Occupational Therapy in Community-Based Practice Settings 2nd Edition by Marjorie Scaffa, Maggie Reitz

Exercise 3

Sean and Serena
Sean is a 9-year-old boy in the third grade who was recently discharged from a residential facility for children with serious emotional disturbances. He previously has been diagnosed with Attention Deficit Disorder and Oppositional Defiant Disorder. He has experienced a number of childhood adversities. His parents divorced when he was a toddler. His mother suffered from postpartum depression after his birth and attempted suicide. She was briefly hospitalized after his birth. After Sean's parents divorced, he and his mother moved into a shelter and received public assistance until she moved in with a new boyfriend when he was 3 years old. Sean was placed in the care of his maternal grandparents when he was 4 years old due to physical abuse by his mother's boyfriend. He returned to his mother's care 1 year later after she completed court mandated parenting classes and psychiatric counseling. Sean was placed in a special education class at the start of kindergarten and was diagnosed with ADHD.
In second grade, Oppositional Defiant Disorder was added to his diagnoses. When Sean was 8 years old, he was again removed from his mother's care due to physical abuse on the part of his mother. After being placed in foster care for 1 month, he threatened to commit suicide by jumping off the roof of his foster home. He was then hospitalized for 3 months and subsequently was placed with his foster family again. He attends school and after-school care and receives intensive individual and family counseling four times per week with his social worker and foster care counselor. Sean's therapy team coordinates their schedules so that two of the days of the week they are able to provide his interventions at the ASP site and coordinate interventions with the ASP staff. The occupational therapist is the member of Sean's team, whose role is to coordinate services.
Sean presents as distractible and disorganized with loose, illogical thinking. He is argumentative, disrespectful, defiant, and non-compliant with adult caregivers. He is easily provoked to verbally and physically attacking peers. His psychological testing indicates that his intelligence falls in the low end of average, but his performance suggests that his mental health issues may have limited his IQ score, and he may have high average intelligence.
Serena is a 7-year-old African American girl who attends the second grade at the same school that Sean attends and participates in the ASP that is offered at their elementary school. Serena lives with her mother in a one-bedroom apartment close to her elementary school. Ms. Smith, Serena's mother, had a long-term relationship with Serena's father Mr. Murphy, but never married him. She terminated the relationship 2 years ago after experiencing verbal and physical abuse for many years. Mr. Murphy lives in the neighborhood but rarely sees Serena. He works intermittently and is known to have a drug and alcohol problem. Ms. Smith works as a waitress in a local coffee shop.
Serena's teacher describes her as often impulsive and inattentive in class. Serena enjoys group activities and seeks out friendship, but she tends to get into difficulty with her peers. She has difficulty waiting her turn and grabs materials from peers when she wants them. When she gets frustrated during group activities on the playground, she frequently becomes verbally aggressive with peers and storms away from her peer group.
As part of fieldwork education experiences embedded with their academic education, graduate occupational therapy students from one occupational therapy program provide a series of occupation-based groups for the ASP that Serena and Sean attend. The ASP director assigned Serena to two occupation-based groups: Healthy Snacks and Edible Art, and Girls' Friendship and Crafts group. See Box 10-2 for the Healthy Snacks and Edible Art Group Protocol; see Box 10-3 for the Girls' Friendship and Crafts Group Protocol.
Serena enthusiastically participated in both groups with six female peers over the course of the school year. Serena initially became embroiled in verbal altercations with a few of her fellow group members over small differences, such as position in line prior to group or taking turns in activities. Group rules were developed, displayed, and reviewed at each group session. For the first four sessions of each group, Serena and a few of her peers received at least one time-out because of a verbal altercation between two girls. To help group members to learn to consciously manage their impulsivity in social interactions, a behavior self-rating form was created and used in both occupation-based groups (Table 10-2). Each group member filled out an individual form at the end of each group session. The group leaders then facilitated a discussion about the girls' overall cooperation with each other. As the girls became accustomed to the rating form, the leaders also encouraged the girls to positively reinforce one another as the girls demonstrated the positive behaviors addressed in the form. Over the course of 2 months of group participation, Serena was successful in participating in most group activities and was able to resolve disagreements with fellow group members within the structure of the group. Serena's teacher also reported that Serena was developing more positive peer interactions within class, especially with her fellow group members.
Sean participated in the occupation-based cooking group where he could learn to bake a variety of desserts while also learning to collaborate and negotiate with a small group of peers. Although Sean is often distracted during other activities, following recipes that are task specific has improved his ability to focus his attention. He seems proud of his culinary efforts.
What interpersonal skills should a child of Sean's age demonstrate?