SOCW6090 Week 4 Discussion: Applying Differential Diagnosis

SOCW6090 Week 4 Discussion: Applying Differential Diagnosis

SOCW6090 Week 4 Discussion: Applying Differential Diagnosis

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

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.

Required Readings

First, M. B. (2014). Handbook of differential diagnosis. Washington, DC: American Psychiatric Association

Note: You will access this e-book from the Walden Library databases.

• Chapter 1, “Differential Diagnosis Step by Step” (pp. 14–24)

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.

• Part 1, “The Basics of Diagnosis” (pp. 3–56)

American Psychiatric Association. (2013). Disruptive, impulse-control, and conduct disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm15

American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01

American Psychiatric Association. (2013m). Other conditions that 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

Walsh, J. (2016). The utility of the DSM-5 Z-codes for clinical social work diagnosis. Journal of Human Behavior in the Social Environment, 26(2), 149–153. doi:10.1080/10911359.2015.1052913

CASE PRESENTATION – FABIOLA

INTAKE DATE: September 2021

IDENTIFYING/DEMOGRAPHIC DATA:  Fabiola is 15-year-old, Haitian-American female in tenth grade.  She lives with her parents and a younger brother who is 9-years-old in Phoenix, Arizona. Her parents immigrated to the United States 16 years ago.

CHIEF COMPLAINT/PRESENTING PROBLEM:  Fabiola’s parents are concerned about Fabiola’s schoolwork.  They believe her intellect level is higher than her grades indicate.  This has been consistent with Fabiola for years and her parents have been trying to deal with the school issues at home.  They are more concerned now since the grades have not increased and she is in high school and they want her to attend college.

HISTORY OF PRESENT ILLNESS:  Fabiola has struggled in school since the third grade.  She is now in serious academic trouble. After a psycho-educational evaluation at school, it was found that she has above-average intellectual ability.  From the third grade, Fabiola had more difficulty keeping up with assignments and completing her work each year. While she comprehends the material, she didn’t retain what she read. She appeared to understand lectures, but she couldn’t organize her thoughts well enough to write them down on paper.  “I just stare at the page and nothing comes out,” she said. Adding to these difficulties was the fact that she often forgot to write assignments down and “just couldn’t get organized”.

If she did at some time remember to write down her homework, she loses the paper she wrote it on.  Fabiola’s mom worries that she has failed Fabiola and thinks Fabiola is intentionally not remembering these tasks.

Fabiola has no behavioral challenges in school and has never been disciplined in anyway by the teachers or principal.  She is reported to be nice to others and does have several friends in her class.  Fabiola does bring home report cards that seemingly fail to reflect her intelligence.  Her work remains unfinished, and she seldom gives the correct answer when called on in class.

PAST PSYCHIATRIC HISTORY: 

Fabiola’s parents tried all kinds of culturally traditional ways to help their child focus on schoolwork.  When nothing changed, they chose to seek outside help.

SUBSTANCE USE HISTORY: 

Fabiola denies any use of drugs or alcohol.

PAST MEDICAL HISTORY: 

Fabiola has been fairly healthy throughout her life.  Any illness was remedied through her parents’ natural means and their religion.

FAMILY MEDICAL AND PSYCHIATRIC HISTORY: 

This is a Haitian family which adheres to the behaviors and parenting of their culture.  There is no reported psychiatric history in the family.  Any medical conditions were treated with herbal remedies or medicinal foods.

CURRENT FAMILY ISSUES AND DYNAMICS:  

Fabiola’s parents are from Haiti.  In the Haitian culture, Fabiola’s behaviors might be interpreted as indicating a poorly raised child whose behavior could be modified by parental discipline.  Her family suggested that these “unnatural” behaviors are attributed to bad spirits.  According to Haitian American tradition, the family often tried therapeutic foods, natural sedatives and purgatives from herbal medicine, and religious treatments to help alleviate these issues. 

The parents report running a strict Haitian household.  Both children are required to do household chores daily.  Fabiola’s parents get worried when Fabiola is assigned chores and she does forget sometimes, and they think she is worried about trying to please her parents and the failing school grades.  The parents are not comfortable bringing Fabiola in for an evaluation, but they were referred by the school system.

