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CASE STUDY ASSIGNMENT

CASE STUDY ASSIGNMENT 3 - THEO

Herb Baylor

School of Behavioral Science, Liberty University

Author Note

Herb Baylor

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to Herb Baylor.

Email: hbaylor@liberty.edu
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THEO’S CONCERNS

SYMPTOMS BEHAVIOR STRESSORS

Changes in mood Theo experiencing emotional
and behavioral difficulties
Nightmares Theo wakes up both parents to
sleep with them after
experiencing nightmares
Restless Theo appears fidgety and is
unable to sit still
Scared Theo sat in the middle of the
back seat when his parents were feeling that another PTSD event will probably occur
driving
Distracted Theo experiencing a decline in
completing his school
assignments. Theo is unable to
be focused during his sessions at no playing with friends in the hall or during recess
his Kingdom Hall.
Aggressive Theo is slamming and throwing
the Hot Wheel cars during
school recess
Assessment
Theo having mood changes. Spending countless
hours playing video games exceeding his screen
time which resulted in his mother yelling & and his
dad being distracted resulting in the car accident
Theo has nightly dreams of a car crash, waking him
before the car crash occurs in dreams.
Theo states if he doesn't sit in the middle of the car,
he cannot help his parents watch for oncoming cars.
Two-lane roads caused him to become reactive to
cars that appeared to be in front of the family car
Theo stated that he is afraid to be home due to his
if he continues to play video games
Theo is not focused in school, as observed through
no reading time and misspelling words. Theo has
multiple trips to the house’s bathroom. Limited to
Antisocial will
not engage
schoolmates.
The teacher
reprimanded
him because he
focused only
on playing
with his cars
and ignored
potentially
hitting other
students.

In Theo’s case study, there will be a need to develop assessments to be administered for

Post Traumatic Stress Disorder (PTSD) and Acute Stress Disorders (ASD). The Diagnostic and
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Statistical Manual of Mental Disorders (DSM-5) will aid us in defining the criteria for PTSD and

ADD. In the DSM-5, a PTSD assessment, the DSM-5 shows us the PTSD Symptom Scale

Interview (PSS-I and PSS-I-5. ) (Foa & Capaldi, 2013) The PSS-I is a 17-item semi-structured

interview useful for the assessment and diagnosis of a single traumatic event that causes the most

current distress. The presence and severity of associated DSM-IV PTSD symptoms experienced

will be assessed. Each of the 17 items is assessed with a brief, single question with no probing

or follow-up questions (Foa & Capaldi, 2013).

The PSS-I has been updated to correspond to the DSM-5 (PSS-I-5) as a brief interview

that assesses the presence and severity of symptoms over the past month. The PSS-I-5 consists of

20 symptom-related questions and 4 additional questions to assess distress and interference in

daily life as well as symptom onset and duration (Foa & Capaldi, 2013).

The Acute Stress Disorder Scale (ASDS) is a self-report inventory that (a) indexes acute

stress disorder (ASD) and (b) predicts posttraumatic stress disorder (PTSD). The ASDS is a 19-

item inventory that is based on the Diagnostic and Statistical Manual of Mental Disorders (5th

ed.; DSM-V, American Psychiatric Association, 2022) criteria (Bryant et al., 2002).

To meet the criteria for ASD, one must experience a stressor and respond with fear or

helplessness (Criterion A), have at least three of five dissociative symptoms (Criterion B), at

least one reexperiencing symptom (Criterion C), marked avoidance (Criterion D), and marked

arousal (Criterion E). In addition, the introduction of this new diagnosis has raised the need for

standardized instruments to measure ASD. The only measure that has been subjected to standard

psychometric study is the Acute Stress Disorder Interview (Bryant et al., 2002).

