Melissa Morris Case: Tobias Eaton SPSY 5377 – Spring 2014

•  Caucasian, 6-year-old male •  Born and raised in Austin, Texas •  Parents – Veronica & Marcus Eaton •  Four brothers (ages 21, 13, 9 & 5) •  Four sisters (ages 25, 22, 17 & 15) •  One more sister on the way to be born mid-April •  All born to the same parents

•  Identifies and is very involved in the Catholic faith

•  No difficulties with conception, pregnancy or birth •  Did not smoke cigarrettes, drink alcohol or take any prescribed

medications during pregnancy •  Did take OTC Tylenol and Benadryl for headaches and seasonal allergies

•  Was not exposed to x-rays, chemicals or infectious diseases during pregnancy

•  Received prenatal care and took vitamins •  Tobias was born at 40 weeks after 5 hours of natural labor •  11 pounds, 5 ounces •  Easy infant to care for, established regular feeding and sleep

patterns shortly after birth

•  Met all developmental milestones on time or slightly early, including fine and gross motor, speech and potty training

•  Never had any major medical or psychological conditions •  Never had head injury or lost consciousness •  Main behavioral concern seen by mother is hyperactivity and

short attention span •  she attributes both to age

•  Gets along with most siblings, although he occasionally fights with his 2 male siblings that are around his age •  He self-reported that they “pick on him”

•  Tobias is currently learning 1st grade curriculum •  Has been homeschooled during the entirety of his education

along with his other siblings •  Mother reported that he learns quickly if she can help him focus

his attention •  Especially likes to learn about animals and reading about

animals

•  Appeared to be a boy of stated age, average height and average weight

•  Dressed casually and exhibited good hygiene •  Cooperative, persistent and engaged throughout test session •  Did not exhibit frustration and was quick to respond comfortably •  Did not exhibit any signs of hallucinations, obsessive thoughts,

delusions, etc. •  Did not use any prosthetic, hearing or sight device •  Fidgety and moved a lot in chair throughout testing, but seemed

comfortable •  Exhibited good insight, judgment and competence

•  Emotional Symptoms Index subscales = all within normal limits

•  Indicates that Tobias perceives himself to be developing emotionally the same as his peers

•  Indicates that he holds positive attitudes toward school and teachers (i.e. parents)

•  2 Critical items that Tobias answered yes to include: •  “My classmates make fun of

me” •  “Other kids hate to be with

me.” •  These two statements most

likely relate to social stresses that are indicative of arguments with siblings as they are his main source of social interaction

•  Interpersonal relations subscale in the at-risk range •  Expressed concerns about

being teased and not being liked

•  Externalizing problems scores = at-risk range, suggesting that she views him to exhibit slightly atypical externalizing behaviors • main concern = hyperactivity • Corroborated by parent

interview

•  Internalizing Problems = average range

•  Behavioral Symptoms Index = average range • Attention problems

subscale = at risk range

•  Adaptive skills Index = average range • Activities of daily living =

at-risk range – mom stated that he almost always needs reminders to brush his teeth and do chores

Tobias

•  Views himself to be within normal limits in all areas except Interpersonal Relations and Social Stress •  Suggests that Tobias views

himself to have some issues interacting with peers and maintaining meaningful relationships.

Mother

•  Classified At-Risk in Hyperactivity, attention problems, and Activities of Daily Living •  Commensurate with parent’s

previously identified concerns with hyperactivity/inattention •  Rated at-risk for activities of

daily living because he needs to be reminded to brush his teeth and complete daily choress

•  Social Skills Scale = average (SS=105, PR=59)

•  Self-reported Average in all areas: communication, cooperation, assertion, responsibility, empathy, engagement and self-control

•  Indicate that Tobias perceives himself to have an average ability to interact socially, in many different ways with peers and adults

•  Problem Behaviors Scale = Above Average (SS=131, PR=95) •  Suggests that Tobias

views himself to struggle with hyperactivity/inattention, fighting with others, scaring people and acting sad or withdrawing from others

•  Results should be interpreted with caution as Tobias tried to answer in a certain way using patterns (SSOOAAAASSOO)

•  Results indicate that Tobias views himself to be a typical 6-year-old who has many friends and does well in school, but is still learning about rules, structure, and proper interaction with peers.

•  Social Skills Scale = Below Average (SS=86, PR=16)

•  Reported that Tobias demonstrates average ability in cooperation, assertion, engagement and self-control

•  Parent rated communication, responsibility, and empathy in the below average range

•  Problem Behaviors Scale = Above Average Range (SS=119, PR=89) •  Average scores on

bullying, internalizing and Autism Spectrum subscales, but reported above average scores on externalizing and hyperactivity/inattention subscales

Tobias

•  Views Social Skills to be average compared to peers

•  Views problem behaviors to be in the above average range •  identified hyperactivity as main

problem

Mother

•  Views Social Skills to be below average •  Notably communication and

responsibility

•  Views problem behaviors in the above average range •  Identified hyperactivity as main

problem

•  Reported a high average total score (T=64) •  Rated in the average range on Negative Mood/Physical

Symptoms (T=58) and Interpersonal Problems (T=59) •  Suggests that any sadness that Tobias exhibits does not show up in

physical ways such as affecting appetite, fatigue, etc. •  Also suggests that Tobias does not view himself to have problems

interacting with peers or family members

•  Rated in the high average range on Ineffectiveness (T=66) and Negative Self-Esteem (T=61) •  Suggests that Tobias sometimes views his abilities in a negative light •  His elevated score in negative self-esteem suggests that Tobias has some

low self-esteem and dislike occasionally

•  Overall, Tobias’s mother reported symptoms in the elevated and low levels

•  Reported emotional levels in the low range (T=38) •  Suggests that mother does not perceive Tobias to exhibit negative self-

esteem, mood or physical symptoms

•  Reported functional levels in the elevated range (T=66 •  Suggests that mother views Tobias to have some issues with interpersonal

problems and a negative evaluation of his abilities.

