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 meet with the client’s mother today to update the client’s treatment plan. Since the beginning of the school year, the client has been suspended for a combined total of 8 days. He has responded poorly to many of the behavioral classroom interventions. The mother has reluctantly granted the school permission to begin testing to determine if the client qualifies for an Individualized Education Program. You inform the mother of her parental rights pertaining to this process, particularly as they apply to protections against disability-related discrimination and the maximum number of disability-related suspensions. She is encouraged by the possibility of the client receiving additional supports that consider the client’s strengths and challenges.  The mother reports that she has tried to use planned ignoring when the client interrupts but reports that this behavior has actually worsened

Question: The mother reports that she has tried to use planned ignoring when the client interrupts but reports that this behavior has actually worsened. This is likely attributed to which of the following?
(A): Negative reinforcement
(B): Response cost
(C): Extinction burst
(D): Behavioral activation

Correct Answer: Extinction burst
Explanation: Planned ignoring involves deliberately ignoring a predetermined target behavior. In this case, the target behavior is interrupting. An extinction burst occurs when the client increases his maladaptive behavior (ie, interrupting) to gain the mother’s attention. If the mother does not consistently hold a firm boundary, the behavior is reinforced and becomes more difficult to extinguish. Behavioral activation is a cognitive-behavioral technique used to help clients initiate values-based activities to improved depressive symptoms. Negative reinforcement occurs when there is a behavioral change that happens with the removal of unpleasant stimuli. For example, a parent yells at their child to clean up, the client complies, and the negative stimulus (ie, yelling) discontinues. Response cost is a consequence-based strategy for ADHD that involves taking away token reinforcers in the presence of negative behaviors. Token reinforcers can be exchanged for preferred activities (ie, extra computer time). An example of response cost would be to remove a token each time the client interrupts. Therefore, the correct answer is (A)
Competency: counseling skills and interventions