WK3Assgn_DiToto_A

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1 Case study: Marley Amy DiToto Department of Social Work, Walden University SOCW 6090: Psychopathology and Diagnosis for Social Work Dr. Felicia Wilson March 17, 2024

2 F 91.3 Oppositional Defiant Disorder, moderate Diagnostic Criteria: A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. o Angry/Irritable Mood 1. Is often touchy or easily annoyed. a. This is evidenced by Marley’s mother reporting that he is unable to joke around, has become sensitive if he feels he is being attacked, and is triggered easily. o Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults. a. Marley is reported to be argumentative with his parents and his teachers. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. a. At home, Marley’s parents reported that he stopped following rules, will not clean up messes, and will not go to bed when told. b. In school, teachers report having difficulty bringing Marley back into the classroom after spending time on the playground.

3 6. Often deliberately annoys others. a. Marley’s parents report that he deliberately annoys/bothers his mother. o Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. a. These behaviors have been evident for 18 months. B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. 1. Marley’s defiant and argumentative behaviors are affecting his family, but have not impacted social or educational areas of functioning. a. Family functioning is impacted by Marley’s mother admitting she gets frustrated in response and yells at him which makes her feel terrible. C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder. o Marley’s behaviors are not occurring as part of a psychotic, depressive, or bipolar disorder. There is no reported substance use history. Specify current severity:  Moderate: Some symptoms are present in at least two settings. o Marley was reported to have symptoms present at home and in school. No other settings were reported.  Differential diagnosis and exclusions

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4 At the onset, I considered that Marley may have a diagnosis of adjustment disorder, conduct disorder, or that Marley was acting out for attention as his parents suspected, due to jealousy of the new baby. Jealousy was ruled out due to the persistent defiant behaviors which have been ongoing since the baby was born but have not improved. Furthermore, the behaviors did not only occur at home which indicated a problem beyond jealousy. I ruled out conduct disorder as, per the DSM 5-TR, conduct disorder often includes aggressive behavior toward people or animals, destruction of property, and a pattern of theft or deceit (American Psychiatric Association, 2022). Also, Marley’s family indicated an emotional aspect (sadness, anger) which are not present in the conduct disorder criteria (American Psychiatric Association, 2022). Lastly, I ruled out adjustment disorder. Marley’s symptoms have been ongoing for 18 months, and according to the American Psychiatric Association (2022), criteria for adjustment disorder includes a symptom duration of less than six months. Since Marley’s behavior has occurred for longer than six months, Adjustment disorder was ruled out in favor of a diagnosis of Oppositional Defiant Disorder. Culture Marley is bi-racial, with parents who identify as Caucasian and African American. He is also a 9-year-old third grade student. Culture can affect the diagnosis as according to researchers, the criteria limits cross-cultural use of diagnostic criteria (Watabe et al., 2022). In the case of Marley, is it important to note that he has been raised by Western values which are supported by the diagnostic criteria in the DSM-5-TR (Walden University, 2024; Watabe et al., 2022) Z codes and rationale Z63.8 Other specified problems related to primary support group, family discord NOS. Marley’s behavior is causing challenges for the entire family, and he is outwardly defying his

5 parents in ways that affect him and his family. Z60.8 other problems related to social environment. Marley’s behaviors started after a change in his social environment and have continued and are now also evident in school at times. There are problems related to his social environment; however, the specific problem has not been identified in other Z-codes.

6 References American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev). https://doi.org/10.1176/appi.books.9780890425787 Walden University. (2024). Case of Marley . Watabe, Y., Lee, S. K., & Matsuhashi, Y. (2022). Cross‐Cultural investigation in differential perceptions of externalizing symptoms. Japanese Psychological Research . https://doi.org/10.1111/jpr.12411

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