Evidence-based assessment/Vignettes/Jay

From Wikiversity
Jump to navigation Jump to search


Clinical description[edit]

Jay is a 22-year-old male undergraduate student at the University of North Carolina at Chapel Hill (UNC). Jay was previously diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). In college, Jay complained of having difficulties with sustaining attention, reading, inadequate study habits, and poor performance in his college courses (relative to his high school performance). He has been experiencing mood fluctuations. Jay has been feeling anxious for a long time. He has panic attacks and persistent worrying.

History of presenting a problem[edit]

Jay had previously been evaluated for Attention-Deficit/Hyperactivity Disorder (ADHD) and was diagnosed. In addition to attention and reading difficulties, Jay reported clinically significant disordered mood and fluctuations in mood (i.e., periods of “highs” and “lows”), and a strong family history of bipolar disorder. Finally, Jay reported a longstanding history of anxiety, including panic attacks and persistent worrying.


Initial treatment plan[edit]

Assessment Findings[edit]

Checklist Scores[edit]

ASEBA Scores
Scale Mom Arlene Teacher
Externalizing 67 73 68
Internalizing 59 68 46
Anxious/Depressed 57 62 50
Withdrawn 66 68 52
Somatic Complaints 50 70 50
Attention Problems 62 68 58
Social Problems 61 63 62
Thought Problems 55 64 50
Delinquent/Rule-Breaking 62 70 65
Aggressive Behavior 69 72 68
Extended content

Select more specialized scales to refine probabilities[edit]

Updating probabilities[edit]

Critical items[edit]

Diagnostic Interview findings[edit]

Cognitive and Achievement Testing[edit]

(Not done as part of the evaluation; may be able to match up information later)

Prediction Phase[edit]

Let's see how we would apply the EBA principles to Arlene:

Shortlist of Probable Hypotheses[edit]

Based on Jay's age and the common clinical issues, here are the possible issues:

  • Attention problems
  • Anxiety disorders
  • Substance misuse should be another hypothesis, based again on its prevalence in his age group.
  • A mood disorder

Risk and Protective Factors and Moderators[edit]

Arlene's gender and age increase the probability of a mood disorder, and may reduce the chances of conduct disorder. Her solid academic performance previously suggests potential resilience.

Her conflict with her father, and her keeping things secret from her parents, would be considerations before doing family therapy, and they may complicate consent for treatment (Arlene is still a minor).

Some data suggest that Interpersonal Psychotherapy (IPT) may be particularly effective with Hispanic teens, perhaps moreso than Cognitive Behavioral Therapy (CBT), because of the greater emphasis on family (and familism). IPT would have an advantage of not requiring active participation of the father (unlike family therapy), since IPT is designed as an individual therapy.

Updating Probability of Diagnoses[edit]

Could add table with DLRS and revised probabilities, or leave them blank and have a "key" section?

Cross Informant Perspectives[edit]

Mention that these have DLRs. Also unpack the implications of agreement and disagreement for the client (and add a section about treatment implications of disagreement on the Conceptual Model Pages)

Prescription Phase[edit]

Mental Status and Clinical Observations[edit]

add content

Treatment Selection[edit]

The diagnostic interview suggests a combination of a major depressive episode and a prior dysthymia, sometimes referred to as a "double depression." This suggests that Arlene's stress and mood problems have persisted for a long time, and may be more difficult to treat. The mood disorders clearly are associated with impairment and should be a major focus of treatment.

Moderating Factors[edit]

Client Preferences[edit]

Process Phase[edit]

Clinically Significant Change[edit]

Reliable Change Index[edit]

Pick a treatment target and specify what the RCI would be for it. Discuss how you would explain to Arlene

Nomothetic Benchmarks[edit]

A, B, Cs of Jacobson definitions. General stuff about limitations would go on the main concept page. Here it is focused on the client -- what are the benchmarks they will focus on? How explained to them?

Interpreting benchmarks[edit]

Minimum Important Difference (MID)[edit]

Note that this section is a dangler -- not originally called out in the 12 steps. Medium d as a rule of thumb from Streiner, Norman, & Cairney (2015). Could work from AUC to d to raw units as a way of estimating, since psychology hasn't done research on this yet. Might be able to back into it with studies that had CSQ and outcome data.

Client Goals & Tracking[edit]

These would be personal goals and idiographic measurement -- YTOPS, etc.

Process Measures[edit]

This would be traces such as coming to sessions, doing homework assignments. (Not sure of other specifics involved in current IPT protocols?)

Progress Measures[edit]

YTOPS again and goal setting.

Termination Planning and Maintenance[edit]

Revisit Jacobson benchmarks. Is there much chance of relapse? What things would the client need to pay attention to if they were going to nip that in the bud?