Assignment 1

Social Work 679

Collins Nwabunike

University of Calgary
 Formulation

Presenting Concern

Zoey Z is a 3 ½-year-old girl, brought into the Early Childhood Assessment and

Treatment Services for support by her parents, Jeff and Sarah, for “explosive behavior.” They

described rapidly fluctuating moods, saying, “She goes from zero to 60 in seconds flat.”. Zoey is

the couple’s oldest child and she has a brother Dylan who is 1/5 years.

Predisposing Factors

It is important to note that Zoey’s birth came out of an unplanned pregnancy. During

Zoey’s early development she has had some sleep difficulties, sensory concerns, and regulatory

concerns. A developmental screening tool was completed called “the Ages and Stages

Questionnaire-3rd Edition (ASQ-3)”. According to the screening, Zoey scored positively on her

gross and fine motor skills and problem-solving skills. She needs monitoring in her

communication skills, and her personal social skills need further assessment. Zoey’s social, and

emotional behaviors were observed and reported using the ASQ Social/Emotional Questionnaire.

Zoey scored higher than the cut-off, thus suggesting the need for intervention. Zoey also has

some separation anxiety.

Zoey’s mother, Sarah, has experienced some mental health concerns related to depression,

anxiety, and postpartum depression. Sarah suffered from postpartum depression for 6 months

after having Zoey and suffered a relapse with her son but for a shorter duration and less severe

symptoms.

Precipitating Factors
 Zoey’s parents report that she has difficulties self-regulating which lead her to regularly

have tantrums and explosive behaviours including aggression and disruptive behavior.

Sarah’s parenting style appears to be inconsistent. It does not stay strictly to authoritarian,

authoritative or permissive parenting styles. To discipline Zoey, Sarah will ignore, remove

privileges or yell as a way to deal with the behavior or issue. In observation of Sarah’s

interactions with Zoey, some emotional miscues were noted when Zoey became frustrated in

play. Sarah appeared intrusive in trying to make Zoey feelings of frustration go away and her

eagerness to join Zoey, the moment an issue arose. While Sarah appeared to interrupt the circle

of security in attempting to help Zoey deal with her frustration

Perpetuating Factors

Zoey experiences night terrors which have been leading to difficulty sleeping for the past

year and a half. Zoey often resists going to bed, and she wakes during the night, calling out for

her mother. It can take over an hour to get her back to sleep again. In her self-report, Zoey was

able to list out four things she wanted the counselor to know about her. First, she stated she hates

having her hair washed, brushed or cut. Secondly, she commented on being a picky eater, and

how she often refuses new foods and textures. Thirdly, Zoey complained about the tags in her

clothes. Lastly, She stated having difficulties dressing up. These self-reported preferences

indicate that Zoey has some sensory issues. Zoey’s parents also described she has “personal

space” issues.

Sarah’s mental health concerns have continued to bring stress to her husband, Jeff who

has described feeling helpless in the face of his wife’s distress. Jeff and Sarah report having a

loving relationship but noted that they do not effectively communicate regarding their emotions.

Jeff often works for long hours, which means he is often not around to provide support. In
regards to family, Jeff and Sarah shared that they both continue to have strained relationships

with their family-of-origin. In particular, Sarah reported to her therapist that raising Zoey,

reminds her of her relationship with her mother. Sarah explained that when she was Zoey’s age,

she felt deserted by her own mother who went to another city to pursue her education. Further,

Sarah has noted that her own mother was often emotionally unavailable and unpredictable. Sarah

engaged in some reflection of these memories and had a powerful insight and stated that “It just

occurred to me that Zoey needs me and not just anyone.”

Zoey’s parents, Jeff, and Sarah are young parents in their mid-twenties, who are new to Calgary,

having moved here from Ontario two years ago and have limited family or social supports.

Protective Factors

Despite, the pregnancy of Zoey being unplanned, her mum, Sarah, had prenatal care,

which resulted in healthy childbirth. The due date came at its full term, with no complications

during labor/delivery and she was born 7lb 7 oz. Sarah did not use any drugs, and/or alcohol

during pregnancy. Zoey's current health appears to be good and her parent's perception of her

health is good. Zoey has access to a pediatrician/family doctor. He last visit was January 15,

2018. Her immunization and dental care are up to date. Sarah appears to rely upon taking a

break as her parenting strategy. Zoey does not live in a dysfunctional household, there are no

forms of physical, sexual or emotional abuse within the family. She appeared to be clean and

well kept. There is also no abuse of substances in the household or physical illness in the

household. Zoey has an intact family whose parents are in a loving relationship. Zoey has a

parental grandmother (Jeff’s mother) named Lois Z who cares for Zoey during the day while

parents are working.

