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: In a research study, which methodological feature considers ethnocultural variables when determining external validity?
(A): Choice of outcome measures
(B): Design of the study
(C): Length of follow-up
(D): Criteria for inclusion-exclusion

Correct Answer: Criteria for inclusion-exclusion
Explanation: A research study’s inclusion-exclusion criteria are a methodological feature that considers ethnocultural variables (eg, race, ethnicity, gender, and age). Inclusion criteria are characteristics of the subjects participating in the study, whereas exclusion criteria disqualify individuals from being included. External validity, or how well the results can be generalized to other settings, is contingent upon the characteristics of the study’s participants. For example, a study concludes that certain foods and additives may impact symptoms of ADHD. However, if the study was only conducted with white adolescent females, it has limited value and thus cannot be generalized to the client, an African American 7-year-old male. The design of the study (whether it is quantitative or qualitative), outcome measures (ie, symptom reduction), and the length of follow-up (ie, the intervention effects over time) are crucial elements of a research study; however, only inclusion-exclusion criteria affect the study’s generalization to ethnocultural groups. Therefore, the correct answer is (D)
Competency: professional practice and ethics