Case Study Three - Saper

Case Study #3
Counseling Case
Student Name: Randy A. Grade: 1st Date of Report: 3/5/13 Background Information: Randy is a 6 year old student who entered Friends Elementary School at the beginning of this school year as a first grader. Randy currently lives with his mother, sister, and their chihuahua, Tito. His father has been in and out of his life since he was born. At the time of his evaluation, Ms. S. stated that the last time Randy saw his father was in November, 2012. Randys past is notable for trauma due to domestic violence he witnessed among his immediate family members. There is a history of substance and alcohol abuse on both sides of his family as well as mental health issues. In addition, both parents experienced significant disruptions in their lives as they were growing up. Within the recent past, a 51A was filed anonymously due to suspicions of sexual abuse towards Randy. As of this case study, no allegations have been confirmed. In August of 2011, Randy was enrolled at a school in Framingham for Kindergarten. March of that school year, Randys mother, Daisy S., requested a full evaluation to address possible learning disabilities and behavioral concerns. Results from the May 2012 Psychological Report indicated significantly stronger non-verbal perceptual reasoning skills than verbal and processing speed abilities (Zaki, 2011). It was noted that these scores may not be an accurate representation of Randys skills due to variations in his ability to sustain attention, concentration, and cooperation. As a result of the evaluation, Randy began speech/language services two times a week for 30 minutes and special education services within his general education class room four times a week for 30 minutes. Randys transition to Friends Elementary School was difficult for him. He was often noncompliant and had difficulty following classroom rules. Due to his difficult adjustment to Friends, additional assessments were needed to determine what appropriate supports should be put in place for Randy to be a successful learner. In the assessment setting, Randy presented as charming yet oppositional. After he had formed a relationship with the examiner, he presented as Date of Birth: 6/22/06 Age: 6 years, 8 months Counselor: Becky Saper

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a curious and eager to please child. With incentive, he was able to focus his attention and complete requested tasks. The most current cognitive assessment results indicated that Randys verbal and working memory abilities were solidly developed; processing speed abilities falling within the High Average range. In addition to looking into Randys cognitive functioning, his social and emotional functioning was assessed. Results indicated that he is a child with some significant fears, aggressive tendencies, and a low sense of self-efficacy. In both the classroom and home settings, Randy has shown aggressive and dysregulated behaviors such as talking back to adults and losing his temper easily. In collaboration with Randys teacher, an incentive system was created to promote appropriate behaviors in the classroom setting. Randys behavior has significantly improved from the beginning of the year suggesting that the strategies in place were effective. Despite this progress, Randy continued to demonstrate disruptive behaviors in the classroom and difficulties with self-regulation.

PROBLEM IDENTIFICATION:

According to teacher, parent, and self-reports, Randy has significant difficulty in regulating his emotions and behavior. In working with Randy, it was also important to consider his history of trauma. Randys difficulty in regulating both his ability to tolerate negative emotions and his ability to control his expression of emotion are often seen in children with traumatic pasts. On several occasions Randy has made negative comments about himself and his abilities to be a successful student. Treatment for students with traumatic backgrounds must be corrective and responsive. It is important to focus on helping the child in his/her current circumstances, moderating his/her current symptoms, and helping the child work through the trauma. When working with Randy it was important to keep this in mind in addition to the work we do on self-regulation. His ability to regulate his emotions and impulses and behave in a socially appropriate way will directly affect how he expresses and internalizes his past. Randys emotional and behavioral dysregulation consisted of talking back to adults, not complying with adult directions/blatant refusal to engage in a requested task, and engaging in physical actions which require the removal of Randy from his class. Upon discussion with his classroom teacher and behavior specialist, the function of these behaviors were found to be

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avoidance. To narrow our description further, Randys avoidance was broken down further to include: feeling overwhelmed by the situation, activity, or task and his low sense of self-efficacy. As a result of these two factors, Randy was often unable to attend to instruction or engage in activities with the rest of his class. In order to support his engagement, Randy was provided with ample opportunities to take breaks throughout his school day. Randys teacher tracked the time he spent engaged/disengaged with the rest of the class over a four week period of time. This data was used as his baseline data. Results are shown below: Time Engaged/Disengaged
Baseline Data Collection
Engaged Disengaged

Expectation of Time Spent Engaged vs. Disengaged

Engaged

52% 48%

75% 25%

Disengaged

As can be seen from the chart on the left, Randy was engaged with his class an average time of 48%, and was disengaged 52% of the time. His teacher expressed that while he was spending more of his time engaged after implementing breaks, she wanted him to reach the point where he was spending 75% of his day engaging with the rest of the class. Given his experiences with trauma and variable performance in school, it was hard to distinguish whether Randys challenges were a result of a skills deficit or a performance deficit. Using the two subcategories of Randys avoidance behaviors (overwhelmed & self-efficacy) and discussion with his mother and teacher, it was determined that his difficulties were both a skills deficit (emotional dysregulation) and a performance deficit (inability to take risks).

