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Crystal is a 14-year-old girl in the tenth grade. Crystal’s school counselor has contacted you in order to refer her due to concerns about recent changes in her behavior. Last year, when Crystal was in ninth grade, her grandmother had a fatal stroke. Crystal was very attached to her grandmother, as she had lived with her intermittently during childhood. Crystal’s teachers reported that she seemed extraordinarily sad about this loss; she lost interest in her studies and seemed very withdrawn, spending entire class periods with her head on her desk. This year, however, Crystal has been very irritable toward her teachers and has been caught fighting with other girls on several occasions over minor provocations. She has been suspended twice for this behavior. She was recently referred to a community health center, where no physical problems were found. When you talk with Crystal, she confirms all this but also tells you that she witnessed her grandmother’s death, and that her father blames her, saying Crystal “stressed her out.” Crystal says she hates her current family situation because her father plays favorites with her siblings and step-siblings, and admits to occasionally sneaking whiskey from her father’s stash when she feels very upset. She says she finds it difficult to concentrate in school. She feels very guilty about her grandmother, and says she sometimes wishes she could join her “on the other side.”
Develop a differential diagnosis for Crystal by reviewing the following DSM-5 Handbook for Differential Diagnosis Decision Trees and Tables:
o 2.1 Decision Tree for Poor School Performance.
o 2.15 Decision Tree for Behavioral Problems in a Child or Adolescent.
o 2.9 Decision Tree for Irritable Mood.
o 2.9 Decision Tree for Depressed Mood.
o 2.16 Decision Tree for Trauma or Psychosocial Stressors Involved in the Etiology.
o 3.4.1 Depressive Disorders.
o 3.4.4 Disruptive Mood Disorder.
o 3.14.1 Oppositional Defiant Disorder.
o 3.7.1 Trauma- and Stressor-Related Disorder.
o 3.15.1 Substance Use Disorders.
The differential diagnosis for your chosen case will be used in this unit’s discussion.
Resources
· DSM-5 Handbook of Differential Diagnosis.
Diagnosing Children and Adolescents
In your Discussion post, use the differential diagnosis you developed for your chosen case in this unit’s third study:
o Note your thoughts for each of the six steps, including your rationale for your initial diagnosis.
o What other diagnoses did you consider, but tentatively rule out?
o List three questions you could pursue in future sessions to be even surer of your diagnosis (by ruling out other potential diagnoses).
Resources