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Week 4: Putting It All Together: Differential Diagnosis and Neurodevelopmental Disorders
Clinicians often have to employ multiple skills simultaneously while engaging with clients. Not least among them are reflective listening, information gathering and sensitive questioning, recording key responses, observing for signs of syndromes, and identifying the chief complaints. This week you address the complex process for identifying and distinguishing among similar diagnostic syndromes.
This process begins in the diagnostic interview. Research of skilled clinicians shows that forming diagnostic impressions too quickly increases the risk of errors in diagnosis. Every clinician should be evaluating differential diagnoses at the diagnostic interview and beyond. While social workers want to resolve their own uncertainty, using the formal steps of a decision tree ensures accuracy. A decision tree is especially important when all available data is not pointing in the same direction.
This week, you walk through the steps of a differential diagnostic decision tree using a case within the neurodevelopmental disorders. At the same time, you begin to meet with your colleague in case consultation about your individual case assignment.
Learning Objectives
Students will:
Develop a DSM diagnosis utilizing a differential diagnostic process
Analyze a case study focused on a neurodevelopmental disorder utilizing steps of differential diagnosis
Assess progress with a colleague on a collaborative assignment
Outline a plan to create a diagnosis
Learning Resources
Required Readings
First, M. B. (2014). Handbook of differential diagnosis. Washington, DC: American Psychiatric Association
Note:
You will access this e-book from the Walden Library databases.
Chapter 1, “Differential Diagnosis Step by Step” (pp. 14–24)
Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Part 1, “The Basics of Diagnosis” (pp. 3–56)
American Psychiatric Association. (2013f). Disruptive, impulse-control, and conduct disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm15
American Psychiatric Association. (2013k). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01
American Psychiatric Association. (2013m). Other conditions that may be a focus of clinical attention. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.VandZcodes
Walsh, J. (2016). The utility of the DSM-5 Z-codes for clinical social work diagnosis. Journal of Human Behavior in the Social Environment, 26(2), 149–153. doi:10.1080/10911359.2015.1052913
Blackboard. (2018). Collaborate Ultra help for moderators. Retrieved from https://help.blackboard.com/Collaborate/Ultra/Moderator
Note: Beginning this week, you use a feature in your online classroom called Collaborate Ultra. Your Instructor will assign you a partner and then give you moderator access to a Collaborate Ultra meeting room. This link provides an overview and help features for use in the moderator role.
Document: Case Collaboration Meeting Guidelines (Word document)
Note: Download these guidelines and consult the Assignment instructions. You are encouraged to orient yourself to these instructions and take action as early in the week as possible.
Document: How to Write a Diagnosis According to the DSM-5 (PDF)
Required Media
Laureate Education (Producer). (2018f). Steps in differential diagnosis [Video files]. Baltimore, MD: Author Retrieved from https://mym.cdn.laureate-media.com/2dett4d/Walden/SOCW/6090/04/DD/index.html.
Optional Resources
American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures
Coker, T. R., Elliott, M. N., Toomey, S. L., Schwebel, D. C., Cuccaro, P., Emery, S. T., … Schuster, M. A. (2017). Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics, 138(3), 1–11. Retrieved from http://pediatrics.aappublications.org/content/138/3/e20160407
Document: Suggested Further Reading for SOCW 6090 (PDF)
Note: This is the same document introduced in Week 1.
Optional Media
University at Buffalo School of Social Work (Producer). (2017). Episode 221—Dr. Jennifer Cullen and Dr. Jolynn Haney: Understanding and treating autism in women: Using lived experiences to shape practice [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=221
Discussion: Applying Differential Diagnosis to Neurodevelopmental Disorders
Social work clinicians keep a wide focus on several potential syndromes, analyzing patterns of symptoms, risks, and environmental factors. Narrowing down from that wider focus happens naturally as they match the individual symptoms, behaviors, and risk factors against criteria A–E and other baseline information in the DSM-5.
Over time, as you continue your social work education, this process will become more automatic and integrated. In this Discussion, you practice differential diagnosis by examining a case that falls on the neurodevelopmental spectrum.
To prepare:
Read the case provided by your instructor for this week’s Discussion and identify relevant symptoms and factors. You may want to make a simple list of the symptoms and facts of the case to help you focus on patterns.
Read the Morrison (2014) selection. Focus on Figure 1.1, “The Roadmap for Diagnosis,” to guide your decision making.
Identify four clinical diagnoses relevant to the client that you will consider as part of narrowing down your choices. Be prepared to explain in a concise statement why you ruled three of them out.
Confirm whether any codes have changed by checking this website: American Psychiatric Association. (2017, October 1). Changes to ICD-10-CM codes for DSM-5 diagnoses. Washington, DC: Author. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5/coding-updates
By Day 3
Post a 300- to 500-word response in which you address the following:
Provide a full DSM-5 diagnosis of the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Identify which four diagnoses you initially considered in the case of the client, using the DSM-5 diagnostic criteria to explain why you selected these four items. In one or two sentences each, explain why three of these diagnoses were excluded.
Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the primary disorder that you finally selected for him. Note two other relevant DSM-5 criteria for that illness from the sections on “diagnostic features” and “development and course” that fit this case.
By Day 6
Respond to at least two colleagues in the following ways:
Compare the diagnosis you provided and the process in which you reached the diagnosis with those of your colleague.
Explain how the Z codes (other conditions that may be a focus of clinical attention) that your colleague identified may influence the client’s upcoming treatment.
Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5. You do need to include an APA reference for any other resources you use to support your response.
Note:
You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum.
If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 4 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 4 Discussion
Assignment: Case Collaboration Meeting
Collaboration is a key part of social work practice. Most MSW professionals engage in these processes during the postgraduate practice years that each state requires before their licensing moves from supervised to independent status. Even beyond those requirements, peer consultation and collaboration are key aspects of most social work practice settings.
For this Assignment, Imagine that you are working with the client featured in the case study your Instructor assigned. Your task is to provide a diagnosis and present your findings in the Week 7 Discussion.
Your diagnosis can come from any part of the DSM-5, so frequent communication and research with your colleague may be needed.
The collaboration that begins in this Assignment is intended to provide a safe venue for developing your differential diagnosis and case discussion skills with your colleague. This week you meet with your assigned partner at least once via Collaborate Ultra and begin considering the assigned case. In this Assignment, you describe that meeting and any initial analysis of the case.
To prepare:
Using the case study provided to you by your instructor.
Consult the Case Collaboration Meeting Guidelines document found in the Learning Resources.
Read ahead to the Week 7 Discussion instructions so that you can plan and reflect accordingly.
Note: In the Week 7 Discussion, you make your final findings presentation as an individual, not with your partner.
By Day 7
Submit a 1- to 2-page paper in which you describe your team meeting. In your write-up, make sure to address the following:
Describe the quality of your working relationship with your colleague.
Critically reflect on strengths of collaborative relationship and areas for improvement.
Describe your case in 100–150 words.
Identify the red flags in your case study to be further evaluated.
Outline your and your partner’s plan for further research and consultation, identifying specific tasks that you are each doing in this regard.
Identify days/times you have agreed to meet together, including the date planned to complete the CFI interview required for the Week 5 Assignment.