F94 Case Studies
In case 8.9 we are presented with Sonny Blalock, a 7-year-old African American boy. Sonny is in the second grade at Lanier Elementary School. He has been in foster care for two years and was recently removed from his fifth foster care placement. He was put into foster care because he was experiencing abuse and neglect from his mother and her various boyfriends. When Sonny was five, his kindergarten teacher reported that he was hyperactive, highly distractible and impulsive. He was also reported to have continuously asked if he could go home with her and would wrap himself around her legs at dismissal (Pomeroy, 2015). Based off of the information provided in case 8.9, Sonny presents with many of the symptoms and behaviors of Disinhibited Social Engagement Disorder (F94.2) and it is persistent (American Psychiatric Association, 2013). According to the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, in order to be diagnosed with disinhibited social engagement disorder one must meet the following criteria:
A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two …show more content…
of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
Example: Sonny regularly asks adults he does not know very well if he can go home with them and will hang on their legs. He did it to his kindergarten teacher and the new social worker.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
Example: N/A
3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
Example: N/A
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
Example: Is willing to go off with random adults and does not seem to be phased by it.
B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior.
Example: N/A
C. The child has experienced a pattern of extremes of insufficient care as evidence by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
Example: Sonny experienced abuse and neglect before being taken away from his biological mother.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments. (e.g., frequent changes in foster care).
Example: Sonny had been in five other foster placements before being placed in his current placement.
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
Example: N/A
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A. Example: N/A
E. The child has a developmental age of at least 9 months.
Example: Sonny is 7-years-old.
According to Kaplan and Sadock, when considering treatment for disinhibited social engagement disorder the main priority to consider is the child’s safety (Sadock, B., Sadock, V.
& Ruiz, 2015). The child’s physical state must be assessed as well as a thorough assessment of their psychological well-being. There are various interventions available for families that have a child with disinhibited social engagement disorder. These interventions include psychosocial support services, which involves obtaining more adequate housing, decreasing the family’s isolation and improving family finances. Other treatments associated with disinhibited social engagement disorder include individual psychotherapy, psychotropic medications and family therapy. Educational counseling can also benefit individuals with this disorder and their
families.
Based off of the information in case 8.9, Sonny could potentially be at risk of suicide. Although he does not present any of the warning signs mentioned in the suicide risk assessment guide, the poor judgment he experience with this disorder could be dangerous to him (Columbia, 2016). He also may be at risk of suicide because of the abuse and neglect he experienced at such a young age. In order to ensure his safety, his behaviors and moods should be monitored and he should be assessed regularly. Based off of the information provided in this case, Sonny appears to have various supportive factors in his life. His social worker appears to genuinely care about his well being. From the information that was provided, Sonny’s current foster placement appears to be a safe placement, which he can hopefully benefit from.
A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two …show more content…
of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
Example: Sonny regularly asks adults he does not know very well if he can go home with them and will hang on their legs. He did it to his kindergarten teacher and the new social worker.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
Example: N/A
3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
Example: N/A
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
Example: Is willing to go off with random adults and does not seem to be phased by it.
B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior.
Example: N/A
C. The child has experienced a pattern of extremes of insufficient care as evidence by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
Example: Sonny experienced abuse and neglect before being taken away from his biological mother.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments. (e.g., frequent changes in foster care).
Example: Sonny had been in five other foster placements before being placed in his current placement.
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
Example: N/A
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A. Example: N/A
E. The child has a developmental age of at least 9 months.
Example: Sonny is 7-years-old.
According to Kaplan and Sadock, when considering treatment for disinhibited social engagement disorder the main priority to consider is the child’s safety (Sadock, B., Sadock, V.
& Ruiz, 2015). The child’s physical state must be assessed as well as a thorough assessment of their psychological well-being. There are various interventions available for families that have a child with disinhibited social engagement disorder. These interventions include psychosocial support services, which involves obtaining more adequate housing, decreasing the family’s isolation and improving family finances. Other treatments associated with disinhibited social engagement disorder include individual psychotherapy, psychotropic medications and family therapy. Educational counseling can also benefit individuals with this disorder and their
families.
Based off of the information in case 8.9, Sonny could potentially be at risk of suicide. Although he does not present any of the warning signs mentioned in the suicide risk assessment guide, the poor judgment he experience with this disorder could be dangerous to him (Columbia, 2016). He also may be at risk of suicide because of the abuse and neglect he experienced at such a young age. In order to ensure his safety, his behaviors and moods should be monitored and he should be assessed regularly. Based off of the information provided in this case, Sonny appears to have various supportive factors in his life. His social worker appears to genuinely care about his well being. From the information that was provided, Sonny’s current foster placement appears to be a safe placement, which he can hopefully benefit from.