Case_Study

Mrs. Hernandez is a 35 y/o Puerto Rican female who is currently married for seven years and has two twin boys from a previous marriage and is currently expecting her third child. Mrs. Hernandez presented herself well-dressed as well as the children. Mrs. Hernandez is currently employed. Mrs. Hernandez was born and raised in Puerto Rico with her parents. Mrs. Hernandez relocated to New York at the age of 29 along with her husband Joshua Hernandez. Mrs. Hernandez had twin sons named Jay and Jayson but was abandoned by the children’s father before delivering the twins. Mrs. Hernandez was referred to our facility from her son’s school due to the children acting out in school, misbehaving, bullying other children, having multiple fights and becoming aggressive. Mrs. Hernandez was accompanied by her husband, Joshua of seven years. He is attentive to Mrs. Hernandez because she is currently seven and a half months pregnant. After the family settled in the office, the mother sat next to her husband along with the twins (Jay and Jayson). Upon starting the interview, Jay and Jayson both 10 years old began wrestling with their hands and the step-father became upset and Mrs. Hernandez told the kids to stop play fighting and to sit down however, the children ignored her and continued playing. The step-father stated “she can’t even control her kids”. I requested the children to go to the play room with another staff member who will supervise them until we finish our interview and they both agreed. As we continued the interview, Ms. Hernandez was the first to speak; and she stated that she feels overwhelmed because she is handling the kids situation all by herself and Joshua is not being supportive. According to Ms. Hernandez, she stated that her mother felt that Maria was unable to raise her two sons while she was attending school and working part time and also because she was a single-parent. According to Maria, the twin’s father left her 4 months before giving birth and he has never seen the kids. The maternal grandmother took temporary custody of her grandchildren until residing with her in Puerto Rico until 6 months ago. Ms. Hernandez stated that 6 months ago her mother became ill and was no longer able to take care of the children. Ms. Hernandez decided to bring her two sons to New York. After the children arrived to New York; they started presenting the following behaviors: they were misbehaving at home, at school and she is constantly receiving phone calls from their teachers. Prior to the children’s arrival, they did well in school, had multiple friends and family and although there were times that they did not listen, just like every other child, Mrs. Hernandez reports that the children don’t want to listen to her when she reprehends them at home. Even for the children to complete a simple task of cleaning their room it becomes an argument. Now, meetings are taking place twice a week with the kid’s teachers because of their behavior. The teachers believe that the children have ADHD and that is the reason why Ms. Hernandez was referred to our facility. Ms. Hernandez is requesting assistance with her two sons because she knows that her children have never presented this issue before. At the same time, she feels overwhelmed because Joshua is not taking a role as a parent towards Jay and Jayson. Prior to the children arriving in the home, Joshua was very supportive, loving, understanding and was open to bringing the children to the house. Two months after, that Jay and Jayson arrived at the house, Joshua began changing his attitude towards Maria and other behaviors such as not coming home, staying out late and when he comes home it’s well after the children are in bed. Maria reported that Joshua is constantly arguing with her about the children’s behavior and the lack of respect that they have towards her. Ms. Hernandez reports that they argue because the kids are always misbehaving and the lack of respect they have towards her that is why he stays away from the situation because he feels that he can’t tolerate that amount of disrespect in his own home. Maria also reported that Joshua feels that if she can’t handle her own two kids now, how she is going to handle a new baby. After Maria stated her feelings, Joshua spoke up and stated that he is sick and tired of how Jay and Jayson treat their mother. He knows that he is not being supportive at the moment, because he feels that he can’t handle the situation with the kids because he feels that he would end up losing his temper with the kids. According to Joshua, he grew up in a strict household and this type of behavior was not tolerated by his parents. Maria stated that the behavior the children are presenting was not tolerated at her home either as a child by her parents, however Maria feels guilty because she has not been in the children’s life and she feels that she needs to give them time to adjust to a new environment. This family is composed of the mother, step-father and the twin boys. Maria and Joshua were born in Puerto Rico. They both came from middle class families and about six years ago they decided to move to New York because of Joshua’s employment being relocated to New York City. Maria is 36 years old and Joshua is 37 years old. They both come from strong Catholic families and attend service every Sunday and even on holidays. Maria works as a receptionist 25 hours a week for a law firm and Joshua works for a shipping company and has a 65,000 gross income to the year. They currently live in a four bedroom house in Bushwick, Brooklyn, which they were able to purchase the house about five years ago with the help of Joshua’s family and his job. Joshua’s income covers most of the income in the household, while Maria’s income is used for essential things in the house such as for herself and the necessity of the children. Maria reported although that they own their own home they are not really thrilled about the neighborhood they reside. According to Maria, it is not a safe place to raise the children and the schools are not so great. She has been thinking about transferring her children to a nearby Catholic school, however she fears that the children might not get accepted because of their behavior at this time. According to Maria, she can’t allow the children to be outside without supervision because of the neighborhood and this