This week at clinical, Jodi and I were able to sit in on several admitting and psychiatric sessions for a young boy who was being dropped off by his mother this past week. He has a history of manipulative behaviors, violence, aggression, and deviant behavior. In the time that we were able to interact with this patient, we saw at least three different personalities. In the admission process, we observed this child who was very hyperactive and did not respond to his mother whenever she spoke to him. He latched himself to Jodi during the assessment process whilst his mother was talking with Nurse Bachman. He untied Jodi and my shoelaces, retied them, and very tightly double-knotted them. After that, he acted like he was tired and fixated himself between Jodi’s leg and the arm of the chair. Nurse Bachman stated something about needing to teach this patient about boundaries and how that many of the boys would not appreciate this clingy behavior. When with the group of boys waiting in line for lunch, the boy was interacting with the mental health associate from Texas State and giving her, what seemed to me, as major attitude and not wanting to answer her questions or ignoring her altogether. He seemed to fit in pretty well with the boys once his mother was not with him. Later that afternoon, we were able to see his physical assessment and psychiatric assessment in the clinic. I was extremely upset that the NP student had performed the assessment as they were walking together to the clinic. I really would have liked to have seen this interaction between the two.
It was definitely interesting to see the different personalities of this young boy. In my mind, it was easy to see how manipulative he could be and that if he didn’t have any structure in his life, it could cause problems. I don’t think that I reacted in any way to his behaviors but I tried to maintain a straight face or a non-judgmental face during the initial assessment or psychiatric assessment. I learned that the health assessment done by the nurse practitioner in the clinic is a fairly simple assessment: basic height and weight, hearing, vision, allergies, etc. She even explained to Jodi and I that if a child has had a total assessment in the last 45 days, they only receive a focused overall assessment. She even gave us two assessment handouts to look out while her and the student NP did each of the assessments. The saying goes to never judge a book by its cover, and that definitely applied to this young boy….he appeared one way and a second later, he expressed himself in another.
When looking back and thinking about what was read in the chart, it said that this boy’s brother was diagnosed with BP disorder and aggression, his father has ADHD, and that his mother is not very good about setting firm boundaries and limitations. He was also born as a premature baby. I really think that these problems have accounted for why this young boy has reacted in such a negative way. He does not have much structure and any type of constructive consequence initiated an explosive response such as punching his mother in the face, and not coming out of the nearby lake when police asked him to, which in turn required the fire department to rescue him.
The knowledge that I gained from this last experience will help me to not judge these children before learning their whole story. These children can put on a show which can make you feel sorry for them, but they are in San Marcos for a reason…to get help and learn to cope better. Hopefully this young boy can learn to manage his anger through therapeutic coping skills.