Reference no: EM133460165

Question: The social worker interviewed his mother and during the interview she provided the following information about:

• Home Life
• School
• Mother's Concerns

Home Life

John lives with his mother Jessica and his aunt Sue, in a small town in Washington. John's mother has a high school diploma but did not attend college. 

Sue works as a nurse's aide in a nursing home approximately thirty-five miles from where they live. Prior to getting this job, Jessica received Temporary Assistance for Needy Families (TANF). She got this job through the required work program and has been working there for three years. She reports that her job is stressful, but is glad that she has a job and is no longer receiving TANF. Jessica makes $9 an hour. 

Jessica works the second shift so she is not home when John gets home from school. Her sister, Sue, is Jessica's day care provider. Sue does not have a steady job, but does odd jobs during the day. Jessica reports that she trusts Sue to take care of her son and that she is grateful to have her because she could not afford to pay a day care provider. Jessica reports that she always worries about money. The cost of gas has really affected her because she has a long commute to work. She also reports that her car is unreliable, and that there is no bus line that serves her area. 

Jessica said she divorced John's father because he was emotionally abusive to her and physically abusive to John. She said he still lives two blocks away and watches her home to see who comes and goes. Jessica said she is concerned about John having contact with his father because of the abuse history. She reports that prior to this relationship she was in a physically abusive relationship with another man. She also reported a history of sexual abuse as a child. Jessica explained talking about her ex-husband makes her very anxious.

School

John attends an elementary school in his neighborhood and receives special education services. He is in a self-contained, all-day kindergarten class for children with developmental delays. He receives speech therapy and occupational therapy as part of his educational program. Jessica said she is concerned that John is not receiving enough speech therapy in his school program because he is not making progress.

Mother's Concerns

Jessica described her son's behavior problems. She said she first became concerned when he was not talking by age two. She said he has always been fascinated with trains and spends hours lining them up. Jessica said John becomes angry when she changes his routine or when she tells him its time for bed. She said he gets in other children's space at school and bites or scratches his classmates when he is frustrated or agitated. Jessica mentioned that John occasionally licks doorknobs and playground equipment. She said he will throw a temper tantrum in a store when he wants something he cannot have. He will also throw a temper tantrum when he wants something but cannot express himself. John's mother reported that sometimes it seems like he just can't get the words out to say what he wants.

John's mother said he is somewhat behind other 6-year olds in self-help skills. However, she reported that he has had some recent success in toilet training. While toilet training has taken a long time, he is now staying dry most days and asking to go to the bathroom. However, he still has accidents at night. John is learning how to dress himself, but is still having some trouble. He puts his clothes on inside out or backwards. On a positive note, Jessica reports that John will stay in the house when told and does not wander off into the neighborhood. She tries to keep John at home because some of the neighborhood boys pick on him. Also, she is concerned that these boys will be a bad influence on John. She thinks that one of the neighborhood boy's parents is doing drugs.

Jessica admitted that she doesn't understand John's behavior. Jessica said her mother thinks that John's behavior is due to her bad parenting. She said her mother adamantly believes that spanking should work. She said she has tried spanking him, but it doesn't seem to work. Jessica said she is frustrated and wants to find a way to address John's behavior.

During the interview, Jessica's affect was flat and she appeared to have a depressed mood. When asked if she felt depressed she admitted that she has attempted to have a mental health evaluation for herself in the past, but had a difficult time following through because of time conflicts with taking care of John and having to drive to the larger nearby town for the appointments.

• Case Name
• Presenting problem
• Brief mental status report
• Most likely diagnosis and diagnostic criteria 
• Differential diagnosis statement