Question

Hi! Below is the case study and I want to make sure I'm on the right track. I bolded the questions I'm interested in (1-5). Looking for people who are familiar with the DSM-5/abnormal psychology and able to answer all questions completely. Thank you!

Questions:

1. Diagnosis; what is the evidence for it?

2. Treatment; typical treatment used for this diagnosis AND most effective treatment. IF the person is in treatment, what should we target first in terms of symptoms? How likely are they to stay in treatment and how likely are they to recover? Are meds involved and if so, what broad “type” of meds work for this disorder,?

3. Differential diagnosis (why is it this disorder and not this disorder)

4. Does the person have more than one diagnosis, what would DSM say about the criteria for diagnosing that

5. What would the primary causal theories be?

CASE STUDY BELOW:

Shane is an 11 year old boy in the sixth grade at a private Catholic middle school. Shane has a history of being hyper, irritable, and off task at both school and home - he has difficulty with motivation and attention and is quite impulsive and is a risk-taker. He has frequent behavior problems both at school and at home, mostly due to being impulsive and not thinking much about rules and consequences. Shane plays sports and is very good at them - he is on the all-star team with soccer and basketball and his coaches love him. He is also a very talented musician, but he always forgets to practice, so his music teacher is frequently frustrated with him. Shane gets very poor grades in school also, he tends to fail tests and he often forgets to turn assignments in. He has a tutor, but it does not help. He says he just does not understand or care about much of the work he is supposed to do. Shane loves video games and this takes up a lot of his free time, it is also a source of frequent arguments with his parents, as they want him to spend less time on this activity. Shane actually argues about lots of things - he even argues when it is clear he will lose! Shane also has a long history of having “friend issues” - he has a couple of friends, but he often seems to just “not fit in” with many of his peers and he sometimes seems to almost “seek trouble out”. He tends to hang with troublemakers also, so that’s an ongoing issue. Shane’s parents have tried everything to help him, but Shane does not respond to their attempts and he continues to have the above problems and issues despite their hard work.

Answer 1

1. Shane's showing symptoms of Attention Deficit Hyperactivity Disorder (ADHD) or ADD with Hyperactivity. Symptoms shown by him matches that of ADHD from DSM. His symptoms include, as mentioned in case study:

1. Irritability
2. Hyperactivity (excessive physical movement and being hyper)
3. Impulsive
4. Risk-Taking
5. Lack of attention
6. Difficulty focusing on task
7. Forgetfulness
8. Unable to listen to instructions
9. Little or no sense of danger

These symptoms are that of Attention deficit (lack of attention, difficulty focusing on task, forgetting, not listening to instruction) and that of Hyperactivity (Hyper, physical movements, risk taking, impulsive, no sense of danger)

2. If Shane decides to get a treatment the symptoms first treated would be for his lack of attention and impulsiveness and irritability. It can be done by using Behavior therapy, anger management, education programs and social skill training. Using behavior therapy and anger management Shane's irritability and anger can be managed and using behavior therapy certain behaviors can be encouraged using a rewarding system. This will help Shane get over bad behaviors causing problem for him. Using education programs, a specific program can be tailored to help increase his attention, his can include playing games or using activities to help raise Shane's concentration. It can also help Shane's parents in managing him as these programs aim to teach parents and caretakers in managing children with problem. Using social skill training Shane can be taught how to behave socially and make friends, etc.

Treatment of ADHD takes time depending upon how regular a person is. Usually most of these treatments are to be continued at home and chances of recovery is high when treatment is administered regularly. Treatment works fast when therapies are combined with medications. If Shane's parents are determined they will see to the end that Shane gets remission from the symptoms of ADHD and they will be regular with the treatment causing a fast recovery.

In case of medications most commonly used drugs are stimulants like Ritalin, Methylphenidate, etc. These medications help in containing impulsiveness and increase concentration. Non-stimulant drugs are also administered like Stratter, Kapvay, and Intuniv, etc. But these are less effective when compared to stimulants. But these medications are usually administered by medical doctors and it would be best that a doctor be consulted before deciding to put a child on medication as medicines have side effects.

3. Given below are differential diagnosis of this disorder and its difference from ADHD

DIFFERENTIAL DIAGNOSIS	DIFFERENCE FROM ADHD
Learning Disorder	Lacks symptoms of Hyperactivity Symptoms are specific to subjects or academics
Conduct Disorder and Oppositional Defiant Disorder	Does not show attention lacking (only defiance to authority) Lacks hyperactivity even though impulsiveness is present Shows behavioral problems like rebelling, stealing, lying, etc.
Anxiety and Mood related disorders	Lack of attentiveness is not observed There is a lack of hyperactivity (they are overinhibited) There is no aggressive or disruptive behavior Mood is generally low, with always a lack of excitement
Mental Retardation and Autism Spectrum Disorders	Attention span is severely impaired (MR) Lack of speech development or broken speech Other activities and skills are impaired Completely isolated, unable to make any friends or belong to any group
Bipolar Disorder	mood swings from being maniac to being depressed Lack of attention is not seen in bipolar Decreased need for sleep promiscuousness or hypersexuality

4. More than one diagnosis are possible, but that is only and only if the child is known to have co-morbid disorders. Co-morbid disorders for ADHD includes learning disability, depression, schizophrenia, etc. If Shane has shown any symptoms for these co-morbid disorders he will be diagnosed and treated for both. DSM-5 specifically states that for ADHD to be classified it should satisfy the following criteria:

• Symptoms of both hyperactivity and attention deficit should be persistent and interfering with functioning of daily life.
• There should be at least 6 or more symptoms
• Symptoms must be evident before the age of 12 years
• Symptoms must be present in 2 or more settings (like home, school, etc.)
• Symptoms do not appear exclusively at the time of psychotic disorder and these symptoms are not better explained by other mental illness or due to substance abuse.

5. Exact cause of ADHD is unknown and there are little research results proving any linkage to any cause otherwise. Mostly the cause of ADHD is attributed to it running in genes. Other causes that many researchers believe might be due to mother’s use of substance, drug, smoking, etc. during pregnancy. This can increase the risk factor of getting ADHD in children. Some researchers also attribute the cause to sugar and other food additive and preservatives used. These can cause damage and might increase the risk of acquiring ADHD. Sometimes diet change is also included as a part of therapy for treating ADHD.