Thus far, we have covered a variety of theory related to mental health and, most recently, childhood trauma. Using this theory as a backdrop, here are some examples of potential scenarios that a mental health professional and, by extension, an interpreter might face. The scenarios are presented as “vignettes” which are typically used by mental health professionals to describe key identifiers about a client, in a biopsychosocial format. This detailed overview allows the clinician to begin formulating a potential diagnosis and subsequent treatment plan. (all scenarios are fictional)

Acute Trauma
Cassy is a 16 year old female who has been referred for services by her school counselor. Cassy shared with her counselor that she was present when her mother committed suicide six months ago and attempted to resuscitate her to no avail. Since that time, Cassy has persistent nightmares about the suicide and gets little sleep. Likewise, when she is in school, she starts to think about the details of her mother’s death with no apparent trigger (intrusive thoughts/memories). Sometimes, it feels like these memories are actually occurring in real life, as if she were watching a movie (dissociative reactions – flashbacks) and she begins to sweat and has difficulty breathing. Cassy will not go into the room where her mother passed away and, in fact, will avoid that whole area of the house. Of particular concern are Cassy’s recent high risk behaviors, including drinking, driving at high speeds and cutting. When it is least expected, Cassy will yell, scream and throw things at people, whether she is at home or school. (outbursts) Initially, Cassy was prescribed a mild anti-anxiety medication but she stopped taking the medication against medical advice.

Chronic Trauma
Jose is a 10 year old male who has been referred by his primary care physician. During Jose’s annual physical, his mother reported that Jose had been having difficulty sleeping for several months, oftentimes tossing and turning during the night. His mother reports that, 3-4x a week, Jose complains of stomachaches and headaches so that he doesn’t have to go to school (somatic complaints). When he does go to school, Jose’s teacher reports that he does not pay attention and cannot focus on the task at hand. This is concerning because he used to be an accomplished student. He used to love playing soccer, in fact any sport, but has indicated that he has no interest and no energy to play anymore. He has become increasingly withdrawn from his friends, not wanting to play after school. In fact, he has told his mother that he has no real friends and that no one likes him (low self-esteem). At mealtime, Jose picks at his food, much to his mother’s dismay, as she has tried everything to get him to eat. She is concerned because in recent weeks it appears that he has lost weight. Jose oftentimes cries and has difficulty making eye contact. Mother has recently learned that Jose has been bullied, daily, for the last several months by a group of children one grade ahead of him, including a boy who had been Jose’s best friend for several years.

Complex Trauma
Kyle is a 6 year old male who has been brought in by his maternal aunt, based on a referral from his pediatrician. Kyle has been living with his aunt for less than a year, after having lived in several other homes from the time he was removed from his mother’s care at birth, due to positive toxicology results at that time (methamphetamines). He has had no contact with his mother since birth, as she is currently incarcerated on drug-related charges.

From birth to 2 years of age, Kyle lived with his uncle’s family and then moved to his maternal grandmother’s home until 4 years of age. When his grandmother passed away unexpectedly, Kyle moved again to another relative’s home, finally settling in with his aunt last year. It has been reported that in earlier placements, Kyle was oftentimes left alone in his crib for extended periods of time and not provided the necessary comfort when he required it. As a result, Kyle does not know how to respond to his aunt’s attempts to provide him love and affection. Sometimes, he accepts her attempts and sometimes he withdraws.

Kyle tends to be hypervigilant, making sure not to move anything out of place or create any disruption in the home. Likewise, he resists attempts to engage in play, preferring to sit quietly and go unnoticed by others. He readily complies with any request and frequently asks if he has done his task correctly. There is a suspicion that in his original placement, Kyle experienced some verbal and physical abuse, as intermittent bruising on his extremities was noted. There was no confirmation of this allegation and his caregivers reported that Kyle was clumsy and fell easily.

Currently, Kyle cannot read or write and will soon be evaluated by the school to identify delays, potentially related to in-utero exposure to drugs.

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While each of these scenarios depicts a specific set of causal agents, there may be an overlap of some symptoms, individually or in a cluster. Treatment plans are tailored to the specific symptoms being experienced, with consideration for the root cause. In short, both the trauma and the symptoms are factored into the diagnosis and the subsequent goal setting for symptom reduction and improvement of mental health functioning.

http://www.apa.org/pi/families/resources/children-trauma-update.aspx

In the next post, we will explore the potential long-term effects of untreated childhood trauma.

 

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