Required Readings
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)
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
Optional Resources
Document: Suggested Further Reading for SOCW 6090 (PDF)
Note: This is the same document introduced in Week 1.
Optional Media
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
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.
CASE PRESENTATION – DIEGO
INTAKE DATE: September 2020
IDENTIFYING/DEMOGRAPHIC DATA: Diego is 15 years old, Cuban Hispanic male in tenth grade. He lives with his parents in Miami, Florida. His parents immigrated to the United States 16 years ago. He has a younger brother who is 9 years old.
CHIEF COMPLAINT/PRESENTING PROBLEM: Diego’s parents are concerned about Diego’s schoolwork. They believe his intellect level is higher than his grades indicate. Diego has had challenges with his schoolwork for several years and his parents chose to work with him at home, even hiring private tutors. They are more concerned now since the grades have not increased and he is in high school and will be heading towards college soon.
HISTORY OF PRESENT ILLNESS: Diego has struggled in school since the third grade. He is now in serious academic trouble. After a psycho-educational evaluation at school, it was found that he had above-average intellectual ability. From the third grade Diego had difficulty keeping up with assignments and completing his work each year. While he comprehends the material, he didn’t retain what he read. He appeared to understand lectures, but he couldn’t organize his thoughts well enough to write them down on paper. “I just stare at the page and nothing comes out,” he said. Adding to these difficulties was the fact that he often forgot to write assignments down and “just couldn’t get organized.”.
If he did at some time remember to write down his homework, he would misplace the paper he wrote on. Diego’s mom worries that Diego is intentionally not remembering these tasks because of her parenting and blames herself. Mom was so happy to have her children in the United States, she believes she overindulged him.
Diego has no behavioral challenges in school and has never been disciplined in anyway by the teachers or principal. He is reported to be nice to others as well as helpful and does have several friends in his class. Diego brings home report cards that seemingly fail to reflect his intelligence. His work remains unfinished, even if he knows the answer when called on in class.
PAST PSYCHIATRIC HISTORY: Diego’s parents are from Cuba. Mom is concerned that these behaviors might be interpreted as indicating a poorly raised child whose behavior could be modified by parental discipline. Diego’s parents have tried all kinds of ways to help their child focus on schoolwork. When nothing changed, even though the parents are embarrassed, they chose to seek outside help.
SUBSTANCE USE HISTORY: Diego denies any use of drugs or alcohol.
PAST MEDICAL HISTORY: Diego has been fairly healthy throughout his life. He had normal childhood illnesses.
FAMILY MEDICAL AND PSYCHIATRIC HISTORY: This is a Cuban family which adheres to the behaviors and parenting of their culture. There is no reported psychiatric history in the family.
CURRENT FAMILY ISSUES AND DYNAMICS: The parents report running a strict Cuban household. Both children are required to do household chores daily. Diego’s parents get worried when Diego is assigned chores and forgets to do them or gets distracted when doing the chores and doesn’t finish. His parents are concerned that Diego stresses about trying to please his parents over the failing school grades. The parents are not comfortable bringing Diego in for an evaluation, but they were referred by the school system.
MENTAL STATUS EXAM: Diego presents as a casually dressed teenager who appears his stated age of 15. He is a bit anxious during the interview. His affect is appropriate but gets saddened about disappointing his parents. Motor activity is appropriate. Speech is clear. At times during the interview, he lost his train of thought, got distracted and had to be redirected to the subject. There is no evidence of delusions or hallucinations. Diego’s intelligence appears above average. He is oriented to time, place, and person and denies suicidal or homicidal ideation.