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Aponi Prince's presents several symptoms that align with Oppositional Defiant Disorder (ODD), in its severe form. According to the the DSM-5 criteria for ODD, an individual must exhibit a pattern of angry/irritable mood, argumentative/defiant behaviors, or vindictiveness lasting at least six months, as evidenced by at least four symptoms from any category. When considering Aponi's case, she is described as often irritable and negative. She has displayed anger during her tantrums, which includes shouting, cursing, and crying. Aponi will often bully and threaten her peers if they respond to her; she will attempt to initiate a fight. These behaviors are seen as argumentatice/defiant behaviors, she will often show a disregard for rules and does not comply with requests from authority figures, such as her teacher as well as her mother (e.g. arguing with mother when she requests that she completes chores). Aponi provokes others deliberately by making noises, rocking in her seat and whistling while in class, which all align with defiant and provocative behavior. Although not clearly stated, her behavior suggests a lack or total disregard for other's feelings, as seen when she bullies or takes belongings from peers. In addition to instigating or provoking fights with others. The severity specifier "Severe" can be justified as Aponi's behavior is observed and consistent in multiple settings, incuding both at home and in school. All of which have caused significant difficulties and impairment in her academic performance and social relationships.

Differential Diagnosis Considered

Initially I was considering conduct disorder due to Aponi's aggression towards peers and theft. However, her behavior does not include physical cruelty, animal cruelty, fire setting, or property destruction. The referral also notates symptoms such as difficulty concentrating and unfinished schoolwork, as well as rocking in her seat suggesting inability to stay focused which could suggest ADHD. However, there is a lack of specific indications like hyperactivity or impulsivity that you would typically see in individuals with ADHD. These diagnoses were excluded as there was no mention of severe aggression, deceitfulness, or rule violation that precludes Conduct Disorder. In reference to a potential ADHD diagnosis, it's believed that the lack of attention and incomplete work is related to defiance and inattention.

Cultural and Environmental Factors:

In Aponi's case relevant cultural factors that should be considered is the family's Native American heritage and their preference for traditional treatments. Environmental factors that should be considered are the multiple instances of parental separation and verbal conflicts during these separations, which have contributed to Aponi's challenges. All of these dynamics are critical to understanding her psychosocial challenges.

Z Code Justification:

Z63.5 Disruption of family by separation:This code accurately reflects the familial disruption caused by her parents' multiple separations, which have impacted Aponi's emotional and behavioral stability. Understanding these complexities help frame Aponi's behavior within her cultural and familial context, which allows for a more comprehensive treatment approach that essentially respects her cultural as well as addressing her specific psychosocial challenges. Understanding how her environmental stress exacerbates her symptoms is key to treating Aponi's with the most effective treatment interventions.