 Zoey maintains good eye contact. She has a good peer relationship. In which she has

little trouble playing alongside other children.They are no concerns in regard to her mood and

affect as they appear to be normal. In meeting with Zoey’s parent, Sarah, it was evident that she

had knowledge of Zoey’s developmental needs, and encouraged positive development with her.

Further observations were able to be made when Zoey, Sarah and her therapist interacted. Zoey

was able to engage in play on her own while Sarah and her therapist sat on the floor and talked.

Sarah provided emotional comfort to Zoey, and showed signs of sensitive parenting including

maintaining eye contact. Zoey was able to confidently explore and while she was frustrated

during one point in play, Zoey did calm down after some time spent in Sarah’s lap.

Diagnoses

Zoey meets the criteria for the diagnosis of relationship-specific disorder this cause she

has difficulties self-regulating which lead her to have regular tantrums and explosive behaviors

such as aggression, sleep refusal, food refusal, and disruptive behavior while in the presence of

her primary caregiver, Sarah (American Psychiatric Association, 2013). These explosive

behaviors have lasted over a month. Zoey’s mum is intrusive and reactive in an eagerness to

respond to Zoey’s distress thus limiting her ability to learn and develop. Zoey’s secondary

diagnosis will be sensory-over-responsivity disorder as she shows an intense reaction to multiple

types of sensory stimuli such as food texture, and cloth tags (American Psychiatric Association,

2013). She does not meet the criteria for autism spectrum disorder due to the lack of restrictive,

repetitive behaviors of interest (RRBI) prevalent in such diagnosis.

Treatment Plan and Evaluations Method

The purpose of the program is to improve caregiver-child relationships and increase the

social/emotional functioning of the individual child. From an attachment perspective, there are
possibly some developmental concerns in which Zoey has an insecure ambivalent attachment

(Avram, Miclea, & Stefan, 2017). Insecure-ambivalent attachment refers to children such as

Zoey who worry about their caregiver’s availability and exaggerate their emotional responses to

gain proximity to an inconsistently available parent, who at times ignores the child, and at other

times is overprotective (Avram, Miclea, & Stefan, 2017). Specifically, ambivalently attached

children heighten their display of negative emotions, ostensibly in an effort to gain the attention

of their inconsistently available attachment figure (Avram, Miclea, & Stefan, 2017). Zoey’s

attachment figure is Sarah and she needs to be a safe haven of safety in times of stress and a

secure base from which Zoey can explore and try new things. There seems to be a lack of

attunement in the relationship, in which Sarah is overreacting to perceived danger. We would

need to do some work to promote high parental sensitivity between Zoey and Sarah to ensure a

secure attachment formed.

In order to maximize the impact of a treatment plan for this particular case, the use of the

Circle of Security Intervention (Cooper et al. 2002) should be utilized. This intervention draws

upon a group modality to provide education and psychotherapy that is based upon attachment

theory (Cooper et al. 2006). In addition, while this is completed in a group modality, this

intervention will still create an individualized treatment plan, to uniquely reflect the needs of

Zoey and her parents in this case.

In the use of these intervention treatment goals will include; increasing Zoey’s parents

knowledge on the attachment needs of Zoey and awareness of her non-verbal and verbal cues,

decrease and develop strategies to address Zoey’s aggressive and disruptive outbursts, and

identify and connection the relationship Sarah and Jeff had with their caregivers and how that

impacts their attachment style with Zoey.

To evaluate the effectiveness of this intervention there will be a pre-assessment and post

assessment done. The pre-assessment will indicate the presenting concerns and their severity.

The post assessment will be completed after a six-week period which will include consultation

with the parents as well as observation of interactions between Zoey and her parents. The post

assessment will reveal any changes in the severity of the presenting concerns, as well as the

parents knowledge on their attachment style and strategies moving forward.

References

Avram, J., Miclea,M, & Stefan, C. (2017). Children's awareness concerning emotion regulation

strategies: Effects of attachment status. Social Development, 26(4), 694-708.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(DSM-5®). American Psychiatric Pub.

Cooper, G., Hoffman, K., Marvin, R.S., & Powell, B. (2006). Changing toddlers’ and

preschoolers’ attachment classifications: The Circle of Security Intervention. Journal of

Consulting and Clinical Psychology, 74(6), 1017-1026.

Cooper, G., Hoffman, K., Marvin, R.S., & Powell, B. (2002). The Circle of Security project:

Attachment-based intervention with caregiver–preschool child dyads. Attachment & Human

Development, 4, 107–124