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The Class: Paradigms: Discipline Philosophies: Case Study #1

Sample Case Studies

Diagnosis, Intervention and Treatment Plan

Case : Melody is ten years old and currently in the fourth grade. She was born premature, weighing four pounds, and diagnosed as fetal alcohol syndrome. After four years of foster care, she was adopted and bonded gradually. She suffers from occasional petit mal seizures and is on medication. She is still small for her age, has a first or second grade vocabulary and minimal math skills. A resource aide spends two hours each day in the classroom, assisting her.

Melody is easily distracted, has a very brief attention span and never completes the day's work. She does not stay in her seat for longer than four or five minutes. She is well tolerated by students in the class, but more like a younger sibling. She has no close friends and plays alone most of the time, swinging, staying in the bathroom at the sink, involved in water play, or holding the hand of the teacher on duty. She does not strike out at other students physically, but she does many things the students find irritating -- pinching, stroking hair, repetitive patting that becomes almost aggressive, showing little recognition of personal space or awareness of others' boundaries.

The teacher finds her challenging and asks for help for the following:

unable to stay focused wandering in the room talking out of turn and off subject
irritates some of the students often irritable, whiny "picks and fiddles" with things
talks or hums to self bossy with others says same phrases over and over
poor memory off task most of the day takes others' possessions
very distractible impulsive doesn't seem to hear or understand rules
self involved


Biomedical Attention deficit disorder, fetal alcohol syndrome, hyperactive;
Arrived at through medical tests, checklists, patient report and observation, confirmed through application of medication
Psychodynamic Developmental delays and failure to bond, thrive; poor socio-emotional adjustment; may have conduct disorder;
Arrived at through interview, DSM-IV, case history, testing such as MMPI
Behav/Cog Attention Deficit Disorder (ADD or ADHD), impulse control issues
Arrived at through observation, checklist of behaviors - ex. ABS or Connors
Ecological Eclectic use of many tools and diagnoses - would use ADD,FAS,
Arrived at through looking at the interactions of systems, attending to the feelings and perceptions of students
Humanistic Basic needs are not being met,
Arrived at by asking the student and others in the classroom what is happening and what needs to occur to build the person and relationship

Intervention and treatment:

Biomedical Run tests, Prescribe medication such as phenobarbital for seizures and ritalin for hyperactivity
Psychodynamic Psychotherapy - may be play therapy, dream work, bonding
Behav/Cog Behavior management, behavior contract, ABAB, reinforcement, punishment
Ecological Enhancing communication skills, developing better systemic interactions, increasing attention to the preventive and supportive components, encourage use of personal learning strengths and types of intelligence rather than forcing her to try to become competent in the required curriculum
Humanistic Increasing nurturance, building trust, sense of safety, relationship, validating and valuing perceptions of students and teacher and then teaching Melody to approach others in ways that help them value her uniqueness, working to meet Melody's needs to work at her level of ability rather than grade level, and support her in learning better self control

Once you have reviewed the sample case study, go back to Case Study One. Remember that you can print out the sample case study for future reference.

E-mail J'Anne Ellsworth at

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