Putting It All Together: Differential Diagnosis And Neurodev ✓ Solved

Putting It All Together: Differential Diagnosis and Neurodev

Instructions:

Use the diagnostic interview and differential diagnostic decision-tree to evaluate a case within the neurodevelopmental disorders. Complete two linked tasks:

1) Diagnostic analysis (Discussion task)

- Provide a full DSM-5 diagnosis for the client: disorder name, ICD-10-CM code, specifiers, severity, and relevant Z codes.

- Explain the diagnosis by matching the client’s symptoms to specific DSM-5 criteria, covering the most recent 12 months.

- Identify four clinical diagnoses you considered and explain why you selected them.

- In one or two sentences each, explain why three of these diagnoses were excluded.

- Explain any obvious eliminations from within the neurodevelopmental spectrum.

- Describe in detail how the client’s symptoms match the diagnostic criteria for the primary disorder you selected.

- Note two other relevant DSM-5 criteria from the sections on “diagnostic features” and “development and course” that fit this case.

2) Case collaboration meeting (Assignment task)

- Meet with a colleague and describe the meeting and initial analysis in a 1–2 page write-up that includes:

- Quality of your working relationship, strengths and areas for improvement.

- A 100–150 word description of the case.

- Red flags in the case that require further evaluation.

- A plan for further research and consultation with specific tasks assigned to each partner.

- Agreed meeting days/times and the date planned to complete the Cultural Formulation Interview (CFI).

Deliverable: A single integrated paper that addresses both the diagnostic analysis and the case collaboration meeting.

Paper For Above Instructions

Executive DSM-5 Diagnostic Summary

Primary diagnosis: Oppositional Defiant Disorder (ODD), ICD-10-CM: F91.3 (313.81). Specifier: childhood onset; severity: moderate. Relevant Z codes: Z62.898 (Child affected by parental relationship distress) and Z63.5 (Disruption of family by separation or divorce) to reflect family stressors that are clinically relevant to treatment planning (American Psychiatric Association, 2013; Walsh, 2016).

Case Overview (100–150 words)

Aponi is a 9-year-old female presenting with persistent patterns of irritable mood and defiant behavior at home, school, and with peers. Symptoms include frequent temper loss, persistent arguing with authority figures, deliberate annoyance of others, blaming others for her mistakes, spiteful or vindictive acts, tantrums, physical throwing of objects, bullying peers, declining academic performance, and a disrupted family environment with multiple caregivers and parental separation. Problems began in middle childhood and have persisted across settings for more than 12 months. These behaviors impair academic and social functioning and are accompanied by caregiver strain and parental relationship distress.

Differential Diagnoses Considered

Four diagnoses considered: 1) Oppositional Defiant Disorder (ODD), 2) Conduct Disorder (CD), 3) Disruptive Mood Dysregulation Disorder (DMDD), and 4) Attention-Deficit/Hyperactivity Disorder (ADHD). These were selected because the presenting symptoms (irritability, defiance, aggression, rule-breaking, and attention/impulsivity concerns) overlap across these syndromes and require differential analysis (Morrison, 2014; First, 2014).

Exclusions (one–two sentence rationales)

Conduct Disorder (excluded): The child’s behaviors lack the degree of serious rule violations, cruelty to people/animals, or property destruction that characterizes CD (American Psychiatric Association, 2013).

Disruptive Mood Dysregulation Disorder (excluded): Although severe temper outbursts occur, the pervasive persistent irritable mood between outbursts required for DMDD is not clearly documented; the pattern here fits episodic oppositional behavior and contextual relational triggers more closely (American Psychiatric Association, 2013).

ADHD (excluded as primary): There is no predominant and pervasive pattern of inattention and/or hyperactivity-impulsivity across settings preceding or explaining the oppositional behaviors; attention problems are not the primary driver based on available history (Coker et al., 2017).

Eliminations within the Neurodevelopmental Spectrum

Autism Spectrum Disorder and Intellectual Disability were not supported: there is no consistent evidence of deficits in social communication or restricted/repetitive behaviors, nor documentation of global developmental delays. Learning problems are present but appear secondary to behavioral dysregulation rather than to core neurodevelopmental deficits (American Psychiatric Association, 2013).

Matching Symptoms to DSM-5 ODD Criteria

DSM-5 Criterion A requires a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months, with at least four symptoms present and interactions with at least one individual who is not a sibling. Aponi demonstrates: (1) frequent temper loss and irritability; (2) frequent arguing with adults and refusing to comply with requests; (3) deliberate annoyance of others and blaming others for problems; (4) spiteful/vindictive behaviors (throwing objects, bullying peers). These behaviors occur across home and school settings, satisfying the cross-situational requirement (American Psychiatric Association, 2013).

