Posted: May 23rd, 2023

Joshua is a 12 year old boy

Case Vignette—Joshua
Presenting Situation
Joshua is a 12 year old boy who attends Middle School as a 6th grader. Joshua has
been in placement with his grandmother for several months. His behavior has been on
the decline since his middle sibling was recently placed in the home with him. He was
strongly reactive to any signs that his sister was receiving more attention than he was.
He becomes easily angered, his moods shift from constricted to volatile, with frequent
angry outbursts, that carryover to and interfere with school. Joshua shows multiple
signs of arousal (e.g., difficulty sleeping, impaired concentration, edginess and
irritability). He was recently diagnosed with oppositional defiant disorder and ADHD
although he doesn’t yet have an IEP. In school, he is taking the following classes:
Remedial Reading, Math, 6th grade Science, Art, Social Studies and P.E. His favorite
class is Art and the Remedial Reading class is his least favorite. He is at least two
years behind in reading. When he is in a happy mood, Joshua is talkative and social
with his peers.
Joshua’s grandmother, who has her own history of childhood trauma, has become more
depressed and overwhelmed by his emotional outbursts and she has had difficulty
providing consistent caretaking to either of the children, including sending them to
school. She is reluctant to make contact with the school as it just adds one more
overwhelming responsibility to her life.
Trauma History
Joshua has been in the care of his Grandmother since he was 18 months old at which
time Child Protective Services removed him from his parents’ care due to neglect,
physical abuse and parental substance abuse. When initially interviewed by CPS the
mother acknowledged that she was under tremendous stress due to an often violent
relationship with her husband. She admitted that caring for Joshua was difficult because
he was often irritable and rejecting of her attempts to console him. At other times, he
was very restless and clingy toward the mother, especially when the father was present.
She also said Joshua was “slow to develop.” The mother admitted that she and her
husband had a history of drug and alcohol abuse.
At age 5, an attempt to reunify Joshua with his parents failed when he was once again
removed from their care due to a report made by his Kindergarten of seeing bruises on
Joshua’s legs and arms. He was placed back in care with his grandmother and has
been with her since. His parents have separated and he only sees his mother at family
events and holidays. He has had no contact with his father since the second set of
allegations was substantiated when he was 5.

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It’s evident from the case vignette that Joshua has experienced significant trauma and has been exposed to adverse family circumstances throughout his life. His parents’ neglect, physical abuse, and substance abuse, as well as the violent relationship between them, have contributed to his unstable upbringing. Joshua’s mother reported difficulties in caring for him, describing him as irritable and rejecting, which may indicate attachment-related issues.

Following his removal from his parents’ care, Joshua has been placed with his grandmother. While his grandmother has taken on the responsibility of caring for him and his sibling, she also has a history of childhood trauma and is currently experiencing depression and feelings of overwhelm. This situation makes it challenging for her to provide consistent care and support for the children, including ensuring their regular school attendance.

Joshua has been diagnosed with oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). These diagnoses suggest that he may have difficulty regulating his emotions, impulses, and attention, which could further impact his behavior and academic performance. It’s worth noting that Joshua doesn’t have an Individualized Education Program (IEP) yet, which means he may not be receiving the specific educational support and accommodations he needs to address his learning challenges.

In terms of Joshua’s academic progress, he is significantly behind in reading, being at least two years below grade level. This reading delay could be contributing to his frustration and dislike for the Remedial Reading class, which may further affect his motivation and engagement in school. However, Joshua seems to enjoy his Art class and demonstrates social skills and talkativeness when he’s in a happy mood.

Considering the context of Joshua’s trauma history, emotional and behavioral difficulties, and academic challenges, it’s crucial to provide comprehensive support and interventions for him. This support should address his emotional well-being, social skills, academic needs, and any potential learning disabilities. Collaborating with his grandmother, mental health professionals, and school personnel can help develop a holistic plan to meet Joshua’s needs and ensure his overall growth and development.

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