When looking at any human behavior, it is critically important to take into account the contextual factors around that person. This is a key element in assessing and addressing symptoms that arise in children and adults alike. I

critique the following discussion

When looking at any human behavior, it is critically important to take into account the contextual factors around that person. This is a key element in assessing and addressing symptoms that arise in children and adults alike. I see diagnoses as a big puzzle I must put together using all the pieces available to me before I can see the bigger picture (i.e., the diagnosis). By doing it this way, I am careful to acknowledge the many components of the issue and the many facets of the person. I can then think critically about what is happening and better understand how to proceed. This is the alternate way I believe mental health providers must assess clients and render diagnoses and treatment plans. This holistic approach of learning about the client's physical health, mental health, cultural factors, and contextual factors aids in ensuring nothing is overlooked or dismissed that could be a significant contributing factor to the presenting issues.

This becomes a crucial piece to the puzzle in cases of Oppositional Defiant Disorder and Disruptive Mood Dysregulation Disorder. As Adler suggests, we must look at the structures around the person as we aim to understand them. Parenting practices, parental identities, and home life play a huge role in these types of disorders and, therefore, need to be assessed as well. If a child displays these symptoms, I would look at home life and what is happening and not happening. This is not in a judgmental way, just in a curious puzzle piece-finding way. Externalizing behaviors can stem from unresolved internalized conflicts caused by external factors, thus inducing a harmful and destructive cycle.

I would look at the social bonding theory in relation to the case. I would look for how the child's emotions are being listened to, heard, and addressed. I would want to know how the child's success, no matter how small, is being celebrated. And how the achievements of others are being observed and acknowledged. All these can dramatically affect the child's self-esteem, emotion regulation, and self-regard. As an example, let us say the child's emotions are not being heard or tended to. The child does not feel validation in their feelings and is, in turn, not taught how to express emotions productively. They may experience lower self-esteem and resort to more aggressive behavior to be heard. Similarly, if their accomplishments are not being recognized, this could lead to low self-esteem. Conversely, suppose everything they do is acknowledged and celebrated, and they are not taught to share in the glory of others' successes. In that case, they can overcorrect and lean more toward narcissistic symptoms.

Of course, a balance needs to be mentioned here. And this can be the hardest part. How do we celebrate the child and not over-celebrate them? Teaching positive regard for self and others can come into play here. Learning that all humans, including ourselves, are valuable and important can help teach children how to treat themselves and extend that compassion to others. This teamwork approach includes the counselor assisting the parents in helping the child. This can come in the form of providing resources and positive parent training, providing individual and family counseling, offering psychoeducation, and teaching strength-based approaches. By working together in this way, I believe we can understand the externalizing factors leading to negative symptoms and outcomes and work from there to best support the positive growth, goals, and character development of the individual and the family unit.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders - 5- TRLinks to an external site. (5th ed.). Author.

Donnellan, M. B., Trzesniewski, K. H., Robins, R. W., Moffitt, T. E., & Caspi, A. (2005). Low self-esteem is related to aggression, antisocial behavior, and delinquencyLinks to an external site.. Psychological Science, 16(4), 328-335.