Deficit Hyperactivity Disorder

F90.2   Attention deficit hyperactivity disorder combined presentation moderate  Z81.8 Family history of mental disorder


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Explanation of the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis


According to DSM-5 criteria, for an individual to be diagnosed with inattention and/or hyperactivity-impulsivity disorder, that individual must meet six or more symptoms of each inattention criteria and hyperactivity-impulsivity criteria to be diagnosed as having attention deficits hyperactivity disorder combined. The ADHD symptoms Bryan demonstrates are restlessness, constant running, requiring reminders to stay in the task, difficulty listening and following instructions, destructive behavior both at home and in school to name a few.

· Hyperactivity: The scenario states that Bryan is constantly running, has difficulty sitting in class, listening, and following through with instruction, and requires reminders to stay on task and focus.

· Impulsive: Bryan blurts out answers and interrupts other students in class, is emotionally impulsive, has confrontational behaviors, inappropriate behaviors, cries, gets upset when he does not receive recognition or feels that he has been ignored, is socially immature, and often demonstrates attention-seeking behavior. In addition, Bryan is said to be easily frustrated and emotionally impulsive.

· Opposition defiant behavior: Bryan demonstrates confrontational behavior both at home and at school. He has trouble listening to his parents and teachers and has incidents of destructive behavior in the classroom, often loses his temper, hits others, lies, and is argumentative.


Identification of diagnoses I initially considered in the case using the DSM-5 diagnostic criteria


F84.0 Autism spectrum disorder: According to American Psychiatric Association (2013), to diagnose autism, there are five areas or criteria to look at to have an appropriate diagnosis. These include the client’s social interaction and communication. In the scenario, Bryan enjoys spending time with his friends and participating in physical activities and other social events like swimming, play dates, and birthday parties. It was also stated that Bryan is argumentative, thus showing Bryan has no issues with communication. Therefore, with average social interaction and communication, this diagnosis of autism was ruled out because Bryan did not meet the criteria specified for autism disorder to be diagnosed.


F780.5 Unspecified insomnia disorder: It was stated in the scenario that Bryan had challenges falling asleep and difficulty maintaining sleep. According to American Psychiatric Association (2013), insomnia disorder can be diagnosed in children. This issue was a red flag in Bryan’s case scenario. It needs further assessment because it could be a potential contributing factor to his behavior. However, the diagnosis was ruled out for lack of medical or genetic information that could further shed insight into Bryan’s symptoms.


F90.9 Unspecified attention-deficit hyperactivity disorder: According to American Psychiatric Association (2013), the more symptoms present from a particular illness, the more likely the diagnosis is correct or possible. Therefore, this diagnosis was ruled out because there was sufficient information provided to give a specific diagnosis.


F63.81 Intermittent explosive disorder: According to American Psychiatric Association (2013), this disorder is a recurrent behavioral outburst representing a failure to control aggressive impulses. The outburst can be sometimes unprovoked and can be diagnosed in children as young as six. According to the DSM-5 criteria, this outburst can be verbal or physical and occurs twice a week for at least three months (American Psychiatric Association,2013). This diagnosis was ruled out because we were not given sufficient information about Bryan’s outburst. In addition, individuals with this disorder show serious aggression towards others. However, Bryan was described as a caring young boy. Therefore, he did not meet the criteria for this diagnosis.


Obvious eliminations that could be made from within the neurodevelopmental spectrum 


According to American Psychiatric Association (2013), intellectual/learning disability is diagnosed when specific deficits in an individual’s ability to perceive, process information, reason, and abstractly learn. The obvious elimination is intellectual and learning disability because this disability is a neurodevelopmental disability manifested early in development or before school age. Therefore, Bryan does not present the intellectual or learning disability because it could have been noticed or diagnosed before turning eight. Although, it was stated that Bryan requires regular redirection. However, the case study also stated that Bryan is an intelligent young boy who presents significant potential to excel academically. Having a significant potential to excel indicates that Bryan does not have an intellectual or learning disability.


How the client’s symptoms match up with the specific diagnostic criteria for the primary disorder that I finally selected for him.


According to the DSM-5 criteria, several symptoms must be exhibited in two locations. Thus, in Bryan’s scenario, both the school and the mother states that Bryan is defiant and confrontational both at home and in school. Another criterion is evident that the symptoms interfere with or reduces the quality of social, academic, and employment function. It was stated in the scenario that Bryan gets easily frustrated, has difficulty sitting down and following instructions, he blurts out answers, is often on the go, and never sits when sitting is expected. In addition, DSM-5 criteria require that several of these symptoms of ADHD are present before age twelve. Bryan, who is eight years old at present, has demonstrated these destructive behaviors in his pre-school program at age four and each school year since then, his teachers have reported incidents.



American Psychiatric Association. (2013j). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appbooks.9780890425596.dsm01

Plummer, S.B., Makris, S., & Brocksen, S. (2013). Social work case studies: Concentration year. Baltimore, MD: Laureate Publishing.


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