MENTAL STATUS EXAM: 

Fabiola presents as a casually dressed teenager who appears her stated age of 15. She is a bit anxious during the interview.  Her affect is appropriate but worries about disappointing her parents. Motor activity is appropriate. Speech is clear. At times during the interview, she lost her train of thought and had to be redirected to the subject. There is no evidence of delusions or hallucinations. Fabiola’s intelligence appears average. She is oriented to time, place, and person.

SOCW 6090 Week 4: Putting It All Together: Differential Diagnosis and Neurodevelopmental Disorders

Clinicians often have to employ multiple skills simultaneously while engaging with clients. Not least among them are reflective listening, information gathering and sensitive questioning, recording key responses, observing for signs of syndromes, and identifying the chief complaints. This week you address the complex process for identifying and distinguishing among similar diagnostic syndromes.

This process begins in the diagnostic interview. Research of skilled clinicians shows that forming diagnostic impressions too quickly increases the risk of errors in diagnosis. Every clinician should be evaluating differential diagnoses at the diagnostic interview and beyond. While social workers want to resolve their own uncertainty, using the formal steps of a decision tree ensures accuracy. A decision tree is especially important when all available data is not pointing in the same direction.

This week, you walk through the steps of a differential diagnostic decision tree using a case within the neurodevelopmental disorders. At the same time, you begin to meet with your colleague in case consultation about your individual case assignment.

Learning Objectives

Students will:

• Develop a DSM diagnosis utilizing a differential diagnostic process
• Analyze a case study focused on a neurodevelopmental disorder utilizing steps of differential diagnosis
• Assess progress with a colleague on a collaborative assignment
• Outline a plan to create a diagnosis

Learning Resources

Required Readings

First, M. B. (2014). Handbook of differential diagnosis. Washington, DC: American Psychiatric Association

Note: You will access this e-book from the Walden Library databases.
Chapter 1, “Differential Diagnosis Step by Step” (pp. 14–24)

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Part 1, “The Basics of Diagnosis” (pp. 3–56)

American Psychiatric Association. (2013f). Disruptive, impulse-control, and conduct disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm15

American Psychiatric Association. (2013k). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01

American Psychiatric Association. (2013m). Other conditions that 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

Walsh, J. (2016). The utility of the DSM-5 Z-codes for clinical social work diagnosis. Journal of Human Behavior in the Social Environment, 26(2), 149–153. doi:10.1080/10911359.2015.1052913

Blackboard. (2018). Collaborate Ultra help for moderators. Retrieved from https://help.blackboard.com/Collaborate/Ultra/Moderator

Note: Beginning this week, you use a feature in your online classroom called Collaborate Ultra. Your Instructor will assign you a partner and then give you moderator access to a Collaborate Ultra meeting room. This link provides an overview and help features for use in the moderator role.

Document: Case Collaboration Meeting Guidelines (Word document)

Note: Download these guidelines and consult the Assignment instructions. You are encouraged to orient yourself to these instructions and take action as early in the week as possible.

Document: How to Write a Diagnosis According to the DSM-5 (PDF)

Required Media

Laureate Education (Producer). (2018f). Steps in differential diagnosis [Video files]. Baltimore, MD: Author Retrieved from https://mym.cdn.laureate-media.com/2dett4d/Walden/SOCW/6090/04/DD/index.html.

Optional Resources

American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures

Coker, T. R., Elliott, M. N., Toomey, S. L., Schwebel, D. C., Cuccaro, P., Emery, S. T., … Schuster, M. A. (2017). Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics, 138(3), 1–11. Retrieved from http://pediatrics.aappublications.org/content/138/3/e20160407

Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: This is the same document introduced in Week 1.

Optional Media

University at Buffalo School of Social Work (Producer). (2017). Episode 221—Dr. Jennifer Cullen and Dr. Jolynn Haney: Understanding and treating autism in women: Using lived experiences to shape practice [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=221

Discussion: Applying Differential Diagnosis to Neurodevelopmental Disorders

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.

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.

By Day 6

Respond to at least two colleagues in the following ways:

• Compare the diagnosis you provided and the process in which you reached the diagnosis with those of your colleague.
• Explain how the Z codes (other conditions that may be a focus of clinical attention) that your colleague identified may influence the client’s upcoming treatment.

