Question

WHAT DO YOU MEAN BY "EXTERNAL SOURCE MENTIONED" PLAESE TELL ME SPECIFICALLY!!

Instructions: Read the case study, The Boy with No Restraint, on pages 137-139 in the textbook. Then complete the following sections of the diagnostic report. This assignment should be no more than 5 pages long

Client strengths: All clients have strengths. What are these client’s strengths and how could they benefit his recovery and continued good mental health?

Client limitations: What potential limitations does this client possess in terms of his recovery and continued good mental health?

Differentials: List three differentials for each disorder you are considering, why you considered it, and why you rejected it. Your differentials should be rational, not random. For example, do not use Alcohol Use Disorder as a differential when the diagnosis is Major Depressive Disorder. The client should exhibit some symptoms of the disorder you use as a differential, but not enough to qualify for the diagnosis.

Diagnosis: List all DSM-V diagnoses and specifiers for the client in the case. Some will have only one disorder, others will have multiple diagnoses.

Rationale for diagnosis: Looking at the DSM-V criteria for each final diagnosis you select, provide your rationale for selecting that diagnosis.

Case 2 The Boy With No Restraint

Sam is a nine-year-old African-American male who is new to a school that offers educational services for children who can no longer perform in an ordinary school setting. He came from an elementary school where he attended a special education program. He was referred to the specialized school because he continued to exhibit significant behavioral, social, emotional, and academic difficulties.

The prior public elementary school’s psychological report stated that Sam spent a majority of his time out of the classroom, either on suspension or in counseling sessions because of his behavior. The report also stated that he required physical restraint on a number of occasions and was recently so aggressive and dangerous that the school filed a complaint with the court asserting that he was out of control both at home and in school. No further information was available about the outcome of this referral to the courts, nor about the specifics of the behavior that warranted such a referral.

Sam lives with his mother, his three-year-old brother, paternal great-grandmother, and uncle in his great-grandmother’s home. The family recently moved from the home of Sam’s grandmother after a heated argument between Sam’s mother and her own mother. This is the third move and Sam’s fourth school in just three years. Sam’s father was shot to death a year ago (his mother was no longer with him at the time), and he has no contact with his father’s family except for his paternal great-grandmother. Sam did have a relationship with his paternal grandmother, but she passed away six months ago.

Sam’s mother completed the 11th grade, is currently unemployed, and collects Supplemental Security Income. It is unclear why Sam’s mother receives such assistance. Sam also has a 12-year-old half brother and a 10-year-old half sister. All the children have the same mother but different fathers, and the older children live with their paternal relatives.

Sam’s family had home-based services to assist with the difficulties they were experiencing, but the services were terminated several months ago because the agency lost all contact with Sam’s mother. The home-based worker stated her belief that Sam’s mother may have started a new relationship, and that in the past she has allowed her relationships with men to take away from her time with her children. The worker also stated that the unstable living situation and Sam’s mother’s mental state (which she believes may be persistent depressive disorder) make it difficult to work with the family on a consistent basis. Through the home-based services agency, Sam was connected with mental health counseling, but his attendance and participation were sporadic.

About a year ago, Sam took the Woodcock Johnson tests, which indicated that his reading, writing, and math skills were significantly delayed for his age, IQ, and educational level. His academic achievement is poor because of these delays. Because of his refusal to participate in a number of the tests, his IQ score could not be accurately identified, but the examiner estimated it to be in the range of 74 to 87.

Since the beginning of the school year Sam has continued to exhibit aggressive and dangerous behaviors. In a meeting with the behavior staff director of the school, the social work intern learned that Sam will have to be searched daily because of his many threats of bringing a knife or gun to school to kill staff. Sam has had to be physically restrained by staff at least a dozen times. The director stated that she would never restrain Sam alone and that it takes two to three staff to do so safely. In this same meeting, the director stated that Sam has attempted to stab staff with pencils and thumbtacks grabbed from hallway bulletin boards.

In locked restraint, Sam will kick the door and scream out obscenities. According to incident reports, Sam has spit at, lunged at, and attacked staff and has even tried biting. He tends to blame others for his behavior (“I’m in support because [staff member] said a bad word to me.”). He neither shows remorse for his behavior nor empathy toward people he has been angry with.

