Case Study
Patient Demographic: Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3)
Mental Status Exam: Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea
Presenting Problem: You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.
Other Contexts: The client’s formal assessment, along with informal observations, warrants a psychiatric evaluation to assess for ADHD, and the PGM has agreed to this. The client has done well in therapy and has met her short-term counseling goals. She has processed grief and loss concerning separation from her parents and shows improvement with emotional regulation. The use of brief strategic family therapy (BSFT) has helped address patterns of interaction between the client and her PGM, and the client is having fewer tantrums. The PGM reports that the client continues to talk back, and she is not completing her chores. You plan to conduct a series of home visits to assist the PGM with parent management skills but receive word from your agency’s office indicating the client has lost insurance coverage

Question: Which of the following aspects of parent management training (PMT) illustrates the concept of extinction?
(A): The teacher progressively removes prompts that are no longer required for the client to stay in her seat.
(B): The PGM ignores temper tantrums that were previously reinforced with attention, causing the tantrums to discontinue.
(C): The PGM’s end goal of shaping the client’s behavior (e.g., cleaning her room) is achieved by reinforcing successive approximations to the goal. (I.e., “I need you to pick your clothes up off the floor” or “I need you to pull the covers up to your pillow.”).
(D): The client refuses to do a chore and loses a portion of her allowance.

Correct Answer: The PGM ignores temper tantrums that were previously reinforced with attention, causing the tantrums to discontinue.
Explanation: Extinction is demonstrated when the client’s temper tantrums, which were previously reinforced with attention, are ignored and, as a result, discontinue. Ignoring the behavior does not automatically stop the behavior. For extinction to occur, the behavior must have previously been reinforced, and the behavior must stop after ignoring the same behavior. Punishment is illustrated when the client loses a portion of her allowance due to refusing to do a chore. One way to differentiate punishment from other aspects of PMT is that punishment refers to methods that decrease a specific behavior. Fading involves the progressive removal of prompts that were previously (and successfully) used when telling the client to stay in her seat. Fading is used after the response is consistently performed without prompts. Finally, the end goal of shaping is known as the terminal response. Therefore, the correct answer is (B)
Competency: counseling skills and interventions