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 Social Work Practice with Children and Adolescents 

 Social Work Practice with Children and Adolescents 

 Social Work Practice with Children and Adolescents 

Trauma, Stress, and Adjustment The DSM-IV described adjustment disorders as a single classification. These are now recognized as a heterogeneous group of disorders closely associated with stress, both traumatic and non- traumatic. As such, adjustment disorders are classified in the DSM-5 along with trauma (including posttraumatic stress disorder, formerly included in DSM-IV “Anxiety Disorders”) and reactive attachment disorder (formerly included in DSM-IV “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence”). The new inclusive DSM-5 classification is called “Trauma- and Stress-Related Disorders.” The common criteria across these disorders are exposure to a traumatic or stress-inducing event. Reactive Attachment Disorder The DSM-IV included two subtypes of this disorder, representing distinct behavioral expressions. The DSM-5 separates these subtypes into different diagnoses (though they retain a single numerical identifier). Reactive attachment disorder (formerly the withdrawn/inhibited subtype) results from neglect or other influences early in development that negatively impact a child’s ability to form firm attachments. It is characterized by a pattern of emotional withdrawal, limited or absence emotional responsiveness, and limited positive affect. There may also be observed negative affect incongruent with circumstance. The disorder generally appears during 9 months to 5 years of age. Diagnoses over the age of 5 years should be made cautiously, as little research supports or describes the manifestation of this disorder in older children or adolescents. Disinhibited Social Engagement Disorder In contrast to reactive attachment disorder, this new diagnosis—formerly the indiscriminately social/disinhibited subtype of reactive attachment disorder—is also linked to significant deficits in caregiving at very young ages. However, unlike reactive attachment disorder, children with this diagnosis may have well-formed attachments. This disorder is characterized by a pattern of indiscriminate interaction with adults, such as a willingness to approach and interact with those who are unfamiliar. Behaviors may also include excessively verbal or physical that is inconsistent with cultural or age-appropriate norms. This disorder is also associated with attentionseeking behaviors, overfamiliarity, and inauthentic expression of emotion. Persistence through adolescence is often accompanied by increased peer conflict. Posttraumatic Stress Disorder (PTSD) The DSM-5 includes several changes to this diagnosis. The revised PTSD diagnosis can be used with adults, as well as with adolescents and children over the age of 6. Criterion A, which pertains to the manner in which the traumatic event was experienced, has been significantly revised to more specifically describe direct, indirect, and witnessing experiences. Criterion A2 from the DSM-IV has been eliminated, thus removing interpretations of subjective response. Criterion B now includes more descriptive wording and is described as “intrusion ©  2014  Laureate  Education,  Inc. Page  2 of  2 symptoms.” Criterion C from the DSM-IV has been separated into two symptom clusters: persistent avoidance of associated stimuli (Criterion C in the DSM-5) and negative alterations in cognitions and mood (Criterion D in the DSM-5). The criterion cluster association with alterations in arousal and reactivity has expanded to include verbally or physically aggressive behavior, recklessness, and self-destructive behavior. Another important change in this diagnosis is the addition of specific criteria for children ages 6 or younger. These criteria are founded in the criteria applicable to adolescents and adults; however, they also include important age-specific variations. The DSM-5 also includes important information regarding most common comorbidity differences between children and adults diagnosed with this disorder. Oppositional defiant disorder and separation anxiety disorder most commonly occur with this diagnosis in children. Acute Stress Disorder As with PTSD, the specific wording of Criterion A has been revised to more clearly identify the manner in which the trauma was experienced, with the former criterion A2 from the DSM-IV eliminated entirely. Additional symptomology has been regrouped into five main categories (intrusion, negative mood, dissociation, avoidance, and arousal) with a total of 14 symptoms; individuals need to have 9 of the 14 symptoms present in order to meet Criterion B. Onset and duration have been revised as well, noting the presence of Criterion B symptoms to be present 3 days to 1 month after exposure to the traumatic event. Two additional new diagnoses are also part of this classification: other specified trauma- and stressor-related disorder, and unspecified trauma- and stressorrelated disorder. Both of these diagnoses represent significant clinical distress or impairment based on diagnostic criteria common to this classification, but do not meet full criteria for a specific diagnosis. Clinicians should use other specified trauma- and stressor-related disorder and add the specific reason for the more general diagnosis (e.g., delayed onset of more than 3 months, or culturally-associated concepts). The latter diagnosis—unspecified trauma- and stressor-related disorder—is used when clinicians cannot (or choose not to) identify reasons for the inability to make a more specific diagnosis, yet clearly observe multiple criteria from the trauma- and stressorrelated disorders classification. Reference: • American Psychiatric Association (2013). Highlights of changes from DSM-IV-TR to DSM-5. Retrieved from


Application: Interventions The Assignment (2–3 pages): 

· Describe an evidence-based intervention for the stress or adjustment issue you selected, and explain why this intervention is appropriate.

· Explain one way you might address one culture, family, or social factor in your intervention and how.

· Describe two ways you might educate and/or support the parents/guardians as they try to help their child or adolescent through the stress or adjustment issue. Be specific.

· Use the week’s resources and the current literature to support your response.

Support your Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list for all resources, including those in the week’s resources for this course. 

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