Case Study Formulation Assignment:

Using the case provided below, you will be responsible for completing a diagnosis and case formulation. Read the case study. It is very strongly recommended that you access the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The written product of this assignment will be maximum 7 pages.

For the case formulation, you are to provide a diagnosis including any specifiers, a discussion of how you determined the diagnoses and must include identification of DSM-5/DSM-5-TR diagnostic criteria that apply to the case.

This discussion is to include the signs/symptoms of each diagnosis you assign, as well as a complete discussion of differential diagnoses. Differential diagnosis refers to all of the diagnostic categories that you seriously considered during the diagnostic process with a rationale/examples of symptoms.

Because the symptoms present in the case study may suggest the possibility of several disorders, a thorough discussion of disorders that you excluded is warranted. In other words, you should discuss why you assigned the diagnoses that you did and why you ruled out others.

Secondly, you are to recommend therapeutic options based on the literature (i.e., peer-reviewed articles - do a literature search!) that would clearly address etiological factors.

Diagnosis Not Provided: Case #3 t the time of his initial visit to an outpatient clinic, Hank Brooks was an 11yearold Caucasian boy in the 5th grade. Hank was brought to the clinic by his mother after his teacher recommended that he be evaluated for his excessive anxiety in the classroom setting. More specically, Hank experienced frequent worry regarding his school performance and often became distressed when pre sented with challenging academic tasks. Moreover, his teacher and parents reported signicant distractibility and concentration difficulties, which his teacher attributed to anxiety about his academic performance. His teacher also reported that she was having difficulty managing Hank's behavior in the classroom. Both Hank and his mother reported that he worried about his grades, particu larly in the areas of English and language arts. Hank was receiving average grades overall (i.e., mostly Bs) although he was struggling somewhat in reading/language arts and, at the time of assessment, had a C grade in that area. He had significant difficulty with reading and languagebased tasks. Specifically, Hank had to read material at least three times before he understood the content and had trouble fol lowing class discussions in the English class because he had trouble deriving more abstract concepts and themes. These difficulties caused him significant anxiety regarding his academic performance. Hank and his mother noted that he often wor ried about upcoming exams and projects, particularly in the English class, and that he would ruminate about the possibility of failing. His mother observed that it was difficult for Hank to stop worrying when he was worried about school. Further, she said Hank frequently had difficulty completing his homework, and this was true for all assignments, not just reading and language arts. She explained that Hank rushed through his work, which resulted in frequent careless errors. In addition, she said Hank enjoyed math, but even when he was engaged in the subject, he was highly distractible and did not attend to small details. For example, Hank often failed to attend to the mathematical sign in a problem and would add when subtraction was required, or vice versa. Hank often lost or misplaced items he needed to complete 249 Copy\" Igin 101? Curigage Lean mug. Ali Eights Rest-wee. may not be; (. op ed, teamed. 0: mil}: rated in whole Oi m p-I'i. WCN 93-309 250 Case 20 his work, such as his school books and worksheets, and frequently forgot to write down his homework assignments. Hank's teacher observed similar difficulties in the classroom, and she frequently sent reports home indicating that he was highly dis tractible in class and had difficulty concentrating on his work for extended periods of time. Hank also spoke out of turn in the classroom and was frequently repri manded for interrupting. His mother explained these difficulties seemed to add to Hank's overall anxiety. He worried about his school difficulties and made coma ments about being \"stupid.