Case Study:  Child and Teen Behavior Disorders

Case Study:  Child and Teen Behavior Disorders

Case Study:  Child and Teen Behavior Disorders

Module 2 Assignment: Ryan: A Case Study

Case Description

Child name: Ryan Jones                                Grade: 6th

Age: 12                                                 Gender: Male                                      Race/Ethnicity: Caucasian


Background Information


Ryan is a 12-year-old male who was diagnosed by his pediatrician with Oppositional Defiant Disorder (ODD) and Attention Deficit Hyperactivity Disorder one year ago. Ryan lives at home with his mother, father, and three brothers (ages 6, 8, and 14 years old). A clinical social worker (LISW) employed by the pediatrician conducted an extensive interview with both parents to obtain both a family and developmental history for Ryan.




Ryan’s parents have been together for 15 years, although they report being separated for 6 of those years due to frequent marital disputes and Mr. Jones’ excessive drinking and violent behavior directed at Mrs. Jones. Both Mr. and Mrs. Jones report that their relationship improved after Mr. Jones received treatment for substance abuse and anger management. The parents report that they do not keep alcohol in the house and that Mr. Jones has been sober for 4 years. Both parents reported histories of learning and attention problems when they were in school. Mr. Jones started college, but was not able to complete a degree. He works in construction full-time. Mrs. Jones did not complete high school, but now has her GED. Mrs. Jones works outside the home on a part-time basis. Both report that the household is often chaotic with their 3 active boys and work.


They report that their oldest son, Travis, first experienced problems with attention when he was in kindergarten and was diagnosed with ADHD in first grade when he was 8 years old. They report that Travis’ behavior improved when he started on medication and when he began attending the CWRU ADHD Summer Camp. Travis also received help at school to learn organization and study skills. They state that they are frustrated that Ryan’s behavior did not improve like Travis’ did when he got on medication. They said he was better at staying in his seat at school and he handed in more assignments, but that teachers still complained about his “talking back” and refusal to do work. The parents report that the younger boys are also active and fight with their brothers, but they feel they can control their behaviors with time-out and other punishment like taking away privileges such as riding bikes and gaming.


Ryan was born slightly premature at 35 weeks (rather than the typical 38-40 weeks gestation). His birth weight was below normal and while his growth improved, his weight and height are within the 10th and 15th percentile so he is small for his age. Ryan’s language and motor development were described as normal. Ryan’s parents describe him as “smart” and report that he scores very high on standardized tests. They report that this grades, however, are lower than expected because he often misses in-class assignments because the teachers send him the main office for arguing, work refusal, and disruptive behavior such as wandering around the classroom and talking with peers.


Ryan was prescribed stimulant medication for ADHD (Ritalin, 30 milligrams to be taken twice per day). Initially, he took his first dose at home before breakfast and took the second dose at school before lunch, however, Ryan’s parents reported to the school that they often forgot to “make him take his pills” so they agreed to let the school nurse dispense the medication. Ryan’s teacher reported minor improvements in his classroom behavior since he started taking his medication at school approximately two months ago. Improvements were noted in fewer discipline referrals to the office (ODR’s) from 5 per week to 2 per week (compared to the average class rate of 0.2 per week); more in-class assignments completed (4 per day compared to his previous rate of 0.5 per day and class average of 6 per day).


The school psychologist interviewed the classroom teacher, Mrs. Brown, who expressed several concerns about Ryan’s behavior at school. Mrs. Brown was concerned because believed that school work is not difficult for Ryan but that without doing his work eventually Ryan would fall behind in school due to lack of practice with certain skills. Failure to complete his work did not seem to occur during any specific subject or type of task. She indicated that she thought Ryan was bright, but that he was not interested in school and is easily frustrated and bored. Mrs. Brown indicated that Ryan’s refusal to do work, particularly when accompanied by arguing, is her primary concern. According to his teacher, he has not become physical with her or other adults in the school, but that reportedly he has hit his mother. Mrs. Brown is also concerned with Ryan’s interactions with peers. She reports that he is often rude and frequently initiates physical contact with peers, in the hallways or when he is wandering in the classroom instead of doing his work.


To better understand Ryan’s behavior in the classroom, the school psychologist conducted three 15-minute systematic direct observations of three problem behaviors (Negative Noncompliance, Inappropriate peer interactions, and Work avoidance) and one target behavior (Academic Engagement) defined as:


Target Behaviors:

  1. Negative noncompliance. Noncompliance includes not doing what the teacher or parent asks within 10 seconds of the first request. This includes refusing to work on class assignments and following adult directives or commands.
  2. Inappropriate peer interactions. Inappropriate peer interactions include arguing with peers, making mean comments, kicking or touching peers, making rude gestures.
  3. Work avoidance. Work avoidance is defined as not completing school work or only partially completing schoolwork by the due date and time.
  4. Academic engagement. Sitting at desk working on assignment; eyes on text, reading book; eyes on teacher during lecture; working collaboratively with peer on group projects.


The results of the direct observations are as follows. Ryan averaged of 41% of the observed intervals displaying Academic Engagement; 18% of the intervals displaying Negative Noncompliance; 30% of the observed intervals displaying Work Avoidance and 11% of the observed intervals in which he engaged in Inappropriate peer interactions. The school psychologist noted that when Mrs. Brown was able to redirect Ryan back to his work without using a correction, he was more likely to work on the assignment and less likely to escalate to arguing and interacting inappropriately with peers.


The school psychologist also administered a behavior rating scale to Ryan, his parents, and Mrs. Brown. The Behavior Assessment Scale for Children-3rd edition (BASC-3) results indicated that Ryan, his parents, and Mrs. Brown agree that disruptive behaviors such as fighting and arguing are in the Clinically Significant range compared to other 12 year old males. All respondents also indicated that attention, impulsivity, and hyperactivity continue to be a problem for him. Some differences between respondents were noted. Mr. and Mrs. Jones reported that Ryan may often feel sad and worried, while Mrs. Brown’s BASC-3 responses did not indicate concerns in this area. Ryan’s BASC-3 self-report indicated that he feels rejected by peers and that he sometimes engages in stealing and lying.

Case Study:  Child and Teen Behavior Disorders