SOCW 6090: Psychopathology and Diagnosis for Social Work Practice
Week 4 Applying Differential Diagnosis
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.
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.
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.
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. https://doi.org/10.1080/10911359.2015.1052913
SOCW 6090: Psychopathology and Diagnosis for Social Work Practice