David, Simon and Adam Case Study

David, a 50-year-old Latino man and Simon, a 32-year-old Japanese American man present with concerns about their 6-year-old son Adam. Both David and Simon self-identify as cisgender, gay men. The couple has been together for 10-years. Adam is Simon’s biological son conceived through a surrogate.
David was raised by his mother along with his 4 younger siblings. He describes his father as an abusive, volatile alcoholic who he has not seen since he was 8-years-old. David admits to being the target of severe physical abuse by his father as he would try to protect his younger brothers and sisters from his father’s wrath.
Simon describes his upbringing as ‘traditional’, where he was the only child. He describes his father as a hard worker who took care of his family’s needs, but had difficulty showing or expressing emotions. He describes his mother as loving, yet overly reliant on Simon to meet her own emotional needs.
Little is known about Adam’s surrogate mom, though there is suspicion that the mother was a drug user. David believes she agreed to be their surrogate “for the money” so that she could continue her mal-adaptive lifestyle.
David and Simon are present for the first session where they focus their concern on Adam. They describe their son as being a happy, loving and affectionate child the first 4 years of his life. Once he started pre-school, his mood and behavior began to change. He became sullen, withdrawn, would have temper tantrums, would break his toys or throw them across the room. He refuses to eat what he doesn’t like and throws his food on the floor in a rage. Adam has also been acting out in his first-grade class, and has had to be removed several times for hitting his classmates. Simon reports that he often hears Adam sobbing in his room at night, goes in to comfort him, but that Adam refuses to talk to him.
When asked if anything has changed over the last few years in the household, both David and Simon look at each other with trepidation. Simon is the first to speak. He reports that 2 years ago, David lost his job and is now a ‘stay at home’ dad. Simon does express concern that since David is no longer working, he had become moody, short-tempered and irritated with Adam often. Simon has also found empty liquor bottles around the house. While he has never seen David physically hit Adam, Simon is concerned that David is becoming like his own father.
David denies that he drinks excessively, and that he is nothing like his father. He points to Simon as the problem due to his inability to set limits with Adam and that he is overly indulgent and ‘rescues him’ whenever there is tension in the home. David feels that Simon is overcompensating for his own childhood and that he needs to toughen up and partner with him in parenting.
Second Session
In the second session, David, Simon and Adam are present. Initially, Adam appears rigid and sullen, but after a few minutes, he begins to explore your office, running about, picking up random items and asking you questions rapidly. He does not appear to acknowledge your responses and continues a barrage of questions. David tells him to sit down and be quiet at which point Simon picks Adam up and sits him on his lap. At that point, the couple begins to reiterate what they told you in the first session. David’s voice escalates and Simon holds Adam closer to him. Adam closes his eyes and appears to be asleep.
You notice a few bruises on Adams arm. When you ask about them, David tells you that Adam is clumsy and doesn’t watch where he is going, similar to how Adam just acted in your office. Simon says nothing. Adam continues to appear asleep. You also smell alcohol on David’s breathe.
Directions: Complete each section in the page allotment indicated.
Discuss your immediate legal and ethical concerns in this case. Support these concerns by discussing what you see or suspect. What are your professional obligations and how would you manage the legal and ethical issues you identified?
[1–2 pages]

Formulate a provisional diagnosis for Adam only using the DSM-5 criteria to support your provisional diagnosis. Consider what you see in the vignette as well as what you don’t see but would need to explore to solidify your diagnostic impressions for Adam. [2 pages]

Create a brief treatment plan for Adam, using 1- model of individual therapy (identify the model) and 1-model of family therapy (identify the model) that shows evidence-based intervention specific to what we see in the case as presented. Given factors relevant to culture, diversity and backgrounds of David and Simon, what might you need to consider in your treatment plan and why? What factors relevant to Adam’s birth might you need to consider?
[2-3 pages]