Sam’s teacher reports that he often has difficulty transitioning from one location to another or from one assignment to another. Sam refuses to complete his school assignments and will not accept redirection from his teacher. He often becomes verbally disrespectful toward her, but she reports he has not yet been physically aggressive. She does report that he often destroys property (ripping papers, breaking pencils, turning over chairs and desks) when upset and is known for tearing up his school worksheets when he does not want to work on them.

Sam currently spends a significant amount of time out of class because of his behaviors. He is falling behind in class work because of his absence from lessons and his refusal to participate. Not surprisingly, Sam doesn’t have friends because other children are scared of his out-of-control behaviors.

Sam’s mother is difficult to contact, and she doesn’t return telephone calls in a timely manner. She is guarded about sharing personal information. She attended the most recent individualized educational plan (IEP) meeting and reports that since Sam was a young child, she has seen similar behaviors at home. When Sam gets frustrated, he becomes verbally and physically abusive toward her.

Sam’s mother states that she has sought outside help to control Sam’s behavior. She attempted mental health counseling, but discontinued services because he refused to speak. Sam’s mother says that she is overwhelmed and has tried every punishment—spanking, sending him to his room, taking away privileges—but that none of her efforts has been successful in changing his behavior. She says that he does not seem depressed to her, just angry. Sam’s mother states that she has also called Juvenile Court to relinquish Sam. She was told to come in to complete the intake process but did not do so.

Sam presents as a well-dressed and well-groomed young boy. When he is not upset, he is engaging and very polite. He states that he enjoys coming to the sessions with the social work intern, and he plays games cooperatively, though with high energy, during these times. He shows particular interest in sports, especially basketball. He doesn’t bring up his deceased father or other aspects of his family life and shies away from questions about them, although he admits to feeling “sad” about his father’s and his grandmother’s deaths. He denies, however, that he is sad in general. He says he has not been sexually or physically abused, but says that in the past his mother and a couple of her boyfriends have “whipped” him but not left marks. Sam’s most recent physical examination, performed a year ago, confirms that he is in good health and particularly noted that he has a good appetite.

Answer 1

Client limitations: there are a number of reasons that may be interfering with the treatment of Sam. his family situation, death of the father. Depressive mental state of the mother- the fact that his mother’s relationships are taking her time away from her child. Separation from the grandmother.

Client strengths: when Sam is calm and out of his anger state, he seems to be fairly composed as viewed from the following: Sam presents as a well-dressed and well-groomed young boy. When he is not upset, he is engaging and very polite. He has distractions and has developed interests: He states that he enjoys coming to the sessions with the social work intern, and he plays games cooperatively, though with high energy, during these times. He shows particular interest in sports, especially basketball. He is not cribbing about his deceased father and moaning about the same thing, showing that he is not depressed. He doesn’t bring up his deceased father or other aspects of his family life and shies away from questions about them, although he admits to feeling “sad” about his father’s and his grandmother’s deaths.

Differentials: agitation, inability to control anger and no social interaction or emotional remorse or other actions could have been identified as ADHD, If he did not show emotional composure, which does not get in sync with ADHD. Another differential is of bipolar disorder, in which the person may also be known to be a manic depression where he has periods of increased mood. There may be symptoms of psychosis where the individual shows abnormal behaviours. He is behaving abnormally in phases and is showing bouts of psychosis for example stabbing the staff. But, he is not showing any signs of depression or being sad. Hence, this disease could be eliminated. The next differential can be personality disorder in which a person is showing maladaptive behaviours. He is showing two different types of personalities, one is extremely violent and aggressive and the other form is highly composed and interested in sports. He doesn’t have impulse control or emotions towards his mother or even about his deceased father. Also, it is observed since childhood.

Rationale for diagnosis: DSM V criteria include

- cognition ( interpretation of self and others) : he is constantly saying that he feels some other person is making him do bad things.

- affectivity: emotional responses are nil, as he is not talking about his deceased father or neither thinks of them. Also, he is not showing much emotions towards his mother.

- impulse control: is not present as he cannot control his anger, and sometimes more than one person is required to control him.

- interpersonal functioning is absent: since he lacks empathy.