Table of Contents
Case Study
Hank, 11-year-old Caucasian boy in the fifth grade with recommendations to be evaluated for excessive anxiety in the classroom setting. He had frequent worries regarding school performance and became distressed when presented with challenging academic tasks. Reportedly, Hank’s behavior in the class is distractive. Besides the excessive worry about academic performance, Hank is reported to have been experiencing anxiety and worry concerning social situations. Having been raised in a household of four, he had been showing some level of distractibility and inattentiveness. Compared to the older brother, Hank would always pay less attention to things. These symptoms were more apparent at the age of six when Hank entered the first grade. These features are attributable to the father who had organizational difficulties and distractibility since childhood. Moreover, the mother had features of depression and worried about difficulties in managing emotions.
Differential Diagnosis Systematically
Concerning this information, the six steps of differential diagnosis are significant to Hank’s Impulse-Control Disorder. The first step is to rule out factitious and malingering disorder. Evidently, this step is essential to make sure a patient is honest with symptoms. According to First (2014), malingering disorder is driven by a patient motivation to avoid recognizable goals such as avoiding responsibilities. On the other hand, factitious disorder involves a patient taking a sickness role for psychological reasons and hence, both are not mental disorders. Nevertheless, the two disorders can be ruled out in Hank’s case, as his distractibility and inattentiveness in school are true symptoms.
The second step will involve ruling out any substance use. First (2014) asserts that psychiatric presentation in a patient can be due to substance use. This determination will be done by ordering laboratory tests on Hank, interviewing his parents and family members, and looking for any signs of intoxication. If Hank diagnosis of substance abuse is negative, the third step will be paramount to rule out mental disorder due to general medical state. Clinicians should diagnose medical conditions that are general, which could account for symptoms of psychiatry. General medical conditions might cause issues of mental health through a brain psychological effect, such as cancer diagnosis or stroke (First, 2014). Therefore, the temporal relationship of Hank will be assessed to determine if the impulsive and conduct disorder began after affected by a general medical condition.
The fourth step will involve determining the particular primary disorder. Evidently, the symptoms and clinical history such as anxiety and depression portrayed by Hank display a possibility of impulse-control disorder. Furthermore, a fifth step is paramount that will involve differentiating disorders of adjustment from categories that are unspecified. According to First (2014), clinicians should use adjustment disorder to patients who present severe symptoms of subthreshold nature that cause clinical distress. Reportedly, anxiety and worrying symptoms of Hank are distressful and hence need to use adjustment disorder. Finally but importantly, the last step will involve determining the impact of symptoms to social and occupational impairment. Reportedly, Hank anxiety and distractive symptoms have a distressful effect on his social and academic situations.
Evidence and One Non-Evidence-Based Treatment
Evidence and non-evidence methods exist for the treatment of impulse control disorder. One of the evidence-based techniques for treating children with disruptive behavior disorder is the use of cognitive behavioral therapy (Eiraldi, Mautone, & Power, 2012). These form of treatment assist in controlling behaviors of children that are antisocial and strengthen their behaviors. Evidently, Hank has anxiety and worry regarding social situations, and hence this treatment will be sufficient to make him aware of strategies to control behavioral triggers. On the other hand, an example of a non- evidence based is the use of medication to treat disruptive behaviors, also known as pharmacotherapy. There are different types of drugs that can be used to treat impulse control disorders such as depression, anxiety, and behavioral problems (Boileau, 2011). However, no medication algorithms exist for physicians to consider for treating disruptive disorders of behavior in children (Froehlich et al., 2007). The poor efficacy of pharmacotherapy as a disruptive behavior treatment renders it as a non-evidence based practice.
Inappropriate Perspective of Disruptive Behavior Disorder
Improper theoretical orientations exist regarding disruptive behavior disorder. They include Psychodynamic, humanistic, cognitive-behavioral, and electric theories. The psychodynamic theory is the oldest psychology theory, and therapists analyze individuals as a product of upbringing from their parents (Brookman-Frazee, Garland, Taylor, & Zoffness, 2008). Hank’s parents have a depression history, and hence, this theory would be inappropriately used in this situation to blame the parents. This therapy leaves a lot to be desired. Furthermore, humanistic theory views humans as generally good and positive. Nevertheless, this approach has some significant conflicts such as an individual thinking about being authentic against being fake, life against death and many others. It emphasizes epic but struggles at the same time within someone and hence inappropriate (Brookman-Frazee, Garland, Taylor, & Zoffness, 2008). Hank is an eleven-year-old boy who would be confused by such therapy. Establishment of disruptive behavior in children has different perspectives. The first case was established in 1880 where the originality of the disorder lied within the legal and social problem of delinquency (Simion, Crasan, Calin, Muscalu, & Macovei, 2014). Apparently, antisocial and delinquency problem in children was regarded as an educational and medical problem at this period.
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- First, M. B. (2014). DSM-5 TM handbook of differential diagnosis. Washington: American Psychiatric Association.
- Froehlich, T. E., Lanphear, B. P., Epstein, J. N., Barbaresi, W. J., Katusic, S. K., & Kahn, R. S. (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of pediatrics & adolescent medicine, 161(9), 857-864.
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