- Primary Diagnosis: The disorder that is most pervasive and has the largest impactOnly the following diagnoses are possible: Intellectual Disability, Autism Spectrum Disorder, Childhood Onset Schizophrenia, Communication Disorder, Learning Disorders, Attention-Deficit/Hyperactivity Disorder. What is the primary diagnosis for this case? And provide your rationale for why you believe this is the primary diagnosis (e.g., criteria met and why it is the primary rather than secondary diagnosis)Please answer in point form. Thank you! Case Study "George"Eight-year-old George was brought by his parents for an appointment at his local communitymental health centre with the psychologist, Dr. Milton. His parents reported that they were at the end oftheir rope" trying to manage his behavior and activity level. They were becoming concerned as Georgewas more and more disruptive in their home and he did not seem to have friends at school. George lives athome with his father (Mike, a chef) and step-mother (Nadine, a police officer), as well as his 5-year-oldhalf-sister, Molly. They reported that they agreed in terms of their concern about George, and in fact,agreed about most things related to their children and home. No stressors were reported in terms of socio-economic factors. After a very conflictual period in his biological parent's relationship, George'sbiological mother (Jenna; an accountant) had separated from Mike. Jenna would usually call George onhis birthday and at Christmas, but otherwise George had limited contact with her. The family hadpreviously lived in Cape Town, South Africa before moving to Canada when George was 5-years-old;both of George's biological parents and step-mother were also raised in South Africa. With regard tofamily history, Mike indicated that he himself had struggled with social anxiety and had previously beentaking medication to manage his anxiety. He also noted that he did not do well in school as he thought itwas boring and would rather be doing other things. He indicated an extended family history of anxietydisorders, ADHD, ASD, and bipolar disorder. He also noted that George's biological mother was neverformally diagnosed with a learning disability, but that she always struggled in school. There were noconcerns reported with Molly's development except that sometimes she copies George's behaviour.Mike described that George was born premature at 33 weeks at a very low birth weight, followinga planned pregnancy. Mike indicated he thought Jenna's early labour was due to her smoking duringpregnancy. George's parents were both in their mid-to-late thirties when George was born, waiting untilthey had established their careers before having children. Despite being born premature, George has nothad any health problems and a recent physical examination found him to be in good health. His hearingand vision were also recently checked, and no concerns were noted. He met all of his motor milestones atthe expected ages, but was slow to start speaking, although now there were no language concerns. Mikeindicated that once George finally started speaking in full sentences, he "hasn't stopped since", and talksincessantly, even if no one appeared to be listening. George was described as being a busy child who wasconstantly on the move and getting into accidents because he was always climbing and jumping offthings, seemingly indifferent to the pain caused by his injuries. Sleep was described as slightlyproblematic for George, with some bedtime resistance but that once he was asleep (which took about 20minutes to fall asleep) he stayed asleep and woke up feeling rested. No snoring, nightmares, or any othersleep problem were endorsed.Mike and Nadine indicated that they were concerned about his development and learning, as hisyounger sister was starting to surpass him in some of his academic skills. Nadine described how she hadpurchased a variety of educational materials to try and work on his reading and math at home, but despitethis additional support, as well as additional support at school, he still was struggling with learning. Mikeand Nadine described that George's behavior at home was become increasingly problematic over the pastyear. They described George as being " constantly moving like he has a motor", never able to sit for morethan a minute at a time, leaving his seat often, and running around when he should be seated. This wasreported as extremely disruptive especially if they were trying to have a meal or play a game as a family.Mike and Nadine both expressed that they were extremely frustrated and would often send George to hisgrandparent's house when they could not handle his behavior anymore.George's current Grade 3 teacher, Ms. Johnson, report d that Georg was extremely difficult tomanage in the classroom. She described that George was almost never in his seat during class, and whenhe was in his seat, he would be touching all the objects in/on his desk and fiddling with them. Shedescribed him as the "Energizer Bunny". Whenever there was a noise somewhere in the class, he had togo inspect the source of this noise. Despite the fact that he was wandering around, he appeared to be attending to the lessons the teacher was giving, often blurting out the correct answers to questions sheasked the class. If Ms. Johnson asked George to return to his seat, he would return but within a couple ofminutes he would be up and out of his seat again. She commented that George would often rush throughhis work and make silly mistakes. She also noted that his desk looked like a bomb went off inside it, andhe was forever searching for his belongings. At recess, George always had to be the first at any activity,running to the front and "butting in" on the conversations of other children, often talking about notmuch". Ms. Johnson indicated that she was very concerned about the fact that George did not have anyclose friends at school, nor did he seem particularly interested in engaging with the other children unlessthey were willing to "play by his rules." Ms. Johnson is concerned with George's safety at recess becausehe climbs to the top of the play structure and tries to jump from one structure to another. She describedone incident where he fell when doing this, breaking his arm, which did not seem to deter him from tryingthe same jump again when he returned to school the following week. A review of George's report cardsand academic records indicated that his current pattern of behavior had been fairly consistent at schoolsince he started grade primary.Mike and Nadine also gave Dr. Milton permission to talk to Ms. O'Reilly, who ran the homedaycare that George would often go to after school. She told Dr. Milton that George was a "chatterbox",who seemed to have difficulty sustaining conversations with the other children because he was alwaystalking or interrupting their conversations. She said that the other children would get mad at Georgebecause he was not able to take turns when they were playing games and would take their toys withoutasking. Ms. O'Reilly confessed that she was struggling to keep up with George's activity level. Shedescribed that George was a sweet boy and that she had a soft spot for him. She noted that her grandson(who lives with her and is younger than George) and George like to play together when George is at herhouse.When Dr. Milton met with George one-on-one to conduct the psychoeducational assessment,George was extremely fidgety in his seat and tried to play with all of the objects on Dr. Milton's desk.Given these behaviours, Dr. Milton instituted a behavior program which was helpful in enhancing bothGeorge's motivation for the assessment and his ability to sit and stick with the assessment activities. Withthe behaviour program, George was more settled, and Dr. Milton observed that George shared interestingand detailed stories with lots of animation! Using the WISC-V, she found that George's intellectualability was within the Average to High Average range. Using the WIAT-IV, George was found to beachieving well below the level expected for his age in the areas of reading and writing (approximately at agrade 1 level), but his math skills were age/grade appropriate. She also found significant difficulties withgrapho-motor output (VMI-6) and phonological processing (CTOPP-2), as well as some verbal memoryproblems (WRAML-2), and there was evidence that these were impacting his academic skills. By usingthis behaviour program, Dr. Milton was confident that the results of the assessment were valid andreliable.