DSM-5-TR Diagnostic Criteria: Trauma & Stressor- Client Signs/Reported Symptoms


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Related Disorders (F43.10)
Criterion A: In children 6 years and younger, exposure to
actual or threatened death, serious injury, or sexual violence in
one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to
others, especially primary caregivers.
3. Learning that the traumatic event(s) occurred to a
parent or caregiving figure
Criterion B: Presence of one (or more) of the following
intrusion symptoms associated with the traumatic event(s),
beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing
memories of the traumatic event(s).
Note: Spontaneous and intrusive memories may not
necessarily appear distressing and may be expressed as play
reenactment.
2. Recurrent distressing dreams in which the content
and/or effect of the dream are related to the traumatic
event(s).
Note: It may not be possible to ascertain that the frightening
content is related to the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the
child feels or acts as if the traumatic event(s) were
recurring. (Such reactions may occur on a continuum,
with the most extreme expression being a complete loss his mother due to his thoughts of having
of awareness of present surroundings.) Such trauma-
specific reenactment may occur in play.
4
Theo is a six-year-old black male who
experienced a traumatic event when the
family’s vehicle flipped, Theo's parents had
bodily injuries, and Theo's mother had a
bloody nose. Theo had bruising & no other
serious injuries. The people in the
community called 911, the police
responded, and the family was transported
by ambulance. Theo reported being scared
& thought he was close to being a fatality
1. Theo experienced ongoing nightmares of
the accident of a car about to crash into
another vehicle.
During recess, Theo played out car
accidents with his toy cars & displayed
aggression while crashing cars together.
2. Theo had nightmares, then woke up
from his dreams before the crash leading
him to want to sleep with his parents
3. Theo appears restless, fidgeting, and
having difficulty sitting still.
3. While playing with cars aggressively at
school, Theo is unaware of others around
him.
4. Theo has become withdrawn & doesn't
engage with the new video game bought by
caused an accident. The video game is
correlated to the car accident for Theo.

CASE STUDY ASSIGNMENT
4. Intense or prolonged psychological distress at exposure
to internal or external cues that symbolize or resemble
an aspect of the traumatic event(s).
5. Marked physiological reactions to reminders of the
traumatic event(s).
Criterion C: One (or more) of the following symptoms,
representing either persistent avoidance of stimuli associated
with the traumatic event(s) or negative alterations in cognitions
and mood associated with the traumatic event(s), must be
present, beginning after the event(s) or worsening after the
event(s):
Persistent Avoidance of Stimuli
1. Avoidance of or efforts to avoid activities, places, or
physical reminders that arouse recollections of the
traumatic event(s).
2. Avoidance of or efforts to avoid people, conversations,
or interpersonal situations that arouse recollections of
the traumatic event(s).
Negative Alterations in Cognitions
3. Substantially increased frequency of negative
emotional states (e.g., fear, guilt, sadness, shame,
confusion).
4. Markedly diminished interest or participation in
significant activities, including constriction of play.
5. Socially withdrawn behavior.
6. Persistent reduction in expression of positive emotions.
5
5. Fears he caused his mother to scream in
the car because he was playing the game
too much. Theo fears something will
happen again if he plays the video game. A
two-lane road triggers Theo in fear; the
father avoids two-lane roads so Theo is not
triggered.
1. Theo has become withdrawn &
doesn't engage with the new video
game bought by his mother due to
his thoughts of having caused an
accident. The video game is
correlated to the car accident for
Theo.
2. Theo became detached from
Kingdom Hall activities.
3. Fears he caused his mother to
scream in the car because he was
playing the game too much. Theo
fears something will happen again
if he plays the video game. A two-
lane road triggers Theo in fear; the
father avoids two-lane roads so
Theo is not triggered.
4. Theo has a hard time concentrating
& being still at home, participating
in Kingdom Hall services & school.
5. Theo became detached from
Kingdom Hall activities, he did not
sit still, & frequented the bathroom

CASE STUDY ASSIGNMENT
Criterion D: Alterations in arousal and reactivity associated
with the traumatic event(s), beginning or worsening after the
traumatic event(s) occurred, as evidenced by two (or more) of
the following:
1. Irritable behavior and angry outbursts (with little or no
provocation) are typically expressed as verbal or
physical aggression toward people or objects (including 2. . Theo thought that he was helping his
extreme temper tantrums).
2. Hypervigilance.
3. Exaggerated startle response.
4. Problems with concentration.
5. Sleep disturbance (e.g., difficulty falling or staying
asleep or restless sleep).
6
up to 3x times an hour.. Theo does
not ask to play over with his
Jehovah's Witness friends.
6. Theo engages in thoughts and
activities that are associated with
the traumatic events resulting in
less than positive emotions.
1. Theo strongly feels that the car accident
that the family experienced was his fault.
He showed that he was afraid when his dad
was driving on a two-lane road, and he saw
another vehicle approaching their car,
covering his head & screaming.
dad when he was driving by sitting in the
middle of the back car seat to look out for
other vehicles.
3. As if the traumatic event was
reoccurring to Theo when his dad was
driving, he reacted in trauma, by covering
his face with his hands and screaming if he
witnessed it while driving with his family
& another car was in front of the family
vehicle.
4. Theo's teacher states that Theo was not
concentrating on his schoolwork.
5. Theo had ongoing nightmares &
difficulty staying asleep and & wanted his
father to stay in the room with him till he
fell back asleep