was something that the children were accustomed to in Puerto Rico. Maria also stated that the children were accustomed to playing with their cousins and family members something that they don’t have here because Maria and Joshua don’t have family in New York. According to the intake packet, the children are presenting the following symptoms: a). often has difficulty sustaining attention in tasks or play activities b). often does not seem to listen when spoken to directly, or c) may be more active than normal and tend to act out without thinking which correlates to symptoms of ADHD, however after listening to Maria she stated that prior to the children’s arrival to New York they never presented these symptoms. Looking at this case closer, the children may be presenting an Adjustment Disorder and not ADHD. The reason why I chose Adjustment Disorder with Anxiety is because according to the DSM IV, this diagnosis is defined as: when the predominant manifestations are symptoms such as nervousness, worry, or jitteriness, or, in children, fears of separation from major attachment figures” and ruled out Attention Deficit Hyperactivity Disorder because the children may still be having a difficult time adjusting to a new environment and their new family structure of having a two parent unit. I also believe the children might be experiencing grieving issues due to the fact that they lost their grandmother because she was the only mother they knew for 10 years and the only environment they knew while residing in Puerto Rico. Listening closely to the interview there seems to be an issue on how Maria and Joshua communicate with their new family and how Joshua identifies as a step- father and how Maria interacts as a mother to Jay and Jayson. The major family system models that will best help this family will be the structural approach, communication approach and strategic approach. According to the structural approach theory, this approach will help the family to realize the importance of a family and its structure. As define by Minuchin (1974), “The invisible set of functional demands that organizes the way in which family members interact. Repeated transactions establish patterns of how, when and to whom to relate and these patterns underpin the system” (p.51). For example, Maria told the boys to stop play fighting while in the office and neither child listened to her and continued misbehaving but then again instead of Joshua helping Maria with the children he decides to blame her by saying that she can’t handle her own children. Also according to the structural approach theory, Joshua will be able to identify different components that are needed to become a family. Joshua has never been a parent because he and Maria are expecting their first child together. Joshua needs to understand that they are now a new family and that there are many roles that are expected from him as a “father” figure to these children because they grew up with their maternal grandmother and they never experienced the interaction with a male in their lives. Maria will also benefit from this approach because she has not been in the children’s lives since birth and she needs to construct a new relationship with her sons. The second approach that will help Joshua and Maria is the communication approach. As stated in the article Theoretical and Treatment Approaches to Evidence- Based Family Treatment, “Communication is defined as all verbal and nonverbal behavior within a social context, which can be read by gesture, manner of dress, tone of voice, facial expressions, body posture and so on” (p.39). Although, Joshua and Maria have been together for seven years, the presence of Jay and Jayson is affecting how Joshua now communicates with Maria. He has developed an attitude towards her, comes home later than usual and speaks to her as if she is to blame on the children’s current behavioral pattern in the house. For example, Maria has to be going to the children’s school twice a week for meetings because of their behavioral issues, Joshua now feels that she the kids are keeping her busy and she does not have time for him. This message could be interpreted in many ways based on metacommunicative level. Depending how Joshua is expressing himself towards Maria at a set tone of voice within their conversations. The third approach will be the strategic approach. In this approach there are different ways in which a family may operate in order to have them understand the power of a family. Joshua and Maria can benefit from this approach because it will help them seek the strength and strategies that are needed in the home. Joshua and Maria are new into parenting because Maria has not attended to her children and Joshua does not have any children of his own yet. Both Maria and Joshua need to understand the importance of setting rules and knowing how to carry out the importance of what kind of family they will be because they are all knowing who they are together. As defined by Schilson (1991) “The development of insight is not required for change in daily functioning. Emphasis is placed on relabeling and reframing, which is designed to give the family a different perception of the difficulty it is experiencing, and this will increase the family’s effectiveness in solving its problem” (p.46). Maria and Joshua need to identify what is the problem with the children and themselves in order to function as a family. I feel that this family will benefit from these approaches mentioned above because they are in the process of learning from each other. Joshua and Maria have been together for seven years without the presence of children. Even though Maria had the twins, she has not had the opportunity to understand her children because they can’t relate to her because she is not the mother figure that they have come to know for their 10 years of living. The children also need to learn how to communicate with Maria in order to understand who she is and the role she plays in their lives. Joshua also needs to learn from these approaches in order to start playing the role as a step-father to these kids because he is also going to become a father and he needs to be able and identify how he is going to relate to another addition in their new family. References Janzen, et.al (2006) “Theoretical and treatment approaches to evidence-based family treatment” pp.29-59