GCAP 648 Counselling Children and Adolescents from a Developmental Perspective

Case Vignettes

Select one case vignette from two of the three age bands (early childhood, middle childhood, and adolescents) listed below, for use in Assignments 2 and 3.

Early Childhood

James James (36 months) was referred by his pediatrician to the child development clinic where you are employed. James’ parents, Ken and Judy, separated amicably shortly after his birth. Until recently, they all enjoyed an easy co-parenting arrangement, with Judy caring for James about two-thirds of the time, and Ken about one-third. Ken’s mother, Ella, was also a significant caregiver to James, and they all lived within eight city blocks of each other. Ella and Judy were quite fond of each other; Ella had helped Judy a great deal when James was a baby. All their friends lauded them as a great example of post-separation parenting.

Trouble started when Ella died suddenly of a stroke three months ago. Ken and Judy were both devastated. Judy returned to her job as a librarian soon after the funeral, and describes herself by saying, “It’s hard, but I’m functioning – barely.” On the other hand, Ken has not returned to work, appears unkempt, misses or has been late picking up James, and barely attends to James during his parenting time. James cries much more than before, wets himself during the day after having been day-trained for several months (he is still diapered at night), wakes up twice or more at night (he previously slept through the night since the age of 22 months). Previously an even-tempered happy boy, he is increasingly defiant.

Tina Tina (40 months) was apprehended by the local child protection agency six months ago, and referred to the preschool mental health program in the nonprofit agency where you work. Her parents, Blake and Summer, are an on-again off-again common-law couple who use and sell crack cocaine. Tina was removed from a filthy house with no food in the fridge, drug paraphernalia strewn about, and feces from the family’s chihuahua in most rooms. Several other adults and an eight year old boy were also found in the house. Blake and Summer state they were just “staying over.”

When Tina came to George and Esther’s foster home, she was about 30% underweight, had sores on her face, could not speak, did not sleep through the night, and could not eat with utensils. Behaviorally, Esther described her as a “whirling dervish” – moving rapidly from one activity to another with no focus, inconsolable if upset, and defiant and violent (kicking, spitting, and punching) occasionally when limits were set. Since she has lived with George and Esther, she is almost normal weight and her skin has cleared up. She says a few words, responds to physical affection, and can respond to cues to “slow down,” when she is becoming overly active or emotionally agitated. Still, she is far below norms in her cognitive, social, and emotional development.

Sage Sage’s (30 months), and her mother Linda (age 21), came into the parent support centre where you work as a clinical counsellor. Linda describes Sage as defiant, and very “naughty.” Linda recalls that Sage has “always been a handful. I swear, right from a baby, she did things just to piss me off.”

Sage seems curious in your office, wandering around looking and playing with toys, as you and Linda converse. She speaks in two and three word sentences, and screams loudly, but not unhappily, when she finds something she likes. When it is time to go, Linda tells Sage to put down the toys she has been playing with. Sage yells loudly: “No!” and resists while Linda yells back, “I told you to put that away and you WILL do as you’re told.” Finally, Linda pulls the toy out of her hands. Linda carries her away as Sage kicks her.

Middle Childhood

Joshua Joshua is an 8 year old Grade 3 boy. He lives with both of his parents who are working professionals. Joshua has just been diagnosed with ADHD. He has been referred to you at a publicly funded children’s mental health clinic by his family doctor. Joshua's parents are very involved and spend a great deal of time with him. They do not report any behavior problems.

His parents, Lana and Barbara, describe Joshua as a very happy and outgoing as a preschooler, full of energy. According to his parents, although he was not the highest achieving student, he seemed to enjoy school. However, this year, with its greater curricular demands, Joshua is falling behind academically. He has difficulty focusing, and states that he “hates” school.

Lucas Lucas, a 10 year old boy, has been referred for counselling at the family service agency where you work. Lucas was conceived in a brief relationship his mother Lesley had with colleague; she never lived with Lucas’ biological father, and left the company when she learned she was pregnant, so she doubts he was aware of her pregnancy.

