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:    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. Developmental and Family History: The client’s mother and father are married, and the client has a sister who is 3 years old. The mother denies drug or alcohol use during pregnancy. She is a smoker but states that she cut down when she discovered she was pregnant with the client. The client was delivered at 34 weeks and weighed 5 pounds and 6 ounces. He stayed in the newborn intensive care unit for 10 days after delivery. The client was toilet trained at 24 months, walked at 12 months, and talked at 18 months. The client’s paternal grandmother has been treated for bipolar disorder. His maternal uncle has a history of substance abuse, which his mother cites as the reason why she is opposed to the client going on medication

Question: According to Jean Piaget, the client’s thinking can be characterized by which one of the following?
(A): Can think about what-if or hypothetical situations
(B): The ability to understand abstract ideas
(C): Uses deductive reasoning and logic
(D): Thinks concretely and begins to perform logical operations

Correct Answer: Thinks concretely and begins to perform logical operations
Explanation: At age 7, the client thinks concretely and begins to perform logical operations. Piaget’s concrete operational stage of development occurs between the ages of 7 and 11. During this stage, children form mental operations or rules as evidenced by understanding concepts of conservation and reversibility. Piaget’s next stage of development (occurring at ages of 12+), is the formal operational stage, in which children and adults can use deductive reasoning and logic and think abstractly. Individuals in the formal operational stage of development also have the ability to think about what-if, or hypothetical, situations. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis