Differential Diagnosis and Neurodevelopmental Disorders

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

 

 

 

Respond to 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.

 

 

Colleague: King of Zandro 

Week 4

COLLAPSE

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

The diagnosis that best describes Junior’s symptoms identified in  his case is Delusional Disorder 297.1 (F22). Red flags to explain for this diagnosis include his delusions that he is being plotted against, his anxious and suspiciousness of others, along with the notion that the mental health aides were FBI agents observing him. A Specifier for this is the persecutory type, as Junior is under the impression that someone is out to get him during mention of his delusions. In addition to this specifier is met with bizarre content that is evidence of what he describes as “bad habits” (banging up against refrigerator, checking under furniture each evening for dust, counting can foods in cabinets to ensure there is always a even number). Although severity of his symptoms have not been assessed due to the need of an assessment measure, I would infer that that severity is present but mild. Z-codes that should be considered as it relates to Junior’s case include, Z62.8, Z63.4, Z56.6, Z63.7.

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.

Delusional disorder criteria states that one (or more) delusions with a duration of 1 month or longer must be present. Apart from this functioning is not markedly impaired, manic and major depressive depressive episodes have occurred. The disturbances is not attributed to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder (American Psychiatric Association, 2013). Prior diagnosis I initially considered were Obsessive-compulsive disorder, brief psychotic disorder, and schizophrenia disorder. I selected these for because they displayed some form of delusion or bizarre behavior as outlined in Juniors case. I ruled out OCD due to Juniors ability to still function despite the episodes he had a home. Following, I ruled out brief psychotic disorder due his symptoms lasting for more than a month. Lastly, Schizophrenia was also ruled out because it did not affect Junior’s ability to carry out his daily functions such as work.

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

Obvious eliminations that could be made from with the neurodevelopment spectrum in regards to Junior, is limitations on his learning, control of executive functions to global impairments of social skills or intelligence. This is evidence of his ability to partake in serial 7’s and all memory test. Juniors symptoms matched up with the diagnosis through carefully considering the symptoms that best aligned with the criteria for the diagnosis.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Colleague: Keyonte Willson 

Wk 4 Discussion

COLLAPSE

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Provide a full DSM-5 diagnosis of the client.

 

In the case of Juan  the client has the following diagnosis:

F91.3 Oppositional Defiant DIsorder,Moderate, temperamental

 

Oppositional Defiant disorder has an essential frequent and persistent pattern of angry/irritable mood,argumentative/defiant behavior with symptoms that are confined to one setting typically being the home.  Juan’s behavior meets the diagnostic criteria with the time frame of 6 month longevity, angry irritable mood where he often loses his temper, easily annoyed and often argues with adults. Juan had to be watched closely when around his siblings so that he would not fight with them.He was also having difficulty waiting for others to speak and would often speak loudly in addition to his struggles in school.

 

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.

 

Four diagnosis that I initially identified with this client were:

F80.89 Social ( Pragmatic ) Communication Disorder

The criteria that matched this diagnosis to Juan’s behaviors were difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.

F91.1 Conduct disorder  Childhood onset type

The criteria that matched this diagnosis to Juan’s behavior  were that he often bullies, initiates physical fights.

F63.81 Intermittent Explosive Disorder

The criteria that matched this diagnosis to Juan’s behavior were three behavioral outbursts involving damage and or physical assault involving physical injury a

against animals or other individuals within a 12 month period.

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

 

The F80.89 diagnosis was  excluded because the time frame did not meet the criteria.

F91.1 Conduct disorder was excluded because Juan was not noted to destroy property.

F63.81 Intermittent Explosive Disorder was excluded because the magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of provocation or to any precipitating psychosocial stressors.

 

Obvious eliminations that can be made from the neurodevelopmental spectrum are that Juan has not shown any deficits  in personal independence, he did not show a delay in developmental milestones after age 2.  Juans symptoms of  temper tantrums, jealousy, fighting, trouble listening to rules, speaking loudly and  out of turn along with his inability to adaptation to transition and struggles in school, were aligned with the criteria of the specified diagnosis of Oppositional Defiant Disorder.

Diagnostic features of this diagnosis that also fit are a frequent and persistent pattern of angry/irritable mood, argumentative/defiant behavior and patterns of problematic interactions with others. The developmental and course criteria that fit this diagnosis and are relative to Juan’s behavior are the timing of the symptoms of oppositional defiant disorder usually appearing preschool and later in early adolescence and Juan is age 10. Oppositional defiant disorder also conveys risk for the development of anxiety  disorders and major depressive disorder.

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Colleague: AXEL Real- MCCOY 

Week 4 Discussion

COLLAPSE

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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.

Oppositional Defiant Disorder 313.81

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

Juan displays oppositional defiant disorder with a severity level of moderate. It states in the case study that Juan’s behavior increases when assuming his siblings are receiving more than he does. Juan’s behavior is also known in the classroom setting where he bullies others. Oppositional defiant disorder with moderate severity appears in at two settings (DSM-5). With conduct disorder, it is known that the symptoms occur with the client’s siblings. As stated by the DSM-5, “Given that the pervasiveness of symptoms is an indicator of the severity of the disorder, it is critical that the individual’s behavior be assessed across multiple settings and relationships.” Whether the individual is in the home 90% of the time, behaviors need to be assessed in social groups and public outings. There may be environmental factors that are associated with the symptoms of this disorder.

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.

I ruled out substance etiology on all disorder suspicions or findings. The case study did not mention that Juan was on any medication that may have been the cause of the behaviors that are presented in family and school settings. Oppositional defiant disorder was considered because of the behaviors that were associated with Juan. Such behaviors as agitation, temper tantrums and easily annoyed (DSM, 5th ed.). Juan does not express any argumentative behaviors. Conduct disorder has more expressive behaviors that harmfully effect people and animals. This also is seen to impact the social, physical and emotional behaviors of a client. “The behaviors of oppositional defiant disorder are typically of a less severe nature than those of conduct disorder and do not include aggression toward people or animals, destruction of property, etc” (DSM, 5th ed.). Although, Juan does not display disruptive behavior that are harsh to other living beings, Conduct disorder may be considered

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

Autism Spectrum Disorder normally have an array of symptoms that are obvious signs that are displayed across all aspects. Autism not only affects the mental capacity of an individual, but the social and communication function that increases in severity overtime. Autism is normally diagnosed in children at the age of 4. In working with children with Autism, there are other symptoms that may include ADHD, depression and/or bipolar disorder. There are intellectual disabilities that are associated with the disorders on the spectrum such as IDD, PDD, and Asperger’s. Asperger’s is the most severe form. Juan does not display any symptoms of maintaining eye contact, inability to focus or communicate with others that has progressed since the age of 2. Although, Juan shows some speech delays, but it is does coexist with other symptoms of Autism or ADHD.

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.

The client’s symptoms match up with the specific diagnostic criteria for the primary disorder that I selected was that Juan became jealous of his other siblings which may have been an onset of other behaviors stated in the study. Juan also expresses frequent temper tantrums when Juan is not primed. The client hates transition and becomes disruptive. Juan is unable to follow rules. There were signs of restlessness and easily agitated with hesitation to complete tasks.

References

American Psychiatric Association. (2013). Disruptive, Impulse-Control, and Conduct Disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. Author. Doi: 11.1176/appi.books.9780890425596.dsm15

American Psychiatric Association. (2013). Neurodevelopmental Disorders In Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA. Author. Doi: https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.1176/appi.books.9780890425596.dsm01

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