Jay

Clinical description

Jay is a 22-year-old male undergraduate student at the University of North Carolina at Chapel Hill (UNC). Jay was previously diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). In college, Jay complained of having difficulties with sustaining attention, reading, inadequate study habits, and poor performance in his college courses (relative to his high school performance). He has been experiencing mood fluctuations. Jay has been feeling anxious for a long time. He has panic attacks and persistent worrying.

History of presenting a problem

Jay had previously been evaluated for Attention-Deficit/Hyperactivity Disorder (ADHD) and was diagnosed. In addition to attention and reading difficulties, Jay reported clinically significant disordered mood and fluctuations in mood (i.e., periods of “highs” and “lows”), and a strong family history of bipolar disorder. Finally, Jay reported a longstanding history of anxiety, including panic attacks and persistent worrying.

Conceptualization

Initial treatment plan

Assessment Findings

Checklist Scores

ASEBA Scores
Scale	Mom	Arlene	Teacher
Externalizing	67	73	68
Internalizing	59	68	46
Anxious/Depressed	57	62	50
Withdrawn	66	68	52
Somatic Complaints	50	70	50
Attention Problems	62	68	58
Social Problems	61	63	62
Thought Problems	55	64	50
Delinquent/Rule-Breaking	62	70	65
Aggressive Behavior	69	72	68

Extended content

Select more specialized scales to refine probabilities

Updating probabilities

Critical items

Diagnostic Interview findings

Cognitive and Achievement Testing

(Not done as part of the evaluation; may be able to match up information later)

Prediction Phase

Let's see how we would apply the EBA principles to Arlene:

Shortlist of Probable Hypotheses

Based on Jay's age and the common clinical issues, here are the possible issues:

Attention problems
Anxiety disorders
Substance misuse should be another hypothesis, based again on its prevalence in his age group.
A mood disorder

Risk and Protective Factors and Moderators

Arlene's gender and age increase the probability of a mood disorder, and may reduce the chances of conduct disorder. Her solid academic performance previously suggests potential resilience.

Her conflict with her father, and her keeping things secret from her parents, would be considerations before doing family therapy, and they may complicate consent for treatment (Arlene is still a minor).

Some data suggest that Interpersonal Psychotherapy (IPT) may be particularly effective with Hispanic teens, perhaps moreso than Cognitive Behavioral Therapy (CBT), because of the greater emphasis on family (and familism). IPT would have an advantage of not requiring active participation of the father (unlike family therapy), since IPT is designed as an individual therapy.

Updating Probability of Diagnoses

Could add table with DLRS and revised probabilities, or leave them blank and have a "key" section?

Cross Informant Perspectives

Mention that these have DLRs. Also unpack the implications of agreement and disagreement for the client (and add a section about treatment implications of disagreement on the Conceptual Model Pages)

Prescription Phase

Mental Status and Clinical Observations

add content

Treatment Selection

The diagnostic interview suggests a combination of a major depressive episode and a prior dysthymia, sometimes referred to as a "double depression." This suggests that Arlene's stress and mood problems have persisted for a long time, and may be more difficult to treat. The mood disorders clearly are associated with impairment and should be a major focus of treatment.

Moderating Factors

Client Preferences

Process Phase

Clinically Significant Change

Reliable Change Index

Pick a treatment target and specify what the RCI would be for it. Discuss how you would explain to Arlene

Nomothetic Benchmarks

A, B, Cs of Jacobson definitions. General stuff about limitations would go on the main concept page. Here it is focused on the client -- what are the benchmarks they will focus on? How explained to them?

Interpreting benchmarks

Minimum Important Difference (MID)

Note that this section is a dangler -- not originally called out in the 12 steps. Medium d as a rule of thumb from Streiner, Norman, & Cairney (2015). Could work from AUC to d to raw units as a way of estimating, since psychology hasn't done research on this yet. Might be able to back into it with studies that had CSQ and outcome data.

Client Goals & Tracking

These would be personal goals and idiographic measurement -- YTOPS, etc.

Jay