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Criterion E: The duration of the disturbance is more than 1
month.
Criterion F: The disturbance causes clinically significant
distress or impairment in relationships with parents, siblings,
peers, or other caregivers or with school behavior.
Criteria G. The disturbance is not attributable to the
physiological effects of a substance (e.g., medication or
alcohol) or another medical condition.
DSM-5-TR Diagnostic Criteria: Acute Stress Disorders
(F43.10)
Criteria A: Exposure to actual or threatened death or serious
injury in one or more of the following ways: 1. Directly
experiencing
traumatic events.
2. Witnessing in-person events occurring to others.
3. Learning events occur to close family members & are
accidental or violent.
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1. Theo's parents reported an accident that
occurred six months before the counseling
referral.
2. Theo was an honor roll student & one
month ago, in a meeting, Theo's teacher
reported that Theo was having trouble
completing his work at school and
appeared distracted. He struggles to sit
quietly and read complete spelling
worksheets
Theo's sleep, emotional mental well-being,
home life, school, and friendships are all
affected by the traumatic event of the car
accident.
Theo was never diagnosed with a medical
problem or condition that warranted
medication. In addition, Theo had no
significant health problems or surgeries
and had accomplished all developmental
milestones.
Client Signs/Reported Symptoms
1. Six-year-old Theo was in a severe car
accident with his parents.
2. He suffered some bodily injuries from
the accident & his parents had sustained
broken ribs.
3. There were people from the
neighborhood as well as first responders

CASE STUDY ASSIGNMENT
4. Extreme exposure to aversive details of the traumatic event,
such as first responders and police officers.
Criteria B: Presence of one (or more) of the following
intrusion symptoms associated with the traumatic event(s),
beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing
memories of the traumatic event(s).
Note: Spontaneous and intrusive memories may not
necessarily appear distressing and may be expressed as play
reenactment.
2. Recurrent distressing dreams in which the content
and/or effect of the dream are related to the traumatic
event(s).
Note: It may not be possible to ascertain that the frightening
content is related to the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the
child feels or acts as if the traumatic event(s) were
recurring. (Such reactions may occur on a continuum,
with the most extreme expression being a complete loss Theo of the accident incident..
of awareness of present surroundings.) Such trauma-
specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure
to internal or external cues that symbolize or resemble
an aspect of the traumatic event(s).
5. Marked physiological reactions to reminders of the
traumatic event(s).
8
who showed up on the scene and called
911 thus ensuring that Theo & his family
were taken away to the hospital for medical
assistance.
1. During recess, Theo played out the car
accident with his toy cars and crashed cars
together aggressively.
2. As if the traumatic event was
reoccurring to Theo when his dad was
driving, he reacted in trauma, by covering
his face with his hands and screaming if he
witnessed it while driving with his family
& another car was in front of the family
vehicle.
3. Theo’s behavior showed that he was
afraid when he was in the car. This display
of anxious behavior keeps him
hypervigilant when he is in the car with his
family.
4. Two-laned roads or highways reminded
5. Theo refused or avoided playing his
new video game. It served as a reminder
of his mother yelling at him & relating it to
the car accident.
6. Theo has difficulty staying asleep due to
nightmares.
7. During recess with his friend, Theo
played aggressively with his Hot Wheel
cars & leading him to reenact the car crash.
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8. Theo has a hard time concentrating &

Criterion C: Duration of disturbance lasts over three days and
up to a month.
Criterion D: The disturbance causes clinical distress &
impairment in social, occupational, or other essential areas of
life.
being still at home, Kingdom Hall & in
school.
9. Theo screams & covers his face when
he sees another car while driving on a two-
lane road.
Theo's parents reported the accident to
have occurred six months before being
referred to a counselor.
Theo's sleep, emotional mental well-being,
home life, school, and friendships are
affected by the traumatic event of the car
accident

Other DSM-5 TR Conditions Considered

There are other trauma- and stress-related disorders that can affect Theo and other

individuals and they include.

Acute Stress Disorder (ASD):

DSM-5 explains that ASD occurs shortly after a traumatic event and shares symptoms

with PTSD, such as intrusive memories, avoidance, negative mood changes, and heightened

arousal. The symptoms of ASD appear to last only 3 days to a month after an individual

experiences a traumatic event. Therefore, if ASD symptoms persist beyond this timeframe, they

may evolve into PTSD.

Adjustment Disorders (ADs):

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DMS-5 explains that in adjustment disorders, the stressor can be of any severity rather

than of the severity and type required by Criterion A of acute stress disorder. The diagnosis of an

adjustment disorder is used when the response to a Criterion A event does not meet the criteria

for acute stress disorder (or another specific mental disorder) and when the symptom pattern of

acute stress disorder occurs in response to a stressor that does not meet Criterion A for exposure

to actual or threatened death, serious injury, or sexual violence (e.g., spouse leaving, being fired)(

APA, 2022 cited Strain & Friedman 2011).

