Brief Psychotherapy with the Latino Immigrant Client by De Rios Marlene D.;

Author:De Rios, Marlene D.; [de Rios, Marlene D.]
Language: eng
Format: epub
Publisher: Taylor & Francis Group
Published: 2001-08-15T00:00:00+00:00

Attention Deficit Disorders With Hyperactivity

Nationally, it is estimated that one in six children in the United States suffers from attention deficit disorder with hyperactivity. Since the working poor have little money for preschools for their children and often leave their youngsters in the care of relatives, three-, four-, and five-year-old children who suffer this disorder often are not evaluated by professionals until they enter kindergarten or first grade. For the family involved, however, these children can be a real problem and cause them a good deal of concern. Once a managed care contract is in hand, the Latino family rarely hesitates to bring in such a child for counseling.

For purposes of assessment, I have found that the Hawthorne Scales in Spanish are very useful (McCarney, 1994). The psychotherapist can sit with either or both parents to determine if the child merits a diagnosis of ADHD. Although managed care companies generally do not authorize testing, the scales only take about ten to fifteen minutes to administer, and since the psychotherapist is interactive with the parents, a case can be made that this, in itself, is a therapeutic experience. Once analyzed (taking up another few minutes at most), the psychotherapist can call or write the child's pediatrician or family doctor to discuss results and request a medication evaluation. McCarney and Bauer's (1994) volume that accompanies the scales can be kept handy in the office. For each area of concern—inattention, impulsivity, and hyperactivity—there are very straightforward and direct instructions (in English, unfortunately), for detailed behavior modification techniques that family members can utilize on a daily basis to ensure that the child learns to control these traits.

In many cases, the scales enable the psychotherapist to rule out ADHD and in its place to uncover power struggles between the parents, who use the child as a scapegoat or designated patient. David is a good example of this. A bright seven-year-old, David was brought in by his bickering parents due to his difficulties in school, particularly with learning the alphabet and acquiring writing skills. What emerged was that the child had a learning disability, although his father was so angry at his wife that he refused to seek help for the child and only accompanied the family to therapy because of his wife's nagging. Fortunately, the school was willing to test the child and provide the necessary resources to deal with his learning problem. As might be expected, this youngster was able to play one parent against the other, which added to the delay to diagnose and treat his problem.

Another clinical issue that mirrors ADHD is the treatment of the child who is consentido, or excessively spoiled by the parents. Such a child often misbehaves, and teachers are not likely to tolerate misbehavior in their classrooms as do the child's parents at home. Sometimes hyperactivity, inattention, or impulsivity traits may be reported by the teacher. Dulcina was a fifty-one-year-old mother of a nineyear-old child, Ruben, who was disruptive in school. After evaluating the child and interviewing

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