PROBLEM ANALYSIS:

A hypothesis was generated through consultation with his mother and classroom teacher, interviews with the teaching assistants that work in his classroom, and observations. In addition, Randys traumatic background was factored into the development of a hypothesis. This hypothesis stated: With the ability to identify his emotions, the vocabulary to express them, and

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strategies to manage them, Randys time spent engaged with his class will meet the expected percentage.

INTERVENTION:

Research on brain development show us, that frontal lobe development is accelerated between the ages of seven and ten. Similarly, neural connections become stronger resulting in improved self-control and operational thinking (Richard & Fahy, 2005). Selfregulation, as described by Kuypers (2011), is the ability to do what needs to be done to be in the optimal state for the given situation. This includes regulating ones sensory needs, emotions, and impulses to meet the demands of the environment, reach ones goals, and behave in a socially appropriate way. Randys mother and teacher decided in collaboration with the school psychology intern that an individualized counseling intervention would be appropriate to help him learn strategies for self-regulation. Randy met with the school psychology intern once a week for 30 minute individual counseling sessions over six weeks. Based on the goal of increasing Randys ability to recognize and regulate his emotions, counseling sessions were based around Leah Kuypers curriculum, Zones of Regulation (2011). The Zones is a systematic, cognitive behavior approach used to teach self-regulation by categorizing all the different ways we feel and states of alertness we experience into four concrete zones. The Zones curriculum provides strategies to teach students to become more aware of, and independent in, controlling their emotions and impulses, managing their sensory needs, and improving their ability to problem solve conflicts (Kuypers, 2011). This curriculum used a cognitive behavioral approach to helping students recognize when they are in different states, or zones, and learn strategies and tools to stay in a zone or move to another. Lesson themes are broken into three broad sections: 1. Introduction to the Four Zones. 2. Teaching various tools including thinking strategies, calming techniques, and sensory supports. 3. Teaching students why, when, and how to use the tools to influence their zones in everyday life.

Case Study Three - Saper

This particular curriculum was created in conjunction with the Social Thinking curriculum, which is used in the Social Thinking group Randy also participated in. This will help him to generalize the information he has learned over multiple settings. Throughout the six week intervention period, Randys time spent engaged with his class was recorded by his classroom teacher. It was agreed that Randys mother, teacher, and the school psychology intern would inform the others of any changes in his routines or when external variables (i.e. a visit with his father) occurred. In addition, each week Randy completed a check in at the start of each session which required Randy to state how he felt in that moment and then identify the corresponding Zone. Discussions around this check in activity revolved around sorting through and understanding the ways he feels and acts into the four zones in order to help him understand himself and his classmates better.

EVALUATION: Using the data collected by Randys teacher, his time spent engaged in the classroom was collected to evaluate the effectiveness of the intervention. Please refer to the graphs below for an illustration of the results: Forcasted Progression
After Implementation of Intervention
Engaged Disengaged

Percentage of Time Engaged

Time Engaged/Disengaged

120% 100% 80% 60% 40% 20% 0% Baseline After Intervention 48% 68%

68% 52%

As can be seen from these illustrations, Randys time spent engaged with his class increased from 48% to 68%. The graph on the right provides a projection of future progression based on past performance. According to this graph, Randys predicted growth will meet the class expectation. Since it is not possible to separate the impact of the individual counseling intervention from the social skills group, his growth must be attributed to both services.

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Randy is continuing to participate in both the individual sessions with the school psychology intern and the social skills group once a week. In agreement with his mother and teacher, data collection will continue and will once again be evaluated after another four weeks. At this point, review of the data will determine whether the interventions put in place remain effective or need to be revised to meet his needs.

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References Kuypers, L. M. (2011). The zones of regulation: A curriculum designed to foster self-regulation and emotional control. San Jose, CA: Social Thinking Publishing. Kuypers, L. M. (2011). Zones of regulation. Retrieved from http://www.zonesofregulation.com/index.html Mash, E. J., & Barkley, R. A. (Eds.). (2003). Child psychopathology (2nd ed.). New York, NY: The Guilford Press. Richard, G. J., & Fahy, J. K. (2005). The source for development of executive functions. East Moline, IL: LinguiSystems, Inc. Weisz, J. R., & Kazdin, A. E. (Eds.). (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York, NY: The Guilford Press.

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Appendix A