Client’s Background and Referral Information Charles Darwin is a Caucasian male born on June 14th, 1990; Charles’s chronological age is 28 years and 9 months, and he is right-handed. Hisc biological family history is positive for anxiety disorder, ADHD, and depression. Charles was referred to Neuropsychological Evaluation to determine his current cognitive and emotional status, mostly to clarify diagnostic concerns of attention-deficit/hyperactivity disorder (ADHD), clarify diagnostic issues and offer recommendations for treatment, educational, career planning, and sense of direction that the client reports he is currently lacking.During battery of assessments, Charles maintained fluent speech at a speed, volume, and rate appropriate for the setting, he reported feeling ok and overall appeared to be both indifferent and excitable. He presented with a neutral affect that was appropriate in range, reactivity, and intensity to the situation. Charles appeared to have logical, linear thought processes, with some evidence of some tangential and circumferential thought processes. no suicidal or homicidal ideations, preoccupations, or phobias. There was so responsiveness to external stimuli such as movement and sound. Charles’ level of insight was good with fairly good judgement. Memory and concentration were examined. Charles showed some impairment of memory regarding recent memory, though did not appear to struggle to a noticeable degree with basic concentration task. Charles was oriented x 4 to all spheres (person, place, time, situation).No supplemental tests were used. Regarding physical observations, Mr. Darwin did not appear to need, and did not wear any corrective lenses. The examiner noted no hearing or visual difficulties, nor was there any evidence of physical impediments, restrictions, or motor disturbances.History, Assessment, and DemographicsAccording to the information provided by himself and his mother, Charles is the product of an uncomplicated full-term gestation. The delivery was normal and there were no problems evident at birth. As an infant, Charles had difficulty falling asleep at times, but pediatricians never raised any flags. There were no problems with health, feeding or temperament in infancy. Charles was described as having been a happy baby who exhibited typical sociability. Developmental milestones emerged within the expected intervals. There were no concerns regarding hearing or vision, nor concerns about fine or gross motor coordination. Charles was born and raised in Seattle, Washington. He currently lives with his mother; his father is deceased, and only sister, who is younger than him is already married. His mother loves him and believes that he is not where he should have been in life -mainly referring to him as a leech as he is still living with her-, in fact, she described Charles as a very intelligent, creative and respectful person who is caring toward others and great at singing, and she completes by saying that he should have been successful and independent by now. Charles is very empathetic but also somewhat naive and socially anxious. He used to be the life of the party and very extroverted at Ted John Lennon High School. His teachers described Charles as a kind, respectful, capable, ambitious student who needed help with time management and prioritizing tasks. He earned primarily C’s as a high school freshman, and from there on, his grades only went down, therefore, he barely passed his grades. It does not seem that Charles suffered any bullying in his school years, as well as no assessment or psychosocial tests were completed.Charles was in good health at the time of this evaluation. He takes vitamin D daily. Charles is described as a ‘night owl’ with regard to sleep patterns, sleeping only 6 hours per night. He almost always awakens in a grumpy mood. There are no major concerns regarding appetite or eating patterns although, described as picky eater. Concerning the aspects of his cognitive achievement, though superior in some areas according to the Woodcock-Johnson IV, do not rule out the possibility of Charles having attention-deficit hyperactivity disorder. His results from the ASRS are indicative of an attention-deficit hyperactivity disorder. This information could explain some of his difficulties maintaining work and personal relationships. Furthermore, a disconnect from his natural supports, and constant change in his contribution to his stability might also explain the strain in his relationships and be impacting his overall motivation and feelings of inadequacy. There was a theme of extroversion and strong interpersonal skills which indicates a possibility for developing and maintaining stable personal and professional relationships. Charles has expressed aspirations to live autonomously and connect with others, knowing how in general how one would achieve those goals, yet presents himself as having a lack of motivation, expressing little desire to take initial steps. Charles is sociable and is able to communicate his thoughts and feelings appropriately, showing a level of awareness consistent with his age. He has shown motivation in session; however, his motivation outside of session has yet to be fully measured. Based on his results from the MBTI, he gains energy from being around people, processes new information through his senses, uses his feelings to base his decision-making, and approaches life in a more flexible way instead of a structured