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.
Need to use references
F80.82 Social (Pragmatic) Communication Disorder
Z55.9 Academic or Educational Program
Criteria were met for Social (Pragmatic) Communication Disorder, with a significant number of signs present. Juan is a 10-year-old boy who is in 5th grade. Juan was adopted at the age of 3 ½ and now lives with his adoptive parents and three adoptive siblings. Juan has difficulty in communicating in appropriate manners such as: expressing emotions through tantrums, consistently speaking loudly in conversation, interrupting others when talking, and trouble listening, understanding, and following rules (criteria A1,2,3,4). These deficits are negatively affecting communication and relationships with family members, teachers, and other students (B). Criteria C is met as evidenced by the increased changes in behaviors at home and school over the years. Criteria D was met as there is no evidence of symptoms being attributed to a medical condition, autism spectrum disorder, or intellectual disability.
Other DSM 5 Diagnosis That Were Considered
F70, Intellectual Disability was considered as Juan was having difficulty regulating emotions and behavior in age-appropriate ways. This was noticed by both Juan’s adoptive mom, school staff, and fellow students. This diagnosis was also considered as the orphanage in Guatemala stated Juan had developmental language delays. No standardized testing results were received to confirm this information. The diagnosis was ruled out as Juan did not meet the three criteria for an Intellectual Disability.
F84.0, Autism Spectrum Disorder was considered as Juan had difficulty expressing emotions such as jealousy, using nonverbal communication through tantrums and disruptive behaviors, and difficulty in developing friendships. The diagnosis was ruled out as Juan did not meet the minimum 2 criteria of part B for Autism Spectrum Disorder.
F90.1, Predominately Hyperactive/Impulsive Presentation was considered because of Juan’s restlessness, inability to wait for his turn in conversations, and increased disruptive behaviors. The diagnosis was ruled out as Juan did not meet the minimum 6 criteria for Predominately Hyperactive/Impulsive Disorder.
Two disorders that were automatically eliminated as possible choices with the neurodevelopmental spectrum were the Specific Learning Disorder and Motor Disorders. These disorders were not considered as Juan was keeping up with his schoolwork and had no deficits with motor skills.
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.
F80.82 Social (Pragmatic) Communication Disorder
Z62.891 Sibling Relational Problem
Z91.49 Other personal history of psychological trauma
Z60.4 Social exclusion or rejection
Z62.820 Parent-child relational problem
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Social (Pragmatic) Communication Disorder encompasses all symptoms identified by Juan, such as lack of social skills in regards to communicating with others and knowing when to let others finish their sentences and then speak, as well as knowing how to use a normal volume (“indoor voice”). Additionally, Juan’s communication deficits interfere with his learning environment as he will either disrupt the class with his own comments or will become restless and stumble over his words, take long pauses when speaking and struggles to maintain a normal speech rate and volume.
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.
Attention-Deficit Hyperactivity Disorder was excluded due to the lack of six symptoms present within criterion A1 and A2 although symptoms met the criteria for B, C, D, E.
Language Disorder was excluded due to client not meeting criteria A1, A2 and A3. Although it is reported that Juan stumbles over his words or pauses excessively between words, he can formulate sentences to have a conversation.
Autism Spectrum Disorder was excluded due to client not meeting criteria in section B. Juan did show symptoms in section B2 due to needing a consist plan and disliking transition but did not show symptoms for other restricted or repetitive patterns of behaviors, activities or interests.
Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.
Obvious eliminations from within the neurodevelopmental spectrum are Motor Disorders as there is no indication of motor deficiencies.
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.
Diagnostic Criteria of Social (Pragmatic) Communication Disorder:
A1. Deficits in using communication for social purposes- Juan has no friends and bullies’ others to get what he wants.
A2. Impairment of ability to change communication to match context- Juan needs to be reminded to use an indoor voice (lower volume), needs to be reminded to wait his turn when speaking so others can finish their sentences and he gets restless in small group settings, stumbles over his words, pauses excessively and then begins to speak rapidly and loudly.
A3. Difficulties following rules for conversation and storytelling- Juan has difficulty letting others finish speaking and talks over them (with family members and peers in classroom).
A4. Difficulties understanding what is not explicitly stated- Juan does not respond/understand terms such as “wait his turn” or “indoor voice”.
B. Deficits result in functional limitation in effective communication between his peers and family members, social participation and social relationships as he has no friends and is a bully, and academic achievement as he struggles to follow rules, is disruptive and becomes restless in small group settings.
C. Onset of symptoms are in the early developmental period
D. Presenting symptoms are not attributable to another medical or neurological condition
Diagnostic features also note that social use of language and communication is manifested by deficits in understanding and following social rules of verbal and nonverbal communication in naturalistic contexts. Juan does not understand social rules of letting one person speak at a time and “waiting his turn”. Additionally, another DSM5 criteria noted in the Development and Course section is that by age 4 or 5 years, most children should possess adequate speech and language abilities to permit identification of specific deficits in social communication. Juan shows signs of being able to communicate with others but shows deficits in how to effectively communicate by taking turns speaking and maintaining normal speech volume and rate.