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.
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
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)
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.
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.
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
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.
Post a 300- to 500-word response in which you address the following:
Respond to at least two colleagues in the following ways:
Amber Alanis Week 4 – DB – A. AlanisCOLLAPSE
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.
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.
Naomie Pierre-Noel Week 4 Pierre-noelNCOLLAPSE
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
V61.03 (Z63.5) Disruption of family by separation or Divorce
V62.3 (Z55.9) Academic or Educational Problem
V61 (Z62.820) Parent-child relational problem
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
312.81 (F91.1) Conduct Disorder
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.
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.
To access your rubric:
Week 4 Discussion Rubric
To participate in this Discussion:
Week 4 Discussion
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.
Note: In the Week 7 Discussion, you make your final findings presentation as an individual, not with your partner.
Submit a 1- to 2-page paper in which you describe your team meeting. In your write-up, make sure to address the following: