Counselors of children and adolescents typically receive informal information about their client before the first meeting. Someone has become concerned enough about the young person to suggest counseling. Counselors use this background information to develop questions for themselves that they try to answer in their first interview with a child.
The answers lead the counselor through a process called differential diagnosis, whereby various plausible alternatives are ruled out to form an initial diagnosis. The initial diagnosis is the basis for the initial treatment plan. The initial diagnosis and treatment plan may be changed later as more facts come to light, but they are very important because they offer a counselor a place to start. Your task for this assignment is to develop a differential diagnosis.
Choose either the case of Luis, the child, or the case of Crystal, the teen. Decide upon your diagnosis by working through these six specific steps, as described in the DSM-5 Handbook of Differential Diagnosis, linked in Resources (see pages 1–16).
1. Rule out malingering and factitious disorder. (Are the symptoms genuine?)
2. Rule out substance etiology. (Are the symptoms a result of the consumption of drugs or alcohol?)
3. Rule out an etiological medical condition. (Is there a medical condition that explains the symptoms?)
4. Determine the specific primary disorder(s). (What appears to be the most accurate initial diagnosis?)
5. Differentiate Adjustment Disorder from the residual Other Specified or Unspecified Disorders. (Have the symptoms developed into a sufficiently maladaptive response meriting a primary disorder, or are they better described with one of these other diagnoses?)
6. Establish the boundary with “no mental disorder.” (Is a primary diagnosis merited due to “clinically significant” symptoms, or are the concerns better described as “Other Conditions that May Be a Focus of Clinical Attention“? Not all counseling involves treating a mental disorder.)
The Case of Luis
Luis is in the fourth grade. His mother is concerned that he may need counseling because he has not grown out of a fear he has had since he was young that is now interfering with developing peer friendships. Luis is afraid of vomiting in a public place. As you speak with him, you learn that when he was in kindergarten, he once got upset and cried so much that he vomited. His teacher was not particularly sympathetic and his parents could not be reached for a while, so he spent several hours with soiled clothes, feeling very ashamed and embarrassed. Subsequently, he became fearful that he might vomit again, with no reason or warning. His behaviors have become more restricted over the years, and now he will not eat if his family goes out to dinner because he fears the food might make him sick. He eats very little at school—just a few foods that he has decided are safe—and his peers have beg
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