Read the case provided by your instructor for this weeks Discussion and identify relevant symptoms and factors. You may want to m
- Read the case provided by your instructor for this week’s Discussion and identify relevant symptoms and factors. You may want to make a simple list of the symptoms and facts of the case to help you focus on patterns.
- Read the Morrison (2014) selection. Focus on Figure 1.1, “The Roadmap for Diagnosis,” to guide your decision making.
Provide a full DSM-5 diagnosis of the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months
With the information provided, Emmanual is diagnosed with intellectual disability, ICD-11, an intellectual developmental disorder. This information about Emmanual is as recent as of September 2019. The specifiers in Emmanual’s case include problem-solving abilities, academic level, learning, communication, and attentive abilities. With the multiple levels of severity, they are defined based on adaptive functioning and not through IQ scores because adaptive functioning determines the level of support that is required (American Psychiatric Association., 2013j). The severity of Emmanual’s case is moderate (318.0 (F71)). The Z Code in relation to Emmanual’s case is a parent-child relational problem (Z62.820). Parent-child relational problems are used to test the quality of the parent-child relationship and when it is affecting the course, prognosis, or treatment of the mental or medical disorder (American Psychiatric Association., 2013l). Emmanual’s parents used their own treatment for his conditions by using natural and cultural treatments. This prolonged his condition and was not getting the appropriate treatment. It is important to note that this was done based on religion.
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis
Emmanual displays challenges with his schoolwork, such as direct guidance needed, not retaining information, and challenges with his grades. Additionally, he experiences social cues from his peers, struggles with friendships, behavioral challenges, and lacks of communication skills. Emmanual’s diagnosis matches that on a moderate level. Moderate intellectual disability symptoms include an individual’s conceptual skills lagging behind those of peers, differences in social and communicative behaviors, social cue differences, an extended period of teaching and time is needed for the individual, and friendships affected by communication or social limitations (American Psychiatric Association., 2013).
Identify which four diagnoses you initially considered in the case of the client, using the DSM-5 diagnostic criteria to explain why you selected these four items. In one or two sentences each, explain why three of these diagnoses were excluded.
When diagnosing Emmanual, the four diagnoses I considered for his condition included specific learning disorder, autism spectrum disorder, communication disorder, and intellectual disability. I considered a specific learning disorder for Emmanual because of his inability to process information efficiently. Specific learning disorder was excluded because it implies select deficits in an individual’s inability to process information. Autism spectrum disorder was considered because of the deficits in social communication and social interaction across multiple contexts (American Psychiatric Association., 2013j). Additionally, with the autism spectrum, there are deficits in understanding relationships, nonverbal communicative behaviors within social interaction (American Psychiatric Association., 2013j). Autism spectrum was excluded because Emmanual did not display restricted or repetitive patterns of behaviors and did not have additional specifiers that matched this diagnosis. Lastly, communication disorder was considered because of his communication disorder. Communication disorder was excluded because Emmanual was not experiencing specifically a speech sound disorder such as stuttering and disturbances in speech.
Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.
An obvious elimination within the neurodevelopmental spectrum includes ADHD. ADHD is defined as disorganization and or hyperactivity-impulsivity behavior (American Psychiatric Association., 2013j). Emmanual did not present with this diagnosis.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the primary disorder that you finally selected for him. Note two other relevant DSM-5 criteria for that illness from the sections on “diagnostic features” and “development and course” that fit this case.
Emmanual’s symptoms match up to intellectual disability due to his relationship with peers and behavior in school. Emmanual’s parents choose to treat him at home with culturally traditional ways such as religious treatments, natural and herbal medicines. With this type of treatment he has received in the home, his behavior has now reached the classroom itself. Emmanual struggles with his grades, school work, instructions, inability to retain information, behavior differences, and relationships with peers. Emmanual shows signs of intellectual disabilities. Also, Emmanual may be facing a parent-child relational problem (Z62.820). This is due to cultural treatments and his family’s belief that his condition is attributed to bad spirits. Due to this, he has experienced an increase in his conditions.
References
American Psychiatric Association. (2013j). Neurodevelopmental disorder. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01
American Psychiatric Association. (2013l). Other conditions may be a focus of clinical attention. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.VandZcodes
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CASE of ALIM
Intake Date: August 2020
IDENTIFYING/DEMOGRAPHIC DATA: Alim is a 12-year-old male in 7th
grade who lives with his mother, father and brought in for services by
his adoptive mother. The adoptive parents are upper middle class and have three
biological children (ages 9, 7, and 5).
CHIEF COMPLAINT/PRESENTING PROBLEM: The mother reported that
Alim often hides food in his room and gorges himself when he eats. She said she
does not understand this behavior because he always has enough food, and she
never restricts his eating. In fact, because of his small size and weight, she often
encourages him to eat more. Alim sometimes reacts when his lunch is packed
differently within his lunch box for school. He also seems to pay less attention to
teachers and often interrupts class with his own comments.
HISTORY OF PRESENT ILLNESS: Alim acts younger than his 12
years, carrying around toy cars in his pockets, which he proudly displays and talks
about in detail. Aim’s mom reports that Alim hates any type of transition and will
get upset and have temper tantrums if she does not prepare him for any changes in
plans. He is reported to kick and hit both parents, and they have had to restrain him
at times to stop him from hurting himself and others.