Response 1

 Amber Alanis Week 4 – DB – A. Alanis

I would diagnose Aponi with the following:

F91.3               Oppositional Defiant Disorder, Moderate

Z62.898           Child Affected by Parental Relationship Distress

Explain diagnosis/Match symptoms:

Aponi meets criteria A because she often loses temper, is easily annoyed, is often angry, often argues with authority figures and adults, blames others for her mistakes/behavior, and has been spiteful/vindictive. She is angry, irritable, argumentative, and defiant. Her behavior has been assessed and is occurring in more than one setting and across multiple relationships (home, school, friends). Aponi is also justifying her behavior because of the way others treat her. The DSM-5 also points out that children who have had multiple caregivers are more likely to struggle with ODD.

Identify 3 other considered diagnoses:

Conduct Disorder: I initially thought Aponi might have conduct disorder until I read in the differential diagnosis portion in DSM-5 that conduct disorder has a higher prevalence in aggression and destruction of property.

Antisocial Personality Disorder: although she does have some antisocial behavior, due to her age, she does not meet criteria for this diagnosis.

Disruptive Mood Dysregulation Disorder: although she does meet some of the criteria for this disorder, I feel that it is missing the other components mentioned above in the explanation for ODD diagnosis.

As mentioned above, I feel that ODD is the most appropriate diagnosis due to her defiance, anger, irritability, the fact that Aponi has had multiple caregivers her entire life, she is having frequent tantrums, is having these issues in the school setting and with peers, blames others for her issues (mother and brother), always wants her way, has a difficult time with peer relationships, and struggles to effectively communicate with others.

Reference:

American Psychiatric Association (2013f). Disruptive, impulse-control, and conduct disorders. In

Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association Publishing.

Response 2

 Naomie Pierre-Noel Week 4 Pierre-noel

Aponi is a 9-year old who has been displaying some challenging behavior’s such as irritability, negative, and defiant behaviors at school and home. The severity levels are mild, moderate, and severe as reported in the DSM-5. 

V61.29 (Z62.898) Child Affected by Parental Relationship Distress

• Argues with mom, cries, throws object.

V61.03 (Z63.5) Disruption of family by separation or Divorce 

• Parents separated at least two times, dad drinking, 

V62.3 (Z55.9) Academic or Educational Problem 

• Bullying others, serious academic trouble 

V61 (Z62.820) Parent-child relational problem

• Doesn’t help with chores argues with mother

Aponi presents with Oppositional Defiant Disorder, argues, refuses to comply with request from others, annoys others, bad temper, and angry. The client is very mean and bullies others in the school settings, and says her mother is picking on her, slams doors and throws objects in the home. The Z code: Parent-Child relational problems  the case study demonstrated issues between the two the client’s parents lacks efficient and adequate control over Aponi. Aponi doesn’t seem to have a relationship with her twin brother and believes brother gets more attention and frequently throws tantrums. 

Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

313.81 (F91.3) Oppositional Defiant Disorder

 Moderate 

312.81 (F91.1) Conduct Disorder

 Childhood-onset type 

 Moderate 

312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder

Aponi has a hard time following rules in the home she does not do any chores, is doing poorly in school, and throws tantrums in the home. 

Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.

The neurodevelopmental disorders are a group of conditions with onset in the developmental period (APA 2013). I would not change the diagnoses. 

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. 

The clients symptoms match most characteristics of oppositional Defiant Disorder . Aponi continues to show difficulty in listening to her mother and does not do well in school. Aponi consistently believes her mom and others are picking on her and doesn’t see a major problem in her behavior. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: Author.

Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5. You do need to include an APA reference for any other resources you use to support your response.

Note: You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum. If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 4 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 4 Discussion

Assignment: Case Collaboration Meeting

Collaboration is a key part of social work practice. Most MSW professionals engage in these processes during the postgraduate practice years that each state requires before their licensing moves from supervised to independent status. Even beyond those requirements, peer consultation and collaboration are key aspects of most social work practice settings.

For this Assignment, Imagine that you are working with the client featured in the case study your Instructor assigned. Your task is to provide a diagnosis and present your findings in the Week 7 Discussion.

Your diagnosis can come from any part of the DSM-5, so frequent communication and research with your colleague may be needed. 

