COUN 5107 WK 10 Discussion 1

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Feb 20, 2024

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Week 10 Discussion 1: Assessing Conduct and Oppositional Defiant Disorder Review the case study beginning on page 314 of the Abnormal Psychology text and respond to the following using headings to match content in each bullet point: Jeremy has been increasingly difficult to manage since nursery school. At school, he teases and kicks other children, trips them, and calls them names. He is described as bad tempered and irritable, though at times he seems to enjoy school. Often he appears to be deliberately trying to annoy other children, though he always claims that others have started the arguments. He does not get in serious fights but does occasionally exchange a few blows with another child. Jeremy sometimes refuses to do what his two teachers tell him to do, and this year he has been particularly difficult during arithmetic, art, and science lessons. He gives many reasons why he should not have to do his work and argues when told to do it. At home, Jeremy’s behavior varies. Some days he is defiant and rude to his mother, needing to be told to do everything several times, though he usually complies eventually. Other days he is charming and volunteers to help, but his unhelpful days predominate. His mother says, “The least little thing upsets him, and then he shouts and screams.” Jeremy is described as spiteful and mean with his younger brother, Rickie. His mother also says that he tells many minor lies, though when pressed he is truthful about important things. (Source: DSM Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, 2013.) ● Compose three open questions you would want to ask Jeremy and his mother during your assessment that will invite them to expand upon their perspective of the presenting problem. Consider ways to phrase questions that will help you assess the biological and social risk factors for conduct and oppositional defiant disorders. Provide a brief rationale for each question. ● Include any information you learned from using the Differential Diagnosis tool, which you can find in the Differential Diagnosis by the Trees Links to an external site. reading list. ● Identify a potential diagnosis for Jeremy including the psychosocial and environmental problems (V and Z codes) that would be important to provide a holistic description of the context of the focus of treatment.

Questions As someone who has evaluated children and spoken with parents during ER visits, and a person who is genuinely curious about dynamics and interventions, I struggle narrowing it down to three questions. After reviewing the DSM-5, these would be questions I would ask to assess biological and social risk factors. Some of them are grouped together because they have the same purpose and assess at other angles. Jeremy: How old are you? -The information given says since nursery. When I think nursery, I think infant, so right now I would like to know how old she is to have a better understanding when diagnosing. For example: ODD states that children younger than five, the behavior should occur on most days for a period of 6 mths. And for older than five the behavior should occur at least once a week for 6 mths. This just helps me have a better understanding of a timeline. Intermittent Explosive Disorder states a chronological age of 6 years. What are the kids like at school? What are the fights about at school? What makes you so annoyed and/or angry at school? What is your least favorite part about school? Tell me about your friends at school? Who can you talk to at school when feeling upset? This bundle of questions helps me understand the dynamics in school. Possibly he will open up more about the triggers and reasoning for his behavior in school if he is able to identify. I am sure the teachers are overwhelmed so understanding triggers during particular subjects could be beneficial in developing interventions or extra support at school. I think it is important to know about friends and support in school to be able to develop interventions and social support in school. Not only focus on the difficulties, but build on the positives. How do you feel/treat animals? This will help narrow down and rule out diagnosis. What is your relationship like with your brother? What is your relationship like with your Mom? Tell me more about what upsets you at home? What are some coping techniques you use or can use when you are upset or angry? This will help me have a better understanding of family dynamics and triggers at home. Being able to identify coping skills is important too. It is possible the child does not have positive coping skills. Mother: Tell me more about mental illness that runs in your family OR, tell me more about other generations in your family with this type of behavior

It would be beneficial to understand if anyone in the family has suffered from these types of disorders/behaviors and if genetics play a factor. Genes and environment contribute to psychopathology. When has Jeremy exhibited this type of behavior other than school and home? This question would help specify the severity. Whether it is just two settings or three and more. This would determine a moderate or severe diagnosis of ODD and help with other diagnostic criteria of other disorders. What is Jeremy’s behavior like when he is with animals? Tell me more about property damages and destruction if there has been any? These two questions would help rule out diagnosis and help diagnose as there are a few that have criteria of animal cruelty and property destruction. Tell me more about a weekend routine versus a school day routine; is there a difference in his behavior between the two? Tell me more about how the household operates and if there has been any significant changes in the household. Can you tell me more about the charming behavior Jeremy exhibits? These questions could help determine specific triggers in the household. As well as moments to look for and intervene before a behavior surfaces. As well as a positive to move forward with during tasks, change of places, people, tasks, etc. How is Jeremy’s behavior handled at home when he is mean or defiant? Tell me more about the strategies and interventions in place. This would help determine interventions in place. The consistency and effectiveness of interventions already in place. Potential Diagnosis and Decision Tree: Oppositional Defiant Disorder (ODD) Jeremy meets at least four symptoms from the ODD category criteria and has exhibited the behavior with others, not just a sibling (APA, 2013). After navigating the different decision trees, poor school performance and behavioral problems in both children, I landed on the same diagnosis. I decided to just review the DSM5, Oppositional defiant disorder appears to be an appropriate diagnosis. Conduct order has been ruled out due to not having information on behavior towards animals, if he is the bully or a bully and reacting to being bullied and if he states the fights. As well as no information on theft, deceitfulness or property destruction. For Intermittent explosive disorder, it would be important to know his age, and if any property destruction has taken place; as well as any aggression towards animals. He does have verbal and sometimes physical aggression towards people, marked by distress and no premeditated.

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Finding out how often the behavior happens would be important but he has lost his temper, often angry, argumentative with authority figures/adults, actively defies to comply; deliberately annoys and blames others for mistakes as outlined in the DSM 5 (APA, 2013). He meets a moderate diagnosis as his symptoms are present in two settings. Codes (Z62.80) Parent-Biological Child. This is an assumption as we do not know if Jeremy is a biological child but this area could be a focus of clinical attention and review the quality of the relationship between the parent/child duo (Z62.892) Sibling Relational Problem- There appears to be an issue here. Understanding family functioning. (Z63.8) High Expressed Emotion Level Within the Family- this could apply depending on the involvement of the mother (Z55.4) Educational Maladjustment and Discord with Teachers and Classmates. This would apply to Jeremy’s behavior towards other students as well as being argumentative with teachers. (Z60.4) Social Exclusion or Rejection- Although Jeremy appears to be kicking other students, After further evaluation, it is possible he could also be targeted and reacts the way he does because of others. If not then (Z60.9) Other Problems Related to Social Environment- as he struggles with his social environment in school (APA, 2013). Reference American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed., text rev.). https://dsm-psychiatryonline-org.library.capella.edu/doi/book/10.1176/ appi.books.9780890425787

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