Reactive Attachment Disorder (RAD):

DSM-5 shows us that RAD typically develops in children who have experienced severe

neglect or disruptions in early caregiving relationships. The symptoms of RAD include

difficulty forming emotional bonds, social withdrawal, and a lack of trust. Managing of RAD is

accomplished through Early intervention and therapeutic support.

Disinhibited Social Engagement Disorder (DSED):

Like RAD, this disorder also affects children. Children with this disorder exhibit overly

familiar behavior with strangers, lack of appropriate social boundaries, and impulsivity.

Research shows that this DSED often results from disrupted attachment experiences during

early childhood.

Developmental Theories and/or Systemic Factors

In the Theo case study, we can see that he was in the Industry vs. inferiority stage which

is the fourth stage of Erickson’s stages of psychosocial development. Individuals, such as Theo
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during this stage of psychosocial development, should try harder to show more capability and

obedience in carrying out the increasing child development assignments. He should be learning

new competencies provided by his teacher as well as being engaged in new things by exploring

his abilities, giving him the strength to set goals and gain direction in all areas of his life (Maree,

2021).

In this stage, Erickson shows us how trauma led to Theo experiencing regression as he

loses the ability to accomplish recently developed tasks (Clark, 2021, cited Hutchison, 2011).

Children like Theo may experience separation anxiety as they are extremely scared that

something will happen to their caregiver in their absence, refusing to leave their caregiver’s side

(Clark, 2021). In this case study, we see that Theo experienced feelings of guilt due to him

blaming himself for the trauma and for not being able to assist during the crisis. Theo's clinging,

shows a form of regression in this stage, which can occur, thus, causing him to rely on his

parent’s constant presence or a security object from their earlier childhood (Clark, 2021).

The DMS-5 provides criteria for a traumatic event, stating that one, like Theo, must

experience “exposure to actual or threatened death, serious injury, or sexual violence”.

Nonetheless, these events could be experienced in various ways, such as being directly exposed

to the event, witnessing the event as it happened to others, learning of a violent or accidental

event experienced by a close family member or friend, or repeatedly being exposed to the details

of traumatic events (American Psychiatric Association, 2013). This last form of exposure, which

is also known as secondary trauma or compassion fatigue, can often affect first responders who

are frequently seeing the trauma of others, such as disposing of remains or listening to children

report details of horrific abuse.

Multicultural and Social Justice Considerations

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In a review of Theo’s case study, it is imperative to discuss the Multicultural and Social

Justice Considerations from trauma and threats to well-being perspective. Here we can see the

complex ways in which stressful situations had put Theo at risk of psychological

danger and harm; because of the stressors that appeared to well-exceed his ability to cope with

them in constructive and effective ways. In this case study, we can see how the impact of

psychological trauma and post-traumatic stress disorder (PTSD) differs, depending on individual

differences and the social and cultural context and culture-specific teachings and resources

available to individuals, families, and communities (Ford et al, 2015)

From this perspective, we can see a differentiation in the impact on his personal, unique

physical characteristics, including skin color, racial background, gender, family, ethnocultural,

and community membership, religious beliefs and practices, and socioeconomic resources (Ford

et al, 2015). While his personal and social factors helped provide him with positive resources that

contributed to his safety and well-being, we can also see this as a basis for placing him, his

family as well as his schoolmates in harm’s way (Ford et al, 2015).

Key Issue for Treatment

 Mood changes

 Difficulty in participating in social activities

 Fear of dying

Recommendations for Individual Counseling

Treatment recommendations for Theo would include the use of Prolonged Exposure

Therapy (PET) coupled with Cognitive Behavioral Therapy (CBT) for both PTSD and ASD
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disorders. This method has been viewed as very essential in helping PTSD and ASD individuals

like Theo.

From this traumatic event, we see that Theo was struggling with his negative thoughts,

feeling like the world around him is dangerous, coupled with blaming himself as the cause of this

‘horrific event, thus feeling that he was not competent to deal with or cope with the dangerous

world he believed in (Kring & Johnson, 2022).

Theo has experienced a traumatic incident that led to psychological reactions and

symptoms that have involved dissociation, negative moods, and stress reactions. Exposure

therapy and treatment have been viewed as the initial psychological approach to treating

individuals like Theo (Kring & Johnson cited Cusak, Jonas, et al., 2016). This psychological

approach provided much-needed relief for Theo’s PTSD symptoms that he was experiencing,

compared to the use of any medication, supportive psychotherapy, or relaxation therapy (Kring

& Johnson, 2022).