way. Presenting ConcernsCharles currently presents two areas he is concerned about; first, he reports having academic challenges throughout his life, as he described his academic achievement as terrible. He was always joking around in high school, and barely made the grades to be able to graduate. Now that he is getting older and more responsibility is expected of him, he has a suspicion that he fits most criteria for attention-deficit/hyperactivity disorder, and he would like to have a formal diagnosis. The second area of concern for Charles is with his sense of feeling lost, alone, without plans, without a profession, and a job he really enjoys. While his friends are all married and having children, he feels isolated and has no idea what he should be doing with his life. Resources and StrengthsTo empower Charles to follow his dreams and achieve his goals, the focus is going to be exclusively on his strengths. Charles has several great social skills, he loves life, loves to be engaging, make people smile and happy; all the while without withholding flexibility, common sense, respect, generosity, love, politeness, adaptability, spontaneity, and extravagance. All these attributes could be confirmed by Charles’s Myers-Briggs (MBTI) personality test results, nominating him as ESFP (Extraversion – Sensing – Feeling – Perceiving). Curiously, Charles loves to sing and perform, and the test mentions people with this specific personality naturally behave as the ones walking under the spotlight and performing at the world’s stage.Charles mentioned that his mother signed up for a YWCA family membership, that resource could be utilized for the two of them to work out together, take classes and make new friends, as well as work on their stressed relationship. Charles’s warm personality could lead him to volunteer works at that location, as well as job opportunities and new friendships.Charles was very surprised and happy to observe some many career possibilists available to him, as he discovered his array of talents through the Strong’s Interest Explorer (SIE). He was feeling lost without identifying the career he wants to follow; now, however, he wants to explore his talents and passions without worrying so much about impressing others. The SIE gave Charles an opportunity to envision a wide presentation of abilities, curiosities, and strengths; including arts, drama, music, protective services, environmentalist, as well as a special ability to relate to nature, which is really interesting, as he is currently working part time at a nursery, taking care of plants. In fact, demonstrated interest about learning more about this field, perhaps even attending Community College classes. Treatment GoalsThe first goal is to provide Charles the necessary tools to focus on his strengths -instead of his weaknesses- and from there, build his self-esteem, and empower him to seek growth.The second goal is to develop a specific plan of action; tailored to fit Charles’s schedule, help him find schools and classes to develop his skills and invest in his future. Objectives1 step – Starting by taking small, achievable steps, the first goal is to control Charles’s anxiety about revisiting the academic world; by empowering his strengths and practicing emotional regulation;2 step – As Charles masters his emotional regulation techniques and mindfulness, the focus will be on which of his vocational results he feels more passionate about, and explore the possibility of learning more about that specific subject; 3 step – Explore deeper his interests and encourage participation in group activities.InterventionsTo help Charles attain the best results while empowering him to succeed, the SMART technique on interventions is being available to him: Specific, Measurable, Attainable, Realistic, and Timely, according to the following recommendations:1- Just by mentioning the word classes, Charles was inundated by anxiety and fear of not performing well in school; therefore, the first step is to refer him to see the clinic’s Psychiatrists for an evaluation and determine if Charles will benefit from psychotropics.2- Charles is expected to meet the mental health professional weekly to work on strategic interventions to help manage areas of concern. The weekly visits will be a combination of Individual and family therapy modalities, where Family Therapy, Cognitive Behavioral Therapy, Solution-Focus Therapy, Dialectical Behavioral Therapy, and Psychodynamic Therapy will prepare the client to achieve his goals successfully. Integrating and applying these modalities and tools in Charles’s therapy would be carefully orchestrated according to his needs.3- Empower the client to schedule a meeting with an academic advisor and employment specialist for assistance in future-planning; while making good use of his identified strengths according to the StrengthsFinder Assessment, more specifically in the artistic department, perhaps Charles greatest needs is some sort of incentive to develop and flourish in this area. 4- Combine Charles’s social interests, physical activities, and community engagement by starting to explore the family membership at the YWCA, this could be a great start for Charles to get involved in community events and classes; this will help him improve self-esteem. 5- Encourage Charles to consider joining support groups, perhaps this support network could be of tremendous help.
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