Tamara is 15-years-old, Haitian-American female in tenth grade.
IDENTIFYING/DEMOGRAPHIC DATA: Tamara is 15-years-old, Haitian-American female in tenth grade. She lives with her parents and a younger brother who is 9-years-old in Miami, Florida. Her parents immigrated to the United States 16 years ago.
CHIEF COMPLAINT/PRESENTING PROBLEM: Tamara’s parents are concerned about Tamara’s schoolwork. They believe her intellect level is higher than her grades indicate. This has been consistent for years and the parents chose to deal with the school issue at home. They are more concerned now since the grades have not increased and she is in high school and will be heading towards college soon.
HISTORY OF PRESENT ILLNESS: Tamara has struggled in school since the third grade. She is now in serious academic trouble. After a psycho-educational evaluation at school, it was found that she had above-average intellectual ability. From the third grade, Tamara had more difficulty keeping up with assignments and completing her work each year. While she comprehends the material, she didn’t retain what she read. She appeared to understand lectures, but she couldn’t organize her thoughts well enough to write them down on paper. “I just stare at the page and nothing comes out,” she said. Adding to these difficulties was the fact that she often forgot to write assignments down and “just couldn’t get organized”.
If she did at some time remember to write down her homework, she loses the paper she wrote it on. Tamara’s mom worries that Tamara is intentionally not remembering these tasks because of her parenting.
Tamara has no behavioral challenges in school and has never been disciplined in anyway by the teachers or principal. She is reported to be nice to others and does have several friends in her class. Tamara does bring home report cards that seemingly fail to reflect her intelligence. Her work remains unfinished, and she seldom know the answer when called on in class.
PAST PSYCHIATRIC HISTORY:
Tamara’s parents tried all kinds of culturally traditional ways to help their child focus on schoolwork. When nothing changed, they chose to seek outside help.
SUBSTANCE USE HISTORY:
Tamara denies any use of drugs or alcohol.
PAST MEDICAL HISTORY:
Tamara has been fairly healthy throughout her life. Any illness was remedied through her parents’ natural means and their religion.
FAMILY MEDICAL AND PSYCHIATRIC HISTORY:
This is a Haitian family which adheres to the behaviors and parenting of their culture. There is no reported psychiatric history in the family. Any medical conditions were treated with herbal remedies or medicinal foods.
CURRENT FAMILY ISSUES AND DYNAMICS:
Tamara’s parents are from Haiti. In the Haitian culture, Tamara’s behaviors might be interpreted as indicating a poorly raised child whose behavior could be modified by parental discipline. Her family suggested that these “unnatural” behaviors are attributed to bad spirits. According to Haitian American tradition, the family often tried therapeutic foods, natural sedatives and purgatives from herbal medicine, and religious treatments to help alleviate these issues.
The parents report running a strict Haitian household. Both children are required to do household chores daily. Tamara’s parents get worried since Tamara is assigned chores she does forget sometimes, and they think she is worried about trying to please her parents and the failing school grades. The parents are not comfortable bringing Tamara in for an evaluation, but they were referred by the school system.
MENTAL STATUS EXAM:
Tamara presents as a casually dressed teenager who appears her stated age of 15. She is a bit anxious during the interview. Her affect is appropriate but worries about disappointing her parents. Motor activity is appropriate. Speech is clear. At times during the interview, she lost her train of thought and had to be redirected to the subject. There is no evidence of delusions or hallucinations. Tamara’s intelligence appears average. She is oriented to time, place, and person.
Assignment: Diagnosis of Neurodevelopmental and/or Disruptive, Impulse-Control, and Conduct Disorders
This Assignment is your first diagnosis for the course, in which you use a case study to practice diagnosing mental disorders using the DSM-5-TR. You will conduct a similar diagnosis each remaining week. Remember these key requirements:
The diagnosis must have a code written in the correct format on its own line, with specifiers if appropriate.
Any Z codes come below that, each on their own line.
Following this is the diagnostic summary—a discussion of the symptoms that supports the diagnosis.
There may be more than one diagnosis for the client. All diagnoses must be listed.
Remember: This is your fist attempt, so focus especially on the how of the diagnosis. How do you use the DSM-5-TR to connect symptoms and behaviors with criteria?
Finally, recall that neurodevelopmental disorders may be co-occurring (i.e., more than one disorder at the same time). Here, as in many diagnoses, there is no single symptom that miraculously points to a disorder. The principal disorder (i.e., the one needing more immediate attention) should be listed first.
To Prepare
Review the case study for this week.
Review all the resources under the heading Diagnosis Assignment Handouts. These handouts present foundational information and can act as a quick reference to support your diagnosis practice throughout the course.
Review the sections of the DSM-5-TR listed in the Learning Resources.
Look within the noted sections for symptoms, behaviors, or other features the client presents with in the case study.
Review the correct format for how to write the diagnosis noted below. Be sure to use this format.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
By Day 7
Submit your diagnosis for the client in the case. Follow the guidelines below.
The diagnosis should appear on one line in the following order.
Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.
Code + Name + Specifier (appears on its own first line)
Z code (appears on its own line next with its name written next to the code)
Then, in 1–2 pages, respond to the following:
Explain how you support the diagnosis by specifically identifying the criteria from the case study.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for all the disorder that you finally selected for the client. Note: You do not need to repeat the diagnostic code in the discussion.
Identify the differential diagnosis you considered.
Explain why you excluded this diagnosis/diagnoses.
Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
Explain why you chose the Z codes you have for this client.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
Answer preview to Tamara is 15-years-old, Haitian-American female in tenth grade.
APA
402 words