Prolonged Exposure therapy serves as a strategic invention coupled with the use of CBT

that will help Theo address his fears. PET and CBT will help Theo learn to approach his

treatment-related memories, feelings as well as his situations (APA, 2017). Most individuals

including Theo want to avoid those situations that remind them of the traumatic experience.

When Theo begins to face what happened, he will be able to decrease his PTSD symptoms by

learning that these trauma-related memories or experiences are no longer hazardous so there will

be no need for him to continue to avoid them (APA, 2017).

Post-traumatic stress disorder treatment can help Theo regain a sense of control over your

life. With the primary treatment of psychotherapy through the use of PET and CBT, the addition

of medication was helpful ( Kring & Johnson, 2022). The Federal Drug Administration (FDA)
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recently approved paroxetine (Paxil) and sertraline (Zoloft) as two antidepressants that can be

used for the treatment of PTSD. Therefore, we see that the combination of psychotherapy and

medication can help decrease and improve the symptoms of PTSD (Kring & Johnson, 2022).

Specific Considerations

From Theo’s case study, we can see that his diagnostic impressions and the recommended

treatment of both disorders allow us to take into consideration the cultural competence for

familiarizing ourselves with the cultural and religious differences in his traumatic experiences

and how he was trying to cope. The perception mentioned earlier shows us his ethnicity for

using inclusive therapeutic materials and resources that expressed his cultural sensitivity as well

as how depictions of diverse backgrounds he could relate to and felt seen. For me to help Theo,

it would be essential for me to focus on creating trust with him to establish a therapeutic

connection with him by helping him to engage in age-appropriate activities that he may enjoy

with his fellow schoolmates; like drawing, playing, and simple language storytelling during the

first six sessions of counseling that he hopes to benefit from. Building trust with him will

provide a safe environment for him to explore himself through activities that allow him to

communicate his feelings and experiences with issues. It would foster a collaborative and

respectful approach with Theo's parents throughout their counseling session to help support

Theo's healing. Having a clear understanding of the triggering obstacles will help us recognize

the sensitive places within Theo, with the desired goal of him becoming engaged in the decision-

making process so he feels in better control (Sachser et al., 2017)

REFERENCES

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of mental

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Disorders. (5th ed.). American Psychiatric Association Publishing.

American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of

Posttraumatic Stress Disorder (PTSD) in Adults. Retrieved from

https://www.apa.org/ptsd-guidelines.

Bryant R., Moulds M. & Guthrie R. (2002). Acute Stress Disorder Scale: a self-report

measure of acute stress disorder. Psychol Assess. Mar;12(1):61-8.

PMID: 10752364.

Clark, J. (2021). The Effects of and Interventions for Trauma on Child and Adolescent

Development. Trauma on Development.

Cusak, K., Lang, A., Forneris, C., Wine, C., Sonis, J. & Middleton J. et al. (2016). Psychological

treatment for those with post-traumatic stress disorder: A systematic review and meta-

analysis. Clinical Psychological Review, 43, 128-141. https://doi.org/10.1016.

Foa, E. & Capaldi, S. (2013). Manual for the Administration and Scoring of the PTSD

Symptom Scale-Interview for DSM-5 (PSS-I-5).

Ford J., Grasso D., Elhai J., Courtois C. (2015). Social, cultural, and other diversity issues in the

traumatic stress field. Posttraumatic Stress Disorder. 2015:503–46. doi: 10.1016/B978-0-

12-801288-8.00011-X. Epub 2015 Aug 7. PMCID: PMC7149881.

Hutchison, S. (2011). Effects of and interventions for childhood trauma from infancy through

adulthood: Pain unspeakable. Routledge.

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Kring, A. M. & Johnson, S. L. (2022). Abnormal Psychology: The Science and Treatment of

Psychological Disorders, DSM-5-TR Update (15th ed.). John Wiley & Sons, Inc. ISBN:

9781119933489.

Maree J. (2021). The psychosocial development theory of Erik Erikson: a critical

overview, Early Child Development, and Care, 191:7-8, 11071121, DOI:

10.1080/03004430.2020.1845163.

Sachser, C., Keller, F., & Goldbeck, L. (2017). Complex PTSD as proposed for ICD-11:

Validation of a new disorder in children and adolescents and their response to

Trauma Focused Cognitive Behavioral Therapy. Journal of Child Psychology and

Psychiatry, 58(2), 160-168. https://doi.org/10.1111/jcpp.12640.