Seven
ILLUSTRATIVE CASE REPORTS
This chapter provides several sample psychological, psychoeducational, and counseling reports utilizing temperament measures. Temperament data are utilized by a wide range of professionals from the medical, mental health, educational, and career development communities. The reports illustrate integration of temperament data as a component of comprehensive evaluations for a variety of referral concerns, including family therapy, learning disabilities, threat assessment, behavioral concerns, rehabilitation planning, and counseling. The cases also provide application perspectives from a variety of settings, ages, and circumstances for which temperament information can be informative in understanding the individualās functioning. It should be noted, these samples are not all inclusive. There are many other widely utilized functions for temperament data including personality assessment, career planning, and corporate business team-building interpretations that are not represented in these select samples. Each section offers a brief case scenario that describes the context of the assessment and then a full report or summary including intervention or treatment recommendations as warranted.
DONāT FORGET
Multi-faceted Approach to Assessment
As noted in Chapter Four, best practices standards for educational and psychological assessment requires a multi-faceted approach rather than reliance on one data measure (AERA, 1999).
EVALUATION REPORTSāEARLY CHILDHOOD SAMPLES
Parent-Child Interaction Therapy Sample Utilizing the TABS
The first sample report in this chapter provides an example of behavioral concerns related to interactions between parents and their preschool child. The setting is a private clinic that specializes in family-child interaction support services. A variety of resources including parenting workshops, individual or family counseling, tutoring, social skills training, anger management techniques, stress management strategies, and parent support groups are provided. Referrals are generated from other medical or mental health professionals, as well as schools, youth agencies, and parents. The treatment or counseling plan is customized to each familyās needs based on information from prior reports, intake interview, and in-clinic observations. Once services are implemented, participation in periodic follow-up visits are required to assess the effectiveness and adjust services as needed. In addition, the clinic offers collaboration with other agencies including public school systems.
Rapid Reference 7.1
Thomas and Chessās Goodness of Fit Principle
Goodness-of-fi t and poorness-of-fi t are key considerations in parent-child interaction assessments utilizing temperament data. Parent and child temperaments do not have to be the same to foster good relationships. It is the understanding and tolerance of differences or lack thereof that determines if differences become sources of confl ict and stress.
Child & Adolescent Family Clinic 982 Morris Avenue, Waterford, CT 18895
| Intake and Counseling Plan Summary |
|---|
| Client Name: Mr. Robert and Mrs. Amanda Fuyu | Childās Name: Rebecca Fuyu |
| Intake Interview Date: 3-8-09 | Case Number: 654321 |
| Childās Age: 5 years, 5 months | Therapist: Dr. Emilia Rogers |
| Insurance Provider: Blue Cross/Blue Shield 56-56-876 | |
Rebecca Fuyu is a healthy five-year-old female who was first seen in clinic on March 8th, 2009, accompanied by her mother and father. Her parents indicate concerns for her excitability and sometimes disagreeable behaviors. The family is seeking guidance on parenting strategies.
Developmental History
Based on parent report and medical records, Rebecca was born full term without complications, and Ms. Fuyu had good prenatal care. No injuries or illnesses are indicated, and Rebecca receives regular physical wellness exams from her pediatrician, Dr. Patricia Nelson. A developmental history indicates all major milestones were achieved on time and Rebecca began speaking somewhat earlier than typical.
Rebecca is an only child and resides with both parents. Her family is of Japanese descent, and both of her parents were born and educated in the United States. Ms. Fuyu has a masterās degree in horticulture and stayed home to care for Rebecca till this year when she started preschool. She is currently teaching at Vanderson Community College. Mr. Fuyu is a chemist and employed at Alcon Products.
Her parents describe Rebecca as a lively child who is smart and asks questions all the time. They note she is loving and considerate most of the time. She has many friends at preschool, enjoys ballet class, and plays well with others. She has a good sleep routine, appears rested in the mornings, and the family is diligent in maintaining a healthy diet at home. Rebecca is usually provided fruits, nuts, or popcorn for snacks. Her appetite is described as hardy. Her parents enjoy a number of peaceful activities at home including reading and board games. They note Rebecca seems to prefer active hobbies like jumping on the trampoline or her bed, running in the yard, and she likes to have the television on all the time. The family enjoys bike riding, swimming, hiking, and attending movies together. As Rebecca is an only child, they often invite one of her friends along for recreational activities.
Most of the time, Rebecca is noted to be happy; however, her parents indicated as a toddler she had a propensity to whine and tantrum on occasion if she was prevented from engaging in a preferred activity. They thought she would grow out of this stage, and this did decrease with age. However, at the ages of three and four, Rebeccaās behaviors appeared to shift to talking back and defiantly saying āNo-Noā to her parentsā requests when she did not wish to comply. It was also difficult to get Rebecca to sit calming for any length of time. They have noted since entering preschool Rebecca is becoming more skilled at negotiating requests and arguing; she is also increasingly running off to play and just ignoring their directions. This has resulted in more parent-child disagreements and tension. Her parents are also embarrassed when these behaviors occur in public.
At preschool, her teachers describe Rebecca as a lovely child who is craving the attention of other children. They noted she has many friends and enjoys almost any activity. She learned to write numbers, letters, and her name quickly and has memorized all the words to their rhyming songs. They describe her as very bright. They note she can sit and contently chat with friends but becomes impulsive, silly, and teases others if left alone. The school recommended her parents discuss these characteristics with her pediatrician. Rebeccaās parents followed up on the request and have provided this clinic with a copy of the evaluation. Based on parent/teacher ratings and examination, the findings ruled out Attention-Deficit/Hyperactivity Disorder at this time.
Parent/Child Temperament
Observation and interview of the parentsā interaction style appears to indicate both are highly introverted, prefer quiet activities, and present a demur demeanor. They have strong expectations that Rebecca will also be content in solitary and quiet activities. In addition, they expect her to be less active than is developmental typically for five-year-old children. This difference in temperament qualities appears to be creating stress for the family. The parents were asked to complete the Temperament and Atypical Behavior Scale (TABS), a 55-item measure that assesses early childhood indicators of developmental dysfunction. Results indicate no significant concerns for Detached (t-score = 52), Underreactive (t-score = 51), or Dysregulated scales (t-score = 52). However, Hyper-sensitive/ Active (t-score = 37) was in the delayed range.
Detached: Rebecca reportedly does not stare, makes good eye contact, plays with toys appropriately, and does not wander inappropriately.
Underactive: She is noted to smile and enjoy humor, play well, and has appropriate reaction to surprises and noises.
Dysregulated: Her sleep hygiene is good, and she does not experience nightmares.
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