Part 1: Personal check-in: What age is too early to diagnose and why? What are s
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What age is too early to diagnose and why?
What are some challenges in diagnosing children, including (but not isolated to) trauma?
Outlining a basic assessment:
What is the presenting issue and why?
What were the secondary issues?
What is the risk assessment?
What is the diagnosis? Explain your rationale.
Part of diagnosing children is assisting parents and managing adjustment in the family system. Review various resources (this can be anything, but the peer-reviewed literature has a lot of information on this topic) and discuss family interventions and family supports. What are the salient considerations? Include your source(s) here as well and cite them appropriately.
Brandon was a 12-year-old boy brought in by his mother for psychiatric evaluation for temper tantrums that seemed to be contributing to declining school performance. The mother became emotional as she reported that things had always been difficult but had become worse after Brandon entered middle school.
Brandon’s sixth-grade teachers reported that he was academically capable but that he had little ability to make friends. He seemed to mistrust the intentions of classmates who tried to be nice to him, and then trusted others who laughingly feigned interest in the toy cars and trucks that he brought to school. The teachers noted that he often cried and rarely spoke in class. In recent months, multiple teachers had heard him screaming at other boys, generally in the hallway but sometimes in the middle of class. The teachers had not identified a cause but generally had not disciplined Brandon because they assumed he was responding to provocation.
When interviewed alone, Brandon responded with nonspontaneous mumbles when asked questions about school, classmates, and his family. When the examiner asked if he was interested in toy cars, however, Brandon lit up. He pulled several cars, trucks, and airplanes from his backpack and, while not making good eye contact, did talk at length about vehicles, using their apparently accurate names (e.g., front-end loader, B-52, Jaguar). When asked again about school, Brandon pulled out his cell phone and showed a string of text messages: “dumbo!!!!, mr stutter, LoSeR, freak!, EVERYBODY HATES YOU.” While the examiner read the long string of texts that Brandon had saved but apparently not previously revealed, Brandon added that other boys would whisper “bad words” to him in class and then scream in his ears in the hall. “And I hate loud noises.” He said he had considered running away, but then had decided that maybe he should just run away to his own bedroom.
Developmentally, Brandon spoke his first word at age 11 months and began to use short sentences by age 3. He had always been very focused on trucks, cars, and trains. According to his mother, he had always been “very shy” and had never had a best friend. He struggled with jokes and typical childhood banter because “he takes things so literally.” Brandon’s mother had long seen this behavior as “a little odd” but added that it was not much different from that of Brandon’s father, a successful attorney, who had similarly focused interests. Both of them were “sticklers for routine” who “lacked a sense of humor.”
On examination, Brandon was shy and generally nonspontaneous. He made below-average eye contact. His speech was coherent and goal-directed. At times, Brandon stumbled over his words, paused excessively, and sometimes rapidly repeated words or parts of words. Brandon said he felt okay but added he was scared of school. He appeared sad, brightening only when discussing his toy cars. He denied suicidality and homicidal. He denied psychotic symptoms. He was cognitively intact.