Criterion B–D (clinically significant impairment, not explained by psychosis/substance use, and not better accounted for by another disorder) are met: impairment is evident in academic functioning and peer relationships; no evidence of psychosis or substance use; and other disorders (e.g., CD, DMDD, ADHD) were considered and ruled out as primary explanations after differential analysis (First, 2014).

Additional DSM-5 Diagnostic Features and Developmental Considerations

Two relevant DSM-5 points that fit this case: (1) ODD commonly presents in childhood and can be precipitated or exacerbated by inconsistent caregiving, family disruption, or parental conflict—factors present in this case (American Psychiatric Association, 2013). (2) ODD often co-occurs with other disorders (e.g., ADHD, mood disorders), so assessment for comorbidity and longitudinal monitoring is required (Morrison, 2014).

Clinical Red Flags Requiring Further Evaluation

• Escalation toward conduct-type behaviors (physical aggression, property destruction) that would indicate progression to Conduct Disorder.
• Signs of mood disorder or pervasive irritability meeting DMDD criteria.
• Undetected neurodevelopmental issues (e.g., learning disorder, ASD) contributing to behavior problems.
• Exposure to ongoing family violence, substance use by caregivers, or trauma requiring immediate safeguarding.

Case Collaboration Meeting: Quality of Working Relationship

Strengths: The collaboration is collegial and complementary — one partner focuses on behavioral assessment and school liaison, the other on family systems and cultural formulation. Communication has been regular and task-oriented, enabling division of responsibilities (First, 2014).

Areas for improvement: We should formalize shared documentation, set clearer timelines for data collection (teacher reports, school records), and schedule structured supervision to review differential diagnosis decisions to reduce bias and premature closure (Morrison, 2014).

Plan for Further Research and Consultation (Specific Tasks)

• Partner A: Obtain parental consent and school behavior reports; administer standardized behavior rating scales (e.g., ECBI, BASC-3) and collect teacher observations within 7 days (evidence-based assessment) (American Psychiatric Association, 2013b).
• Partner B: Conduct a family systems interview, gather developmental history, screen for trauma exposure, and complete the Cultural Formulation Interview (CFI) on the scheduled date. Also review medication history and pediatric medical evaluation for sleep or hearing problems that may affect behavior.
• Joint task: Convene a case consultation with a supervising clinician within two weeks to review findings and finalize diagnostic impression and a treatment plan (behavioral parent training, school-based interventions) (Kazdin, 2005).

Meeting Schedule and Date for the CFI

Agreed regular meeting times: Tuesdays 10:00–11:00 AM and Thursdays 3:30–4:30 PM via Collaborate Ultra for the next three weeks. Planned date to complete the Cultural Formulation Interview (CFI): Tuesday, 2025-12-09 at 10:15 AM (local time), pending caregiver availability.

Treatment Implications

Diagnosing ODD with accompanying Z codes directs intervention toward evidence-based parent management training, school behavior plans, family therapy to address relational stressors, and monitoring for comorbid conditions (Kazdin, 2005; Loeber & Burke, 2011). Z codes inform systems-level interventions (e.g., family supports, referral to social services) that will be incorporated into the treatment plan (Walsh, 2016).

Conclusion

Using a decision-tree differential diagnostic approach and cross-setting data, ODD is the most accurate primary diagnosis for this client given the pattern, duration, and impact of symptoms. Ongoing evaluation for comorbidity and environmental contributors is essential, and collaborative casework with a clear division of assessment tasks will strengthen diagnostic validity and support an evidence-based treatment plan (First, 2014; Morrison, 2014).

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
• American Psychiatric Association. (2017). Changes to ICD-10-CM codes for DSM-5 diagnoses. Washington, DC: Author.
• First, M. B. (2014). Handbook of differential diagnosis. Washington, DC: American Psychiatric Publishing.
• Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
• 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.
• 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), e20161961.
• Kazdin, A. E. (2005). Parent management training: Treatment of oppositional, aggressive, and antisocial behavior in children. Oxford University Press.
• Loeber, R., & Burke, J. D. (2011). Developmental pathways in disruptive behavior. In T. P. Gullotta & M. Bloom (Eds.), Encyclopedia of primary prevention and health promotion.
• World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO.
• American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.