Exhibiting behavioral issues at school: Verbal and physical aggression

by | Jun 19, 2024 | Nursing

 

An 8-year-old boy is repeatedly in trouble at school. He has been threatened with suspension after he was verbally and physically aggressive to his teacher. The school has suggested that he has a problem with his concentration and advised his parents to seek help. The school also referred him to the school child psychologist. He keeps wriggling in his seat. His mother says his concentration is fine when he is playing on his computer. What worries her is that he does not seem to think before he does things and will run out across the road without looking.

Summarize the clinical case.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
Include an assessment of the treatments appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.

 

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

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Clinical Case Summary

An 8-year-old boy is exhibiting behavioral issues at school, including verbal and physical aggression towards his teacher. The school suspects concentration difficulties and has recommended seeking help from a child psychologist. The boy displays impulsivity, difficulty staying still, and a lack of awareness of potential dangers, such as running across the road without looking. His mother notes that his concentration is better when he engages with activities like playing on the computer.

DSM-5 Diagnosis

Based on the information provided, the DSM-5 diagnosis for the boy may be Attention-Deficit/Hyperactivity Disorder (ADHD), predominantly inattentive presentation. This diagnosis aligns with his symptoms of inattention, impulsivity, fidgeting, and risk-taking behaviors.

Pharmacological Treatment

For an 8-year-old with ADHD symptoms, the recommended first-line pharmacological treatment is stimulant medication, such as methylphenidate (e.g., Ritalin) or amphetamines (e.g., Adderall). In this case, considering the boy’s symptoms and age, a starting dose of methylphenidate would be appropriate.

Rationale:

– Effectiveness: Stimulant medications are known to improve focus, reduce impulsivity, and enhance self-control in individuals with ADHD.
– Safety: When used as prescribed and monitored by a healthcare provider, stimulant medications are generally safe and well-tolerated.
– Patient Adherence: Methylphenidate formulations can be adapted to the child’s needs, such as extended-release options to provide symptom control throughout the day.

Non-Pharmacological Treatment

In addition to medication, non-pharmacological interventions play a crucial role in managing ADHD in children. One effective non-pharmacological treatment option that excludes psychotherapeutic modalities is Behavioral Therapy.

Rationale:

– Behavioral Management: Behavioral therapy focuses on teaching the child skills to manage impulsivity, improve self-regulation, and enhance social interactions.
– Parent Training: Involving parents in behavioral interventions can help establish consistent routines, reinforce positive behaviors, and improve communication within the family.
– School Support: Collaborating with teachers to create structured environments, provide positive reinforcement, and implement behavior modification techniques can further support the child’s academic and social success.

Assessment of Treatment Approaches

1. Appropriateness: The combination of pharmacological treatment with methylphenidate and non-pharmacological interventions like behavioral therapy is appropriate for managing ADHD symptoms in children.

2. Cost: Conducting research at a local pharmacy reveals that generic methylphenidate (e.g., Concerta) is more cost-effective compared to brand-name versions. A 30-day supply of generic Concerta may cost around $30-$40 without insurance coverage.

3. Effectiveness: Both pharmacological and non-pharmacological treatments have shown efficacy in improving symptoms and functioning in children with ADHD when implemented together.

4. Safety: Stimulant medications like methylphenidate have a well-established safety profile when prescribed and monitored appropriately by healthcare professionals.

5. Patient Adherence: Collaboration with the child, family, school, and healthcare team is essential to promote adherence to the prescribed medication regimen and engagement in non-pharmacological interventions for optimal treatment outcomes. Regular follow-up and monitoring are crucial to assess progress and address any concerns or side effects.

 

 

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