\" Hank engaged in similar behaviors at home. He had difficulty completing household chores and was often sidetracked after he started on a particular task. Both his parents and teachers indicated they frequently repeated their commands and instructions to Hank because he had difficulty listen; ing and paying attention. Hank's mother said she often became frustrated with his inattention, and that his failure to follow through with chores and other tasks led to conflict between them at times. However, she did not report any oppositional or defiant behavior from him. Besides his excessive worry about his academic performance, Hank experienced some anxiety and worry about social situations. Although Hank was described as an outgoing child who enjoyed interacting with his peers, he had some difficulty in social situations. Hank often interrupted others and did not seem to attend to social cues. For instance, he had a tendency to persist in talking about a particular topic, even if other children were uninterested. Although Hank spent time with other chil dren, he had difficulty forming close friendships. He had begun to worry about interacting with other children and whether he would be liked by his peers. In addition, Hank felt compelled to engage in certain rulegoverned behaviors. Most of these behaviors pertained to symmetry and the need for things to be even. For example, Hank indicated that he needed to land on an even number when climbing stairs (the first step being number one, the second step number two etc.), and he skipped certain steps, or went back down a step, to ensure that he landed on an even number. He felt the need to speak an \"even\" number of times, and so would often state a question or statement twice or four times. He also felt com pelled to engage in a range of different tasks for an \"even\" amount of time; for instance, he brushed his teeth for exactly 2 minutes, and if he was interrupted, he would brush his teeth all over again. Hank said he first engaged in these rituals out of boredom, and explained they were almost \"games\" he used to entertain himself. However, over the last few months, the behaviors had become more frequent and he now felt uncomfortable if he could not complete them. Hank stated that his need for symmetry \"just feels right\" and told the therapist he worries he will have a bad day at school if he does not engage in his behaviors to keep things symmetrical. Hank was able to complete most of his behaviors discretely, and thus most people did not notice them. However, Hank estimated he now spent 2 hours each day engaged in these behaviors. He described them as distressing and reported feeling as if he is unable to stop the behaviors, even though he found them \"annoying.\" Clinical History Hank was being raised in a household of four, which consisted of himself, his mother and father, and his older brother (age 13). Hank's mother noticed some Co;}y\"ig]|ii 29.2.3'CL-iigdgx"L.G.I!Tl:i.r'1.lllglii$ REE-iv} veti. may no'. he (Dine-d, scanned. 0i (iliiiiif.1ti'fl. in whole (M II glai'i. WCN iii-30E: Diagnosis Not Provided: Case #3 251 level of inattentiveness and distractibility in Hank from very early childhood (e.g., \"Hank always seemed to pay less attention to things compared to his older brother\"). However, these symptoms became most apparent at age 6, when Hank entered 1st grade, where the classroom environment was more structured compared to preschool and kindergarten. Hank's 1stgrade teacher noted that he seemed to have difficulty focusing, even on relatively short tasks or activities. These symptoms persisted throughout elementary school. In fact, Hank was retained in 2nd grade due to difficulties with processing language and learning to read. He underwent psychoeducational testing during the 2nd grade. This testing revealed perceptual reasoning skills in the high average range and low average verbal comprehension skills, which resulted in an average IQ. Academic testing indicated below average reading scores, and high average mathematics abilities. Accordingly, Hank was diagnosed with a learning disorder in reading and received an Individualized Edu cation Program (IEP), which provided him with speech therapy and individual instruction in reading and writing through his school. However, when he reached the 5th grade, school personnel determined Hank had received \"maximum benefit\" from speech therapy, and his IEP was discontinued, despite continued problems with reading comprehension. In regard to the familial history of psychological disorders, Hank's father exhibited features of distractibility and organizational difficulties since childhood, although he was never given a formal diagnosis for these symptoms. Nonetheless, these behaviors were modeled for Hank throughout his childhood. In addition, Hank's mother had a history of depression that was accompanied by worry, and she had been treated with antidepressants over the preceding five years. She said she had difficulty managing her emotions, particularly when she was feeling frus trated with Hank's behavior. She described frequent conflict between them around Hank's inability to follow through with homework and household chores. However, she usually argued with Hank rather than implement specific conse quences for his behaviors. Moreover, she did not seem to use much praise or pos itive reinforcement for Hank's positive behaviors. DSM-5 Diagnosis Based on this information, what DSM5 diagnosis (or diagnoses) do you think best applies to Hank? Copy-'iiglii EMT \"Le-image Leiiiilng. Ali Rights Seem-Jeri. may :im be copied, scanned. oi (imminent-d in whole 0i II part. WCN (ii-30E