The Book that the Case study is coming from is Mental Health in Social Work: A C

Question

The Book that the Case study is coming from is Mental Health in Social Work: A Casebook on Diagnosis and Strengths Based Assessment (DSM 5 Update) (2nd Edition)

The DSM-V is where diagnosis and differentials need to come from

Instructions: Read the case study, The Boy with No Restraint, on pages 137-139 in the textbook. Then complete the following sections of the diagnostic report. This assignment should be no more than 5 pages long.

Client strengths: All clients have strengths. What are these client’s strengths and how could they benefit his recovery and continued good mental health?

Client limitations: What potential limitations does this client possess in terms of his recovery and continued good mental health?

Differentials: List three differentials for each disorder you are considering, why you considered it, and why you rejected it. Your differentials should be rational, not random. For example, do not use Alcohol Use Disorder as a differential when the diagnosis is Major Depressive Disorder. The client should exhibit some symptoms of the disorder you use as a differential, but not enough to qualify for the diagnosis.

Diagnosis:List all DSM-V diagnoses and specifiers for the client in the case. Some will have only one disorder, others will have multiple diagnoses.

Rationale for diagnosis: Looking at the DSM-V criteria for each final diagnosis you select, provide your rationale for selecting that diagnosis.

This Chapter is on Oppositional Defiant Disorder and Conduct Disorder

Case 2 The Boy With No Restraint

Sam is a nine-year-old African-American male who is new to a school that offers educational services for children who can no longer perform in an ordinary school setting. He came from an elementary school where he attended a special education program. He was referred to the specialized school because he continued to exhibit significant behavioral, social, emotional, and academic difficulties.

The prior public elementary school’s psychological report stated that Sam spent a majority of his time out of the classroom, either on suspension or in counseling sessions because of his behavior. The report also stated that he required physical restraint on a number of occasions and was recently so aggressive and dangerous that the school filed a complaint with the court asserting that he was out of control both at home and in school. No further information was available about the outcome of this referral to the courts, nor about the specifics of the behavior that warranted such a referral.

Sam lives with his mother, his three-year-old brother, paternal great-grandmother, and uncle in his great-grandmother’s home. The family recently moved from the home of Sam’s grandmother after a heated argument between Sam’s mother and her own mother. This is the third move and Sam’s fourth school in just three years. Sam’s father was shot to death a year ago (his mother was no longer with him at the time), and he has no contact with his father’s family except for his paternal great-grandmother. Sam did have a relationship with his paternal grandmother, but she passed away six months ago.

Sam’s mother completed the 11th grade, is currently unemployed, and collects Supplemental Security Income. It is unclear why Sam’s mother receives such assistance. Sam also has a 12-year-old half brother and a 10-year-old half sister. All the children have the same mother but different fathers, and the older children live with their paternal relatives.

Sam’s family had home-based services to assist with the difficulties they were experiencing, but the services were terminated several months ago because the agency lost all contact with Sam’s mother. The home-based worker stated her belief that Sam’s mother may have started a new relationship, and that in the past she has allowed her relationships with men to take away from her time with her children. The worker also stated that the unstable living situation and Sam’s mother’s mental state (which she believes may be persistent depressive disorder) make it difficult to work with the family on a consistent basis. Through the home-based services agency, Sam was connected with mental health counseling, but his attendance and participation were sporadic.

About a year ago, Sam took the Woodcock Johnson tests, which indicated that his reading, writing, and math skills were significantly delayed for his age, IQ, and educational level. His academic achievement is poor because of these delays. Because of his refusal to participate in a number of the tests, his IQ score could not be accurately identified, but the examiner estimated it to be in the range of 74 to 87.

Since the beginning of the school year Sam has continued to exhibit aggressive and dangerous behaviors. In a meeting with the behavior staff director of the school, the social work intern learned that Sam will have to be searched daily because of his many threats of bringing a knife or gun to school to kill staff. Sam has had to be physically restrained by staff at least a dozen times. The director stated that she would never restrain Sam alone and that it takes two to three staff to do so safely. In this same meeting, the director stated that Sam has attempted to stab staff with pencils and thumbtacks grabbed from hallway bulletin boards.

In locked restraint, Sam will kick the door and scream out obscenities. According to incident reports, Sam has spit at, lunged at, and attacked staff and has even tried biting. He tends to blame others for his behavior (“I’m in support because [staff member] said a bad word to me.”). He neither shows remorse for his behavior nor empathy toward people he has been angry with.

