family expresses some concerns about John’s life at home. He often loses things, has a messy room, backpack, and notebooks, has significant sleep difficulties, and fights with his sibling. He resists bedtime and avoids homework. As a result, he has difficulty waking up in the morning and is slow with the morning routine. His parents describe him as impulsive in performing personal hygiene tasks. For instance, he may brush his teeth for three seconds and say he was done. His actions are impulsive and quick.

John’s goals are to organize his schoolwork and make friends. He says it is stressful to always look for the relevant classwork. He is motivated to do well in school. He does not just want to make friends, but he wants to make good friends. In addition, he wants to be good at sports, mainly playing soccer with his peers during recess and in PE.

As such, the therapy focused on helping John address difficulties with completing tasks, keeping his work, and waking up.

Explain what you found challenging.

Stigma related to John’s mental health, and specifically to the ADHD diagnosis and treatment, was identified as a challenge. There was concern that following the diagnosis, he would be isolated or forced out of social groups and classrooms and that this would lead to “self-stigma” as John internalizes the societal prejudices and beliefs, resulting in treatment avoidance, anxiety, secrecy, limited aspirations, and low self-esteem.

This is a valid concern, as children with psychiatric disorders are stigmatized by their peers and adults. The stigma leads to discrimination that may be direct and obvious, such as someone making a negative comment about the diagnosis or treatment. The discrimination could also be subtle and unintentional, such as avoidance because of the assumption that the child could be dangerous, violent, or unstable due to the mental illness (Thom & McDougle, 2021). Some parents may not want their children to play with others diagnosed with mental disorders or even live next door to a child diagnosed with a mental disorder. Parents may be more generous when dealing with children diagnosed with physical illness than when dealing with children diagnosed with mental disorders. These prejudices and stereotypes that support the stigma are well-established in society (Dulcan, 2022).

John’s family indicated their concerns about the possible stigma, noting that it could lead to fewer opportunities for school and social activities, harassment and bullying from others, and belief that John would never succeed at certain challenges and that he would never improve his situation.

Explain what you would do differently from your Preceptor.

The case presented by John is one of stigma associated with diagnosis and therapy. It is essential to shed light on the misconceptions and build a more supportive culture around pursuing psychological well-being. First, redefining strength to show that true strength lies in understanding John’s vulnerabilities and seeking support when needed. Just as a physician is visited for physical illness, turning to a therapist for emotional and mental guidance should be perceived as a sign of self-awareness and resilience (Dulcan, 2022). Second, fostering an environment that normalizes therapy to address the fear of societal judgment. This involves encouraging the family to get into peer groups for persons with ADHD, reading about others’ therapy journeys, and consuming media that portrays therapy positively, which would help change societal perspectives (Ranahan et al., 2020).

Explain the cultural differences you found challenging.

A challenging cultural difference is the “one-size-fits-all” misconception. This is the pervasive belief that therapy is a uniform, singular experience. This causes some people with mental health issues to shy away from diagnosis and treatment because they think it will not cater to their unique cultural background or needs. The reality is that therapy is as diverse as the people who seek it. There are various therapeutic specializations, techniques, and modalities, from cognitive-behavioral therapy to psychodynamic psychotherapy, art therapy, and more. Applying culturally sensitive approaches would ensure that individuals from all cultural backgrounds feel respected and understood. Also, disseminating information about the vast range of therapeutic options can help to break down this generalized perception (Yearwood et al., 2021).

References

Dulcan, M. (2022). Dulcan’s Textbook of Child and Adolescent Psychiatry (3rd ed.). American Psychiatric Association Publishing.

Ranahan, P., Kutcher, S., & Hashish, M. (2020). Introduction to Mental Health for Child and Youth Care. Canadian Scholars.

Thom, R., & McDougle, C. (Eds.) (2021). Child and Adolescent Psychiatry. Oxford University Press.

Yearwood, E., Pearson, G., & Newland, J. (Eds.) (2021). Child and Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing (2nd ed.). John Wiley & Sons, Inc.