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 of Bogdan” 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 Bogdan 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 Bogdan. 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 Bogdan, 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 Bogdan’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 his case.
Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Part 1, “The Basics of Diagnosis” (pp. 3-56) https://class.content.laureate.net/ad73cbcc23f16730bd54d7baf40ccdda.pdf
The Case of Bogdan Bogdan is a 12-year-old male in 7th grade who was brought in for services by his adoptive mother. He is very small in stature, appearing to be only 8 years old. He also acts younger than his 12 years, carrying around toy cars in his pockets, which he proudly displays and talks about in detail. Bogdan was adopted at age 3½ from an orphanage in Russia. The orphanage knows little about early developmental milestones, but Russian staff noted that Bogdan’s language was far less developed than that of his peers at the time of his adoption. The mother stated that Bogdan 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 Russia was horrible and that Bogdan 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. The adoptive parents are upper middle class and have three biological children (ages 9, 7, and 5). Bogdan is reported to often get upset with his siblings and hit or kick them. His mother stated that Bogdan 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 Bogdan attempting to suffocate each of his younger siblings when they were babies. Bogdan’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.” The mother reported that Bogdan 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. She also reported that Bogdan 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. He sometimes reacted when his lunch was packed differently within his lunch box for school. He also seemed to pay less attention to teachers and often interrupted class with his own comments. Initially Bogdan’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. Bogdan’s mother shared her frustration with Bogdan’s father, who “just does not understand how hard it is to care for him.” The parents have never sought help before, as Bogdan 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, Bogdan 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. Prior to meeting with the school social worker today, Bogdan had never had any testing for special education, nor had he ever received any counseling services. During this intake, the school social worker met briefly with Bogdan 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. His teachers commented that he talks more about this topic at other times at school. Bogdan appeared oriented to time and place. 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. Adapted from: Plummer, S.-B., Makris, S., & Brocksen, S. (2013). Social work case studies: Concentration year. Baltimore, MD: Laureate Publishing.