Danial 1, 2, 3 Final

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u10a1 Case Study of Danial Parts 1, 2, and 3 Beatriz Rivera PSY 6210 Capella University September 15, 2023

Danial Part 1 Case Summary Danial is a 7 year-old boy who has brought in by his parents, his mother Yalda and his father Nasir. The family emigrated from Pakistan to the United States (US) approximately10 years ago, and eventually, the maternal grandparents moved the US as well. The family reports that assimilation to the American culture has been both religiously and culturally challenging. Nasir owns three convenient stores and Yard works with him. Danial is in second grade and is an A/B student. Danial is small for his age and by the way he moves, he could be mistaken for a girl. Danial is the youngest of two—his older brother is 15 and is a great athlete whom his dad is proud of as he mentions it with no hesitation. When Danial was in a preschool program, Yalda used to work at the school because Danial liked his mom being there. It is evident that Danial is close to his mom as he sits close to her during the session. He has been brought in by his parents because he has been having stomachaches since the beginning of the second grade school year and his parents believe he is doing that just to stay at home with his mom as that is what he did the first month of first grade. His parents report that the stomachache complains are becoming worse every year. When Danial was in preschool, he wanted someone to stay wit him at night until he fell asleep but his dad did not allow that at the start of his kindergarten year, which made Danial cry. Parents report that Danial wakes up at night frequently and has slept outside of his parents’ bedroom as he has nightmares that his mother getting kidnapped. Danial had trouble staying with a babysitter when he was a toddler, but was able to stay with his grandparents.

During the session, Danial holds his mother’s hand or her sweater. When asked if he is afraid, he states he is and fears something will happen to his mom. When asked if Danial can speak to therapist alone, he refuses and Nasir becomes irritated. Parents report there is no history of physical abuse/neglect or domestic violence. Danial’s developmental signs are in the normal range and he has not behavioral issues. Nasir reports that Danial likes to play with girls and dolls and does not like to get dirty, concluding that Danial will never be the athlete his brother is. No evaluations have been conducted on Danial, but it appears that he seems to be suffering from a few things. Diagnosis (F93.0) Separation Anxiety Disorder, (primary diagnosis) (F64.9) Unspecified Gender Dysphoria Other factors (Z62.820) Parent-Child Relational Problem, Parent-Biological Child I diagnosed Danial with Separation Anxiety Disorder (SAD) as a primary diagnosis as he meets the criteria for SAD: has an excessive fear/anxiety concerning separation from those to whom he is attached as evidenced by at least three criteria of SAD. Danial meets the criteria and presents the following symptoms: recurrent excessive distress when anticipating/experiencing separation from major attachment figures, persistent and excessive fear/reluctance about being alone/ without major attachment figure at home in other settings, persistent reluctance/refusal to sleep away from home/to go to sleep without being near a major attachment figure, repeated nightmares involving the theme of separation, and repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment

figures occurs/is anticipated. Danial’s ear/anxiety/avoidance is persistent, lasting at least 4 weeks in children, and a disturbance causes clinically significant distress/impairment in social, academic, occupational, or other important areas of functioning. (APA, 2022) Danial has had a constant fear, for more than two years, of being separated from his mother and does not want to be alone. He has nightmares of his mother getting kidnapped and fears something will happen to her and continues to complain about stomachaches. The constant fear of being away from his mom academically affected him as he did not want to be at school without his mother. APA depicts that SAD develops after life stress, especially a loss (death of a relative or pet, illness of an individual or relative, change of schools, parental divorce, a move to a new neighborhood, immigration, a disaster that involved periods of separation from attachment figures) (2022). I also diagnosed Danial with Unspecified Gender Dysphoria (UGD) as Danial does not meet at least six of the criteria for Gender Dysphoria (GD), but meets at least one by the information provided by his father that Danial likes to play with dolls and girls and does not like to “get dirty.” Other factors in Danial’s diagnosis is the parent-child relational problem with a biological parent. Nasir’s body language and words imply that he does not have a good relationship with Danial as he has with his 15 year-old son. In GD, Kozlowska et. al., (2021) explain that research suggests that some role is played by the quality of children’s relationships with attachment figures, the quality of the family environment, and the presence of adverse events that may have increased family stress or contributed to the bifurcations in the child’s developmental pathway. Recommendations

It is recommended that Danial received Cognitive Behavioral Therapy (CBT) to address his SAD. Davis et. al. (2019) conducted a study on the effectiveness of CBT in children with SAD with different emotional awareness levels. The findings were that children with higher levels of pretreatment emotional awareness had better outcomes with specific regard to improved ability to cope with worry (Davis et. al., 2019). Danial’s developmental signs are in the normal range and seems to have emotional awareness when asked if he is afraid and why he is afraid. Danial would benefit from CBT to help reduce his SAD. Questions Additional information is needed to confirm Danial’s diagnosis. I would need to gather information for the following questions: Was there a loss in the family? Has Yalda taken a trip and left Danial at home with the family or anyone else? How is the marriage between the grandparents? Have you moved in to new neighborhood recently? When did the parents start noticing that Danial has feminine-like manners? Is he getting bullied at school? Is there familial history of anxiety? Have there been conversations between adults that Danial has listened to regarding news and/or stories where individuals are kidnapped? Did Danial’s brother ever present these types of behaviors? These questions would provide more information to better understand Danial and where and when his SAD began. There are also some factors to consider. Danial and his family are from Pakistan and have different cultures/beliefs. Based on his father’s reaction to Danial’s feminine-like behavior and his closeness to his mother, he seems to not have much patience or tolerance to Danial’s non- masculine behavior. Danial’s family lived in a different culture/environment and Danial was not exposed to much of that other than at home since his parents moved to the US before Danial was

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