Until about a year ago, Lucas and Lesley lived happily together, enjoying a close relationship, although at times Lesley did not set many limits. However, Lesley commenced a relationship with Ronald. At first, Lucas seemed happy to have Ronald around, and would enjoy roughhousing and doing “guy things” with him. However, when Lesley and Ronald began to discuss the possibility that Ronald would move in, with a view toward getting married, Lucas was upset. He began to lie and steal, stopped doing homework (he had previously been an excellent student), and shunned contact with his mother, telling her he hated her. Last week he screamed, “Why did you have to meet him? Things were perfect before he came along?”

Undaunted, Ronald moved in anyway, thinking he could impose some structure and “fix things.” Ronald has come to Lesley’s defense, sometimes escalating the conflict by replying, “NEVER talk to your mother like that,” grabbing and almost striking Lucas.

Yousra Yousra is a nine year old girl attending the public school where you are a school counsellor. Her mother Yasmin, an office cleaner, and her father Ibrahim, a factory worker, came to Canada fleeing the Somali civil war. The family are black, and Yousra and Yasmin both wear hijab.

A frantic teacher asked you to see Yousra after she found Yousra in the washroom vomiting. The teacher stated that Yousra told her that the other girls thought she was “too fat.” Moreover, Yousra reported that the other girls told her her hijab looked “stupid,” and that if she did not take it off, they would “do it for me.” Reportedly, Yousra stated, “I was really nervous today because I came to school wearing my hijab, and I felt like throwing up, and then I remembered that sometimes people make themselves throw up to lose weight. So throwing up was not that bad.”

Adolescence

Elena Elena, a 15 year old Latina girl, has been referred to you, a school counsellor, for grief counselling. Elena lives with her father and two younger brothers. Throughout her mother’s struggle with breast cancer, Elena cared for her younger brothers, while her father was occupied with her mother’s treatment. Elena became well-known in her small town for raising funds for cancer research. She continued to attend Catholic youth activities, helping to organize her diocese’s trip to World Youth Day, noting, “Even though my mom is sick, she still wants me to do this.”

Unfortunately, her mother passed away three months earlier. Elena “held it together” through the funeral, but became increasingly withdrawn. She has been missing school, falling to hand in assignments, and declining to participate in extracurricular activities. When asked how she is doing, she simply says, “What’s the point?”

Mark Mark is 14 years old. He has been referred to your private practice by his mother because he has problems using social skills with people his age. She reports that she has made her best efforts getting him involved with others his own age, in lessons, sports teams, Scouting, etc. He expresses a desire to have friends, but just can’t relate to his peers. He tends to sit on the sidelines, and when he does attempt to mix with his peers, as his mother puts it, “He says something uncool and that just makes it worse.” Mark lives with his mother (an executive assistant to a corporate CEO), his father (a criminal lawyer), and his two younger siblings.

Mark has always loved video games. In the last few weeks, he has become increasingly obsessed with one particular game, and its on-line community. One day last week, he stayed home from school (everyone leaves the house before he does, and for the last year he has been able to get himself off to school) and played the game all day. Upon discovering this, his mother called you.

Asha Asha is a 14 year old girl. She has been referred to the community counselling centre where you are employed. Asha’s mother, Lois, received a call from the Assistant Principal at Asha’s school. Apparently, Asha is one of several girls who has been cutting their arms, photographing the cuts, and posting the pictures on Facebook. Now Lois is calling you.

Up until now, Asha has been a well-behaved, but emotionally reserved girl. Her parents divorced when Asha was eight. Initially, it was a high-conflict divorce that required a bilateral parenting evaluation to address parenting issues. The evaluation recommended that the Lois be the primary caregiver, while Asha’s father Bob care for Asha for alternate extended weekends (Thursday after school until the start of school Monday morning). Bob did not accept this recommendation, and went to trial, where the evaluator’s recommendation was upheld. Co-parenting has become less conflictual, settling into what Lois describes as an “armed truce” – a parallel parenting arrangement in which they do not communicate. Bob and Lois does not speak with one another, and currently, Asha makes her own way over to her father’s home for his parenting time. The parents do not attend Asha’s events on the other’s parenting time, either.