Answered: Primary Diagnosis: The disorder that is…

Ciccarelli: Psychology_5 (5th Edition)

5th Edition

ISBN:9780134477961

Author:Saundra K. Ciccarelli, J. Noland White

Publisher:Saundra K. Ciccarelli, J. Noland White

Chapter1: The Science Of Psychology

Section: Chapter Questions

Problem 1TY

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Question

- Primary Diagnosis: The disorder that is most pervasive and has the largest impact

Only the following diagnoses are possible:

Intellectual Disability, Autism Spectrum Disorder, Childhood Onset Schizophrenia, Communication Disorder, Learning Disorders, Attention-Deficit/Hyperactivity Disorder.

What is the primary diagnosis for this case? And provide your rationale for why you believe this is the primary diagnosis (e.g., criteria met and why it is the primary rather than secondary diagnosis)

Please answer in point form. Thank you!

Case Study "George"
Eight-year-old George was brought by his parents for an appointment at his local community
mental health centre with the psychologist, Dr. Milton. His parents reported that they were at the end of
their rope" trying to manage his behavior and activity level. They were becoming concerned as George
was more and more disruptive in their home and he did not seem to have friends at school. George lives at
home with his father (Mike, a chef) and step-mother (Nadine, a police officer), as well as his 5-year-old
half-sister, Molly. They reported that they agreed in terms of their concern about George, and in fact,
agreed about most things related to their children and home. No stressors were reported in terms of socio-
economic factors. After a very conflictual period in his biological parent's relationship, George's
biological mother (Jenna; an accountant) had separated from Mike. Jenna would usually call George on
his birthday and at Christmas, but otherwise George had limited contact with her. The family had
previously lived in Cape Town, South Africa before moving to Canada when George was 5-years-old;
both of George's biological parents and step-mother were also raised in South Africa. With regard to
family history, Mike indicated that he himself had struggled with social anxiety and had previously been
taking medication to manage his anxiety. He also noted that he did not do well in school as he thought it
was boring and would rather be doing other things. He indicated an extended family history of anxiety
disorders, ADHD, ASD, and bipolar disorder. He also noted that George's biological mother was never
formally diagnosed with a learning disability, but that she always struggled in school. There were no
concerns reported with Molly's development except that sometimes she copies George's behaviour.
Mike described that George was born premature at 33 weeks at a very low birth weight, following
a planned pregnancy. Mike indicated he thought Jenna's early labour was due to her smoking during
pregnancy. George's parents were both in their mid-to-late thirties when George was born, waiting until
they had established their careers before having children. Despite being born premature, George has not
had any health problems and a recent physical examination found him to be in good health. His hearing
and vision were also recently checked, and no concerns were noted. He met all of his motor milestones at
the expected ages, but was slow to start speaking, although now there were no language concerns. Mike
indicated that once George finally started speaking in full sentences, he "hasn't stopped since", and talks
incessantly, even if no one appeared to be listening. George was described as being a busy child who was
constantly on the move and getting into accidents because he was always climbing and jumping off
things, seemingly indifferent to the pain caused by his injuries. Sleep was described as slightly
problematic for George, with some bedtime resistance but that once he was asleep (which took about 20
minutes to fall asleep) he stayed asleep and woke up feeling rested. No snoring, nightmares, or any other
sleep problem were endorsed.
Mike and Nadine indicated that they were concerned about his development and learning, as his
younger sister was starting to surpass him in some of his academic skills. Nadine described how she had
purchased a variety of educational materials to try and work on his reading and math at home, but despite
this additional support, as well as additional support at school, he still was struggling with learning. Mike
and Nadine described that George's behavior at home was become increasingly problematic over the past
year. They described George as being " constantly moving like he has a motor", never able to sit for more