The collaboration that begins in this Assignment is intended to provide a safe venue for developing your differential diagnosis and case discussion skills with your colleague. This week you meet with your assigned partner at least once via Collaborate Ultra and begin considering the assigned case. In this Assignment, you describe that meeting and any initial analysis of the case.

To prepare:

• Using the case study provided to you by your instructor.
• Consult the Case Collaboration Meeting Guidelines document found in the Learning Resources.
• Read ahead to the Week 7 Discussion instructions so that you can plan and reflect accordingly.

Note: In the Week 7 Discussion, you make your final findings presentation as an individual, not with your partner.

By Day 7

Submit a 1- to 2-page paper in which you describe your team meeting. In your write-up, make sure to address the following:

• Describe the quality of your working relationship with your colleague.
  • Critically reflect on strengths of collaborative relationship and areas for improvement.
• Describe your case in 100–150 words.
• Identify the red flags in your case study to be further evaluated.
• Outline your and your partner’s plan for further research and consultation, identifying specific tasks that you are each doing in this regard.
  • Identify days/times you have agreed to meet together, including the date planned to complete the CFI interview required for the Week 5 Assignment.

CASE OF IVANDER

Intake Date: February 2020

IDENTIFYING/DEMOGRAPHIC DATA: Ivander is a 19-year-old, biracial male who was raised in Hugo, Oklahoma. Ivander’s mom is Caucasian and his father is African American. Ivander is the only child from his parents union. Ivander is in his first year at college and lives on campus.

CHIEF COMPLAINT/PRESENTING PROBLEM: Ivander presented in the emergency room (ER) having been brought in by his mother and a friend. Ivander indicated that he was having a strange experience – “I go into another world. I can hear people talking, but I can’t talk back. I can no longer trust my roommate – he is taking my food and hiding it”

HISTORY OF PRESENT ILLNESS: Ivander reports beginning to feel strange one month after he started school in August. He reports hearing voices outside his window in the dorm. It was an angel’s voice calling his name. That is when he realized he cannot trust his roommate. He realized the roommate would put TV shows on that were referencing how Ivander was doing in his classes. His school papers were all over his room and he could not organize them the way he wants. At times, the fireflies outside told him not to trust his roommate.

In high school, Ivander socialized with his classmates and was engaged in leisure activities. He went to the senior prom and enjoyed the summer prior to college. Since coming to college, Ivander’s roommate reports Ivander was socially withdrawn.

PAST PSYCHIATRIC HISTORY: Ivander’s mom does not report any psychiatric issues with Ivander in the past. His behavior was a typical teenage behavior, video games, dressing unusual, thinking in a way that differs from his parents beliefs.

SUBSTANCE USE HISTORY: Ivander denies consumption of alcohol or illicit drugs. He denies ever using illicit drugs that were not prescribed to him. Ivander reports now that he thinks about it he is glad he never used drugs since drug dealers will kill their clients.

PAST MEDICAL HISTORY: Mother reports Ivander broke his arm at 7 years old. The arm healed successfully. Ivander had all his childhood shots, but she does recall her fear of his health early on when Ivander was 2 ½ weeks old he came down with a spring cold.

FAMILY MEDICAL AND PSYCHIATRIC HISTORY: There was no significant information about the family history.

CURRENT FAMILY ISSUES AND DYNAMICS: Ivander was incoherent during most of the interview. He was able to indicate some history that was inconsistent with history taken from his mother. Mother indicated that Ivander was picked up several times within the past two months by campus police for “talking in public”.

MENTAL STATUS EXAM: Ivander presented as a casually dressed, unwashed young man. He has a fluctuating mood and an anxious expression on his face. Motor activity appeared agitated. Mood was anxious alternating with hostility and depression. Speech was pressured at times and inappropriately loud. His affect was inappropriate and at times blunted. Ivander’s thought processes were at times incoherent and at times displayed a marked loosening of associations. He also reported bizarre delusions and auditory hallucinations. Ivander’s wishes for 5 years from now were unobtainable. Ivander is oriented to time, place, and person. He was able to state the season. Ivander can name 3 different objects correctly (bed, apple, shoe). He needed to calculate 100 – 3 five times.

SUICIDAL/HOMICIDAL ASSESSMENT: Unable to ascertain.