Identify internalizing symptoms and determine which DSM disorder(s) is most fitting Identify any other symptoms that could represent a comorbid disorder Describe the risk and protective factors in the case study likely involved in the cause and maintenance of these symptoms Based on the 1-3, develop a treatment plan for this child. Be sure to include what the best evidence-based treatment is as well as any critical targets of therapy for this child and their family. Criteria for Success: Correctly identifying all key symptoms and picking the most likely internalizing disorder Correctly identifying symptoms of potential comorbid disorders Correctly identifying key risk and protective factors that include at least one child, family, and physiological factor Correctly pick the matching evidence-based treatment(s) Answers can be in list or paragraph form for 1-4 but must clearly be labeled Internalizing Case Study Presenting Problem: Maryssa, a 15-year-old girl, was referred to the clinic by her school guidance counselor for anxious symptoms. According to her guidance counselor, Maryssa has been isolating herself from her friends and coming into school late multiple times a week. Maryssa has been visiting the nurse during the school day, complaining of frequent headaches and an upset stomach. Maryssa’s parents work long hours and have not noticed any changes at home but cannot remember the last time Maryssa went out with friends on the weekend. Maryssa was a ballet dancer for most of her childhood and recently stopped going to dance class. She reports feeling lonely but has resisted attempts by her guidance counselor to connect her with other students, saying that she will probably just say something “stupid” and that she “wouldn’t be able to take it if they started laughing at her.” Her guidance counselor said this started early in the school year and seems to be getting worse as the summer approaches. Developmental History: Maryssa’s mother, Ms. Ferraro, reports that Maryssa was born on time without any complications. She met her developmental milestones on-time and was an early talker. Both her parents say that she was an engaged, social child who loved to put on dance shows for the two of them. They are not sure when Maryssa started limiting her social engagements, but they do not believe she is bothered by this. They describe Maryssa as a smart, beautiful, functional teenager who has a lot of potential. Family History: Ms. Ferraro, age 50, works long hours at the district attorney’s office and sometimes puts in extra time on the weekends. Ms. Ferraro likes her work but describes herself as a “worrywart who has trouble leaving the job when [she] goes home.” Mr. Ferraro, age 54, works at the local bank and has more standard hours, although he also reports high levels of stress resulting from his job. The two have been married for twenty years and frequently fight, which they both attribute to their high-stress levels. Social & Educational History: Maryssa has never been held back or received special services at school. She is in the National Honor Society and used to tutor children at the local middle school. Maryssa stopped attending National Honor Society meetings and ended tutoring as well, at first calling in sick and then just not showing up.
