CASE STUDY 10: John is an eleven-year-old male who was diagnosed with Attention Deficit Disorder/Hyperactivity Disorder (ADHD), Predominantly Hyperactive-Impulsive Type at the age of 6. He currently receives 15 mg. of Ritalin per day. John was placed in group home care for six months after his mother, who is a single parent, reported significant difficulties in coping with the demands of caring for John and his sister Gloria, who was recently diagnosed with Leukemia. His mother, Ms. Anita Smith, is involved in her own personal struggle with depression. Ms. Smith’s emotional problems are suspected to have been a contributing factor in her inability to simultaneously cope with the demands associated with parenting two children with special needs. The group home setting where John spent six months generally houses six latency-aged boys and girls. The group home offers a structured environment with activities that teach life/social skills. The program also offers movie night, and arts and crafts on site. The group home staff members were able to maintain John’s school placement, by transporting him back and forth. Initially, John found it difficult to adjust. However, over time, he settled into the new environment. John was active in activities offered at the group home. Over the first three months of entering the group home, John averaged about three restraints per day. Most of the physical interventions stemmed from John placing himself and others at risk, attempting to leave the residence without permission, self-abuse, and hurting others. By the fourth month, John had settled into the routine of his new environment. His restraints dropped to three per week. In order to encourage positive interactions with peers, John was given the chore of asking his peers what they wanted placed on the shopping list. This improved John’s status among his peers, which he relished. By John’s discharge date, he was “attached” to one of the senior staff, Ms. Deer. This was evident by his insistence that Ms. Deer read with him nightly, maintaining close proximity of her, requesting that Ms. Deer assist him in choosing clothing for the next day and sharing his feelings with her, which he found difficult to do with other staff members. In order to maintain John’s gains and assist with reunification, visits with his family were slowly integrated. Visits began Saturday mornings from 8:00 am to noon, and then were extended to 7:00 pm. Later, overnight visits from Friday 6:00 pm to Sunday at noon were introduced. During this tiered reunification process, Ms. Smith called the group home for support when she found it difficult to manage John’s behavior. At the time of John’s return home, a Family Support Worker was engaged to provide additional support. John and Gloria share a three-bedroom apartment with their mom. Their dad, Mr. Smith, does not reside with the family; however, he visits twice a week for approximately four hours each time. Mr. Smith is unemployed and shares a one-bedroom apartment with his younger brother. Due to a lack of financial resources, Mr. Smith is unable to permanently parent John as Ms. Smith has requested. Ms. Smith receives public assistance. She was diagnosed with depression and anxiety disorder approximately 10 years ago and is currently on medication for both illnesses. She has seen a psychiatrist for the past ten years. She continues to manifest signs of depression at the current time and states that she has had more “good” days in recent months than a year or so ago. Ms. Smith reports feeling overwhelmed and exhausted, by her illness, and the children’s needs. She spends most of her day on the couch or in bed and only ventures into the community to purchase groceries or for doctors’ appointments. She tends to overlook John’s misbehaviors to avoid power struggles and confrontations. It does not appear that there is any consistency in Ms. Smith’s ability to enforce rules, routines, and expectations in the home. John has displayed independence such as an ability to make his own lunch and get himself to the school bus on time. Ms. Smith reports that John has more good days in school compared to at home. Specifically, John tends to have fewer peer conflicts at school and is able to more closely follow the rules and routines at school. His mother reports that John often talks about Ms. Deer and seems to depend on her a lot for guidance.
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