Sam’s teacher reports that he often has difficulty transitioning from one location to another or from one assignment to another. Sam refuses to complete his school assignments and will not accept redirection from his teacher. He often becomes verbally disrespectful toward her, but she reports he has not yet been physically aggressive. She does report that he often destroys property (ripping papers, breaking pencils, turning over chairs and desks) when upset and is known for tearing up his school worksheets when he does not want to work on them.

Sam currently spends a significant amount of time out of class because of his behaviors. He is falling behind in class work because of his absence from lessons and his refusal to participate. Not surprisingly, Sam doesn’t have friends because other children are scared of his out-of-control behaviors.

Sam’s mother is difficult to contact, and she doesn’t return telephone calls in a timely manner. She is guarded about sharing personal information. She attended the most recent individualized educational plan (IEP) meeting and reports that since Sam was a young child, she has seen similar behaviors at home. When Sam gets frustrated, he becomes verbally and physically abusive toward her.

Sam’s mother states that she has sought outside help to control Sam’s behavior. She attempted mental health counseling, but discontinued services because he refused to speak. Sam’s mother says that she is overwhelmed and has tried every punishment—spanking, sending him to his room, taking away privileges—but that none of her efforts has been successful in changing his behavior. She says that he does not seem depressed to her, just angry. Sam’s mother states that she has also called Juvenile Court to relinquish Sam. She was told to come in to complete the intake process but did not do so.

Sam presents as a well-dressed and well-groomed young boy. When he is not upset, he is engaging and very polite. He states that he enjoys coming to the sessions with the social work intern, and he plays games cooperatively, though with high energy, during these times. He shows particular interest in sports, especially basketball. He doesn’t bring up his deceased father or other aspects of his family life and shies away from questions about them, although he admits to feeling “sad” about his father’s and his grandmother’s deaths. He denies, however, that he is sad in general. He says he has not been sexually or physically abused, but says that in the past his mother and a couple of her boyfriends have “whipped” him but not left marks. Sam’s most recent physical examination, performed a year ago, confirms that he is in good health and particularly noted that he has a good appetite.

Explanation / Answer

Client strengths--The student has faced a mental trauma due to accidental death of his father due to murder which has deeply impacted the student.His mother is also facing depression and anxiety disorder and constantly scolds his son, due to which the child is no longer able to concentrate on studies and his behavior is also not appropriate with teachers in school and is often suspended in school and often fails in class tests.He is undergoing rehabilitation therapy from counselors. His mental strength depicts that he has survived such a disastrous situation with willingness and courage although his behavior is still a concern.The boy is facing TypeV depressive disorder with anxiety,stress,loneliness, isolation,suicidal thoughts and false perceptions in the brain.These false illusions develop in the form of images in the brain with tracts which have no significance in real life in the form of illusion patterns.The student turns abusive and develops concentration disorder with lack of interest in studies.Even after facing such troubled scenarios the student has still passed the intelligence test which shown his confidence and strong attitude towards life.Sam also has a tendency to show obsessive positive towards life with tendency to attract extra friendship ,love and emotions from his friends and shows very polite nature while interacting with others and is not able to withstand rough, harsh emotions due to emotional sensitivity.In situations of abuse, Sam turns aggressive, destroys things around him and cannot be controlled.The child is facing extemities in terms of relationships and emotions and a false perception of remaining excessively, pampered and cared in such situations.

Client limitations--The child remains isolated, secluded and is not able to interact and study properly due to lack of concentration in studies.There is always a false illusion of the traumatic situation faced by the child developed and patterned in the brain of Sam.The brain of such perceptions develops particular patterns and waves with false imaginary tracts which can be studied.Child shows circumstances of misbehavior,and lack of respect with verbal abuses and lack of coordination and interest.The child develops social phobia with lack of confidence and expression of emotions.

Differential diagnosis--personality disorder, autism and Obsessive compulsive disorder (OCD) with bipolar syndrome.

DSM-V manual--hallucinations and false perceptions excessive and obsessive positive and negative emotions, unecessary outword look towards situations and interaction with person not related and excessive,trying to achieve false loving emotion from friends with showing excessive strong pampered approaches towards parents and friends, autism,nervousness,lack of confidence, social seclusion, lack of care even after showing extra care and emotion towards other friends,excessive secretion of dopamine, and serotonin in brain of the person. The student may have the tendency to inherit all property and land aquisition with assests at an early age to death of father and feels the need to get protected in society with tendency for large inheritance leading to depression and anxiety in mother as percepted by mother due to which she no longer communicates and interacts with friend and neighbours and there is lack and coordination from mother is particular situations and leading to lack of respose from mother when asked about such a situation.

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