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

Discussion: Applying Differential Diagnosis to Neurodevelopmental Disorders

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 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.

By Day 6

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.

Response 1

 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.

Reference:

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.

Response 2

 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

• Argues with mom, cries, throws object.

V61.03 (Z63.5) Disruption of family by separation or Divorce 

• Parents separated at least two times, dad drinking, 

V62.3 (Z55.9) Academic or Educational Problem 

• Bullying others, serious academic trouble 

V61 (Z62.820) Parent-child relational problem

• Doesn’t help with chores argues with mother

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

 Moderate 

312.81 (F91.1) Conduct Disorder

 Childhood-onset type 

 Moderate 

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. 

References

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.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 4 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 4 Discussion

Assignment: Case Collaboration Meeting

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.

To prepare:

• Using the case study provided to you by your instructor.
• Consult the Case Collaboration Meeting Guidelines document found in the Learning Resources.
• Read ahead to the Week 7 Discussion instructions so that you can plan and reflect accordingly.

Note: In the Week 7 Discussion, you make your final findings presentation as an individual, not with your partner.

By Day 7

Submit a 1- to 2-page paper in which you describe your team meeting. In your write-up, make sure to address the following:

• Describe the quality of your working relationship with your colleague.
  • Critically reflect on strengths of collaborative relationship and areas for improvement.
• Describe your case in 100–150 words.
• Identify the red flags in your case study to be further evaluated.
• Outline your and your partner’s plan for further research and consultation, identifying specific tasks that you are each doing in this regard.
  • Identify days/times you have agreed to meet together, including the date planned to complete the CFI interview required for the Week 5 Assignment.