Important to note that Tobias is 6 years old and these results are based on 8-year-old norms. Assessment was given for examiner practice

•  Long Hair, he’s very tall with a square head. He’s mad. His arms are very long. He has no toes, ears or fingers because he is an alien.

•  He is a boy •  He is 35. •  He is mad because someone

punched him because they were mad at him because he stole the other person’s stuff and broke it.

•  He is thinking about what to do with his pet.

•  This house has ginormous windows with a very short, teeny, tiny door knob. It has a triangle door and its walls are very large. The person who lives in this house is a fairy.

•  The house is all by itself. •  A fairy lives in this house. She

doesn’t have any wings. She is very, very, very, very mad. She always floats because she has no feet. She is very mad because no one likes her.

•  The weather is windy.

•  It’s very, very small. A very large fairy lives in it because she can shrink. The tree has very big branches.

•  It is a coconut tree. •  It is 198 years old. It is very

weak because it is too old. •  It is winter so there is snow. •  No one hurt this tree. No one

has ever seen it. It is the first tree ever alive.

•  Everyone is invisible except mom, dad and me.

•  Dad is doing a magic trick. Mom is sleeping. I am invisible because I use my invisibility power to camouflage.

•  Annie is doing camouflage twister. Mary is doing camouflage super twister. Noel is sleeping while invisible. Alex is stretching so much that he is camouflaging around the world. Rhett is wrapping around Alex. Matt is wrapping around Rhett with a spacesuit on that has food and water in it. Jordy is teeny tiny and invisible. Kayla is also tiny and they’re fighting. My pet Harley is taking a nap while she’s invisible.

Theme 1: Heavy reliance on father as head of household and the main authority figure

•  Throughout Haak, Tobias frequently said that his father makes him feel “sad and happy” because his father can “be mean” and wishes that his father would “be nice.” When asked to elaborate he stated that his father gets mad when he doesn’t follow the rules. •  He also stated that his father “loves him” and makes him feel loved.

•  In his kinetic family drawing, he chose to draw his father bigger than his mom and himself and he also drew his father’s arms outstretched, holding Tobias and his mother

•  Views his father to be head of household, in charge of discipline and the leader of the family.

Theme 2: Reliance on the emotion “anger” and “being mean” •  Throughout Haak, he stated that he is “mean sometimes” and that his

siblings are also mean. He stated that he gets really mad when “my friends hurt me,” and My biggest problem is when “my friends say ‘I hate you.’” •  When asked to elaborate, he stated that his friends can be mean to him and

that he is sometimes mean back, although he tries to “be nice.” •  He also used many anger thematic elements when explaining his

drawings •  When asked to describe his person, he stated that he was “mad because

someone punched him because they were mad he stole some stuff and broke it.”

•  When asked to describe who lives in the house, he stated that a fairy lives there and that she is “very, very , very, very mad.”s

Theme 3: Prefers to live in fantasy world •  Discussed fantasy themes any time a chance was given •  When asked what three wishes he would make, he stated that

he would want to be able to fly, have a “pet, trained Dolak,” and be able to turn into a wolf •  When asked about a Dolak, Tobias went into elaborate detail describing

alien creatures that can change into different animals, including a wolf and they could take over the work

•  Every drawing that Tobias drew (Person, House, Tree, and Kinetic Family) included a detailed fantasy story

•  Reliance on fantasy theme can be attributed to his age, but he always relied on fantasy themed conversations over reality

•  Throughout most assessments, Tobias and his mother rated him to have difficulty with interpersonal relationships and maintaining strong, healthy relationships with peers

•  Any hypotheses?

•  Tobias also reported that he was hyper and inattentive, but he did not seem to view to be as problematic as his mother

•  Mother reported concerns with hyperactivity/inattention, particularly during schoolwork •  Attributed some to his age and attention seeking behavior with siblings

•  Needs to be administered a Hyperactivity Scale normed for students his age group

•  In order to adequately determine whether he actually exhibits depression concerns, it would be necessary to administer a depression scale that is normed for 6 year-olds

•  Any other areas that you noticed that should require additional

testing?

1.  At this time, Tobias does not exhibit any need for Special Education or 504 services. More assessment is needed to see if Tobias qualifies under OHI (AD-HD)

2.  Because Veronica reported that Tobias is very hyperactive, it is recommended that she provide Tobias with a daily schedule, complete with specified time rewards for completing a certain amount of work or tasks. Helping Tobias stay on task and motivated throughout the day will help him learn to manage his time and remain focused.

3.  Because Veronica reported that Tobias has a short attention span, it is recommended that assignments and tasks be broken up into smaller chunks during instruction. This will help Tobias remain focused on individual parts of assignment and will help him with retention. The length of assignments can slowly become longer in order to build up Tobias’s endurance.

4.  Tobias’s mother should teach Tobias how to use relaxation techniques in order to effectively handle situations where he may feel angry at family members or peers. Teaching effective techniques to help Tobias when he becomes angry or when he feels that someone else is angry at him would possibly help him form/maintain healthier relationships with family members or friends.

5.  Throughout the use of relaxation techniques, it is important Tobias learn the difference between normalcy of the anger emotion and distinguish it from angry behaviors. This will help him learn to manage the emotion instead of externalize it.

6.  Tobias’s mother, Veronica, should use a social skills curriculum to improve Tobias’s social skills. Instruction should focus on learning how to effectively make and manage peer relationships. Instruction could make use of social stories, cooperative learning groups, team sports, etc.