than a minute at a time, leaving his seat often, and running around when he should be seated. This was
reported as extremely disruptive especially if they were trying to have a meal or play a game as a family.
Mike and Nadine both expressed that they were extremely frustrated and would often send George to his
grandparent's house when they could not handle his behavior anymore.
George's current Grade 3 teacher, Ms. Johnson, report d that Georg was extremely difficult to
manage in the classroom. She described that George was almost never in his seat during class, and when
he was in his seat, he would be touching all the objects in/on his desk and fiddling with them. She
described him as the "Energizer Bunny". Whenever there was a noise somewhere in the class, he had to
go inspect the source of this noise. Despite the fact that he was wandering around, he appeared to be

attending to the lessons the teacher was giving, often blurting out the correct answers to questions she
asked the class. If Ms. Johnson asked George to return to his seat, he would return but within a couple of
minutes he would be up and out of his seat again. She commented that George would often rush through
his work and make silly mistakes. She also noted that his desk looked like a bomb went off inside it, and
he was forever searching for his belongings. At recess, George always had to be the first at any activity,
running to the front and "butting in" on the conversations of other children, often talking about not
much". Ms. Johnson indicated that she was very concerned about the fact that George did not have any
close friends at school, nor did he seem particularly interested in engaging with the other children unless
they were willing to "play by his rules." Ms. Johnson is concerned with George's safety at recess because
he climbs to the top of the play structure and tries to jump from one structure to another. She described
one incident where he fell when doing this, breaking his arm, which did not seem to deter him from trying
the same jump again when he returned to school the following week. A review of George's report cards
and academic records indicated that his current pattern of behavior had been fairly consistent at school
since he started grade primary.
Mike and Nadine also gave Dr. Milton permission to talk to Ms. O'Reilly, who ran the home
daycare that George would often go to after school. She told Dr. Milton that George was a "chatterbox",
who seemed to have difficulty sustaining conversations with the other children because he was always
talking or interrupting their conversations. She said that the other children would get mad at George
because he was not able to take turns when they were playing games and would take their toys without
asking. Ms. O'Reilly confessed that she was struggling to keep up with George's activity level. She
described that George was a sweet boy and that she had a soft spot for him. She noted that her grandson
(who lives with her and is younger than George) and George like to play together when George is at her
house.
When Dr. Milton met with George one-on-one to conduct the psychoeducational assessment,
George was extremely fidgety in his seat and tried to play with all of the objects on Dr. Milton's desk.
Given these behaviours, Dr. Milton instituted a behavior program which was helpful in enhancing both
George's motivation for the assessment and his ability to sit and stick with the assessment activities. With
the behaviour program, George was more settled, and Dr. Milton observed that George shared interesting
and detailed stories with lots of animation! Using the WISC-V, she found that George's intellectual
ability was within the Average to High Average range. Using the WIAT-IV, George was found to be
achieving well below the level expected for his age in the areas of reading and writing (approximately at a
grade 1 level), but his math skills were age/grade appropriate. She also found significant difficulties with
grapho-motor output (VMI-6) and phonological processing (CTOPP-2), as well as some verbal memory
problems (WRAML-2), and there was evidence that these were impacting his academic skills. By using
this behaviour program, Dr. Milton was confident that the results of the assessment were valid and
reliable.

Expert Solution

Step 1: Introduction

After a thorough examination of eight-year-old George's situation, the primary diagnosis that best fits his case is Learning Disorders. This means that George is facing significant difficulties with his schoolwork, especially in reading and writing. These difficulties are consistent and have a substantial impact on his academic performance.