IPP Case Study Suzie

Social/Emotional/Behavioural/Academic - Suzie experiences episodes where she cant emotionally regulate herself. During these episodes Suzie presents as developmentally younger and engages in property destruction, running away and verbal and physical aggression, disrupting the learning environment. Suzie can sometimes accept direction to take some space in a designated area to calm down and re-join the class. - requires a safe and nurturing environment so her reactive attachment is not triggered. - Suzie presents with a low self-esteem and is very reactive when she views something is not fair. - She is very relationship-based. - numerous suspensions for aggression towards peers and teachers throughout her school history (8 schools to date). - impulsive response pattern - strong negative reaction to changes in routine - Suzie will isolate herself from her peers in the classroom and shuts down when upset sometimes - issues of anxiety and depression present - has poor resiliency and few personal resources to adapt and cope with adversity. High levels of stress and anxiety in Suzies life appear to be expressed outwardly through behaviour problems and difficulty controlling frustration. - increased somatic symptoms - hypervigilent and fearful at times with a number of unrealistic fears (e.g. frightened of bugs, worried about foster mother dying when she is not with Suzie or that she will be killed in the middle of the night by an intruder.) Suzie has strong academic skills, loves to read and is athletic (although sportsmanship is a struggle). requires growth around writing abilities and increasing on-task behaviour in class and work completion

History - history of abuse with many symptoms of dissociation and trauma. She disclosed sexual abuse while in biological mothers care from a male adult friend. Sister also made the same allegations. Bio-mother also was physically abusive, neglectful and engaged in substance abuse. Both girls also witnessed domestic abuse between their mother and her partner. Suzie acknowledges it is better she is in foster care. - history of making threats of suicide and experiences feelings of hopelessness Previous Behavioural Support Plans - Some potential triggers previously identified: o losing a game

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feels something isnt fair feels that you dont care about her not noticed immediately when hand is up does not do well on an activity sensitive to what others say to him

Warning signs of escalating negative behaviour: o acting silly (e.g. using a baby voice, erratic body movements, hopping around, strange noises) o getting loud o swearing, crying, whining o direct refusal when given an instruction Immediate interventions to diffuse a situation: o ask Suzie to take a break o positive reinforcement o clear, concise directions o speak with Suzie in a calm voice o remind her of consequences for behaviour o remove triggers o use of empathy statements o validate her feelings and express that you care o allow Suzie to work in a quiet designated space Positive behaviour supports: o humour o transition warnings o positive behaviour chart o teach life skills o use proximity o establish a routine and structured environment o have an adult sit with Suzie during a task when needed or to just add support o frequent acknowledgement and reminders of strengths

Diagnosis: Post Traumatic Stress Disorder (chronic rule out) Reactive Attachment Disorder Academic Problems Relationship Problems NOS WIAT II (2007): Total composite 81st percentile (high average) Reading 87th percentile (high average) Mathematics 63rd percentile (average)

Written Language 82nd percentile (high average) Oral Language 68th percentile (average) WISC-IV (2008): see attached chart

Psychological Recommendations: NEED: Home and classroom strategies to help Suzie understand and cope with her behavioural and emotional needs: Help Suzie take responsibility for her actions. It is essential for teachers to understand the factors that may contribute to Suzies emotional difficulties and poor choices, and choose interventions that address her needs. However, it is vital for Suzie to understand that she is ultimately responsible for her behaviour and the consequences of her actions (e.g. begin aggressive, non-compliance, etc.) Show patience with Suzie and help her develop patience for herself. When correcting a behaviour or redirecting Suzie to task, remain calm. If Suzie perceives anger or disapproval, she will react with an emotional response and be unable to process the content of your statement Be predictable. Continue to provide a predictable learning environment with clear, consistent expectations and immediate feedback. When a change is required, whenever possible, explain in advance what will be done and why. Be available for guidance and advice. Suzie needs realistic, clearly stated guidelines about limits, values and proper behaviour. Suxie may not fully understand decision-making processes, and she will benefit from wise adults to listen and guide as they talk through problems, alternatives, and the pros and cons and try out choices. Help Suzie engage in positive social interactions as this will be extremely important in decreasing the possible development of a mood disorder. Encourage Suzie to develop an awareness of herself and her environment. For example, have her engage in periodic self-talk such as Am I on task and paying attention?, What should I be doing now? Am I bothering or disturbing others? How have I contributed to this problem? Foster Suzies self-esteem. Praise her for good effort. Make all praise specific and legitimate. Clearly state the behaviour to be reinforced and only praise behaviours that matter (e.g. Good job may be legitimate but not specific). Recognize and point out Suzies inner qualities that make her special. For example, her excellent academic skills, ability to have fun, help the teacher, etc. Reinforce positive behaviours frequently. Look for them. Immediately describe and praise her use of the behaviour. Be specific (e.g. You told John you were angry with him, you explained why, and you stayed calm. That was mature behaviour. or Keeping your temper when Amanda yelled at you took selfcontrol. I hope she learned from you). Provide choices. As Suzie feels she has little control over events in her life, it is important for teachers to present Suzie with several choices, help her identify the

choices she has and the associated consequence, and encourage (but do not force) him to make appropriate choices. Challenge Suzies thought process. Suzie may require adult guidance in learning how to think and cope in way that are more positive. For example, if Suzie expresses negative thought towards an event, she should be given an opportunity to evaluate those thoughts and test out if they are, in fact, true (e.g. Am I really dumb or stupid?). Another skill would be to generate more accurate explanations when bad things happen and use these to challenge his negative thoughts. Provide calm down time. When Suzie feels the need, allow her to leave class (with/without asking for permission) to go to a pre-established place to calm herself.