The parents have never sought help before, as Alim managed to largely keep up
with his schoolwork. His mother said that he has always taken things literally, but
up until 6th grade, he had attended school without major problems. They had not
been concerned about his grades or lack of friends. His mother said that he has
always been “very shy” and never had a “best friend.” He has always
shown interest in cars, trains, and trucks. Recently, behaviors at school changed
and worsened. His school has complained of his inability to focus and the increase
in his disruptive behaviors.
Collateral contact with his teachers confirmed that he struggles with school, has
no friends, and often has “meltdowns” when he does not get his way. One teacher
noted that in small group classroom activities, Alim has trouble with restlessness
and will stumble over his words, pause excessively, and restart talking fairly
rapidly and loudly. In 6th grade his teachers were concerned about occasional
facial “tics” that occurred at times. His teachers commented that Alim talks more
about World War II topics than any other topic.
PAST PSYCHIATRIC HISTORY: Alim had never had any testing for special
education, nor had he ever received any counseling services.
SUBSTANCE USE HISTORY: No substance use is reported.
PAST MEDICAL HISTORY: Alim is very small in stature, appearing to be only
8 years old. His parents report that Alim was given all the vaccines required to
attend school.
FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC: Alim
was adopted at age 3½ from an orphanage in Haiti. The orphanage knows little
about his early developmental milestones, but Haitian staff noted that Alim’s
language was far less developed than that of his peers at the time of his adoption.
The mother stated that Alim came to the United States not knowing any English.
She knows very little about his family of origin other than that he lived with
his biological parents until age 2 and then lived in the orphanage until he was
adopted. She reported that the plane ride from Haiti was horrible and that
Alim cried the entire flight and refused to sleep for the first 2 days they had him.
They tried holding him, but he would not quiet down.
CURRENT FAMILY ISSUES AND DYNAMICS: Alim is reported to often get
upset with his siblings and hit or kick them. His mother stated that Alim has
always had issues with jealousy, and when her other children were younger, she
had to closely monitor him when he was around them. She reported several
occasions when she found Alim attempting to suffocate each of his younger
siblings when they were babies. Alim’s mother explained this as part of his
“always being immature” and not good at explaining himself. Besides this, his
mother reported that he is not a “mean” child but tends to function according to his
own rules. He often needed reminders to use his “indoor voice” and to “wait his
turn to speak.”
Initially Alim’s parents were unsure what to do about their son’s behaviors. His
mother is the primary caretaker and his father thought she should handle any
therapy or problems related to school. His mother reported that she was now “at
the end of her rope” and was ready to give her son up to foster care. Both parents
are exhausted. Alim’s mother shared her frustration with Alim’s father, who “just
does not understand how hard it is to care for him.”
MENTAL STATUS EXAM: During this intake, the school social worker met
briefly with Alim alone. During this time, he was clearly restless, appeared
anxious, and avoided her in the room. He was very slow to engage with her
and was distracted by his pocket toys, which he fingered. He had pressured speech
and some facial tics and was unable to keep his legs still during the
interview. When he did engage, he chose to play a board game during his time in
the session and he talked in detail about World War II and each of the boats in the
game. His hand was in his pocket fingering toys at some moments. When asked
how he knew so much about all the warships, he stated that he often watched
television documentaries on the subject. Once on this topic he took less time to
respond and spoke at length. Alim appeared oriented to time and place. His voice
in this interview was somewhat monotonic and repetitive of his interests. He was
generally cooperative, and the interview passed without incident although it was
obvious that he was eager to be “dismissed” from the meeting.
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Social work clinicians keep a wide focus on several potential syndromes, analyzing patterns of symptoms, risks, and environmental factors. Narrowing down from that wider focus happens naturally as they match the individual symptoms, behaviors, and risk factors against criteria A–E and other baseline information in the DSM-5.
Over time, as you continue your social work education, this process will become more automatic and integrated. In this Discussion, you practice differential diagnosis by examining a case that falls on the neurodevelopmental spectrum and/or within Disruptive, Impulse-Control, and Conduct Disorders.
To prepare:
· Read the case provided by your instructor for this week’s Discussion and identify relevant symptoms and factors. You may want to make a simple list of the symptoms and facts of the case to help you focus on patterns.
· Read the Morrison (2014) selection. Focus on Figure 1.1, “The Roadmap for Diagnosis,” to guide your decision making.
· Identify four clinical diagnoses relevant to the client that you will consider as part of narrowing down your choices. Be prepared to explain in a concise statement why you ruled three of them out.
· Confirm whether any codes have changed by checking this website: American Psychiatric Association. (2017, October 1). Changes to ICD-10-CM codes for DSM-5 diagnoses. Washington, DC: Author. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5/coding-updates
By Day 3
Post a 300- to 500-word response in which you address the following:
· Provide a full DSM-5 diagnosis of the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
· Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
· Identify which four diagnoses you initially considered in the case of the client, using the DSM-5 diagnostic criteria to explain why you selected these four items. In one or two sentences each, explain why three of these diagnoses were excluded.
· Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.
· Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the primary disorder that you finally selected for him. Note two other relevant DSM-5 criteria for that illness from the sections on “diagnostic features” and “development and course” that fit this case.
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