Case Study
Patient Demographic: Client Age: 7 Grade:2nd Sex: Male Gender: Male Ethnicity: African American Counseling Setting: Community Mental Health, School-Based Services Type of Counseling: Individual and Collateral Presenting Problem: Impulsivity; Inattention; Hyperactivity Diagnosis: Attention-Deficit Hyperactivity Disorder (ADHD) 314.01 (F90.2)
Mental Status Exam: Mental Status: The client is dressed appropriately, and he is well groomed. His affect is bright when engaged in an activity of his choice, but he becomes irritable when asked to comply with a direct request (e.g., pick up the toys, walk in the hallway). He is energetic, eager to please, and interrupts your conversation with the mother, as evidenced by the client stating multiple times, “Watch this! Hey! Watch! Look what I can do!” The client has difficulty transitioning from your office and back to his classroom. He runs ahead of you in the hallway and does not respond to redirection. The client has not voiced suicidal or homicidal ideation. Developmenta
Presenting Problem: You are a clinical mental health counselor providing on-site school-based services in a public elementary school. Your client is a 7-year-old African American male enrolled in the 2ndgrade. The client is accompanied by his mother, who states that she is here because the school “requested an ADHD assessment.” The school reports that the client is disruptive, refuses to follow directions, disturbs others, and has difficulty staying on task. The mother describes the client as “energetic” and “strong-willed”—behaviors that she believes are “just typical for a boy.” She is upset that the school wants to conduct a formal evaluation to determine if the client qualifies for a more restrictive classroom setting. The school’s population is predominantly white, and the mother believes that her son is being treated unfairly because of his race.
Other Contexts: You have been working with the client weekly and are meeting with the mother today to discuss interventions that she can use at home. She relays that her husband does not support the diagnosis of ADHD and has reached out to their faith community instead. The mother is conflicted about counseling and explains that it is viewed as a sign of weakness in her community. She continues to voice concern over the school’s lack of diversity and her belief that the client is being treated differently because of his race

Question: Which statement accurately reflects the ACA Code of Ethics guideline for working with culturally diverse populations?
(A): Counselors consider the client’s cultural background when providing assessment results and only use bias-free instruments.
(B): Counselors seek supervision when they are at risk of a client imposing their values, attitudes, beliefs, and behaviors onto the counselor.
(C): Counselors recognize existing historical and social prejudices in the misdiagnosis and pathologizing of certain individuals.
(D): Counselors practice only within the boundaries of their competence based on their education, experience, and ability to engage with diverse client populations.

Correct Answer: Counselors recognize existing historical and social prejudices in the misdiagnosis and pathologizing of certain individuals.
Explanation: The ACA Code of Ethics states, “Counselors recognize historical and social prejudices in the misdiagnosis and pathologizing of certain groups and strive to become aware of and address such biases in themselves or others” (ACA, 2014, Section E5c). Section C2 addresses professional competence, stating, “Multicultural counseling competency is required across all counseling specialties, [and] counselors [must] gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor working with a diverse client population” (ACA, 2014, Section C2a). Regarding assessment instruments, counselors must “use assessment as one component of the counseling process, taking into account clients’ personal and cultural context” (ACA, 2014, Section E). Because there is the potential for bias in nearly all assessments, counselors must consider using multiple methods and multiple informants to reduce cultural biases. Finally, counselors avoid imposing their values, attitudes, beliefs, and behaviors onto the client, making option D incorrect. Therefore, the correct answer is (A)
Competency: professional practice and ethics