CASE PRESENTATION:DUSTIN 2
CASE PRESENTATION
I. Key Clinical Issues
A. Client Demographics
Dustin is the oldest child of Stephanie and Michael. Dustin is nine years old and has a
younger brother, Kyle, who is seven years old. Dustin’s mother, Stephanie is a third
grade teacher and his father, Michael, is an architect.
B. Presenting Problem
The client, Dustin, was referred by his pediatrician for psychological testing with
concerns about a learning disability. Dustin has had difficulties in school since second
grade. He has experienced difficulties focusing in school as well as understanding
teacher given instructions for assignments. Dustin’s mother and father have also
reported Dustin has difficulties at home with listening, remembering where he has
placed items, and concentrating on the task at hand. Parents report Dustin is an
otherwise well-mannered and obedient child. During psychological evaluation, it was
found that Dustin has difficulty concentrating and sitting still for more than ten
minutes. The test scores for Dustin showed that his academic IQ is in the High
Average while his executive functioning skills are below average.
II. Diagnosis
A. Diagnostic Impressions:
1. Attention-Deficit/Hyperactivity Disorder (ADHD): Dustin experiences deficits
in his ability to sustain his attention and concentration for more than ten minutes.
According to the DSM-5, for a diagnosis of ADHD the client may experience
CASE PRESENTATION:DUSTIN 3
difficulties paying attention to details, starting and finishing tasks, and can even
make careless mistakes in their work. Dustin has experienced all of these
symptoms (American Psychological Association, 2013).
2. Generalized Anxiety Disorder (GAD): Dustin experiences difficulties with
beginning and completing tasks. Dustin tends to lose focus or interest in school
work and other assignments. With Generalized Anxiety Disorder, individuals may
feel apathetic towards seemingly mundane tasks and may find it difficult to
complete simple duties (American Pychological Association, 2013).
B. Differential Diagnosis:
1. Hyperactivity Disorder: Part of the ADHD diagnosis is episodes of hyperactivity
of impulsivity. However, Dustin has not reported to experience these episodes.
Therefore, the Hyperactivity Disorder diagnosis part of ADHD would not be
applicable to Dustin.
2. Generalized Anxiety Disorder (GAD): According to the DSM-5, Generalized
Anxiety Disorder is characterized by constant and excessive worry. It has not
been reported that Dustin experiences these symptoms. GAD is also characterized
by other symptoms of anxiety such as racing heartbeat, increased fatigue, and
feelings of being on edge (American Psychological Association, 2013). Dustin has
not reported experiencing these symptoms. Therefore, a Generalized Anxiety
Disorder would not be an accurate diagnosis for this client.
CASE PRESENTATION:DUSTIN 4
C. Full DSM Diagnosis: Attention-deficit/Hyperactivity Disorder, predominantly
inattentive
1. According to the client and peer reports, Dustin has been experiencing
difficulties in paying attention to instructions, starting and finishing tasks, and
often makes mistakes on assignments. The client’s academic IQ is in the high
average range while the executive function score is below average. While
Attention Deficit Disorder would be a more fitting diagnosis, the DSM-5 no
longer offers ADD as a diagnosis as it is now a part of the ADHD diagnosis
(American Psychological Association, 2013). Therefore, with the symptoms
reported, the most likely diagnosis for Dustin is ADHD with emphasis on
attention-deficit.
III. Etiology of the Problem
A. Biological Theory: Neuropsychological functioning affects an individual’s attention,
memory, executive functions, and other important functions related to intelligence.
Having a neuropsychological deficit or vulnerability can increase the likelihood and
the severity of symptoms of ADHD (Rajendran et al., 2013). An individual’s unique
brain chemistry and design can influence how they approach and conquer everyday
tasks that include executive functions such as planning, abstraction, and
conceptualization.
B. Psychosocial Theory: Symptoms of ADHD can develop and be influenced by
environmental and behavioral factors. One of these factors that can contribute to the
client’s symptoms is inadequate or maladaptive sleeping behaviors or patterns. One
study conducted by Carpena et al. (2019) concluded that inadequate sleep routines
CASE PRESENTATION:DUSTIN 5
between the ages of 24 to 48 months corresponded with the development of ADHD.
Other factors such as an individual’s personal interests can also affect their attention
abilities. If a child deems an activity as undesirable, they may be inclined to avoid
that activity altogether.
IV. Treatment Recommendations
A. Biological Intervention: The first step in treating the biological causes of the client’s
symptoms is for the client to schedule an appointment with a psychiatrist in order to
confirm the diagnosis. Once confirmed, the psychiatrist may provide a prescription
for a central nervous system stimulant such as Adderall. This type of stimulant works
to increase focus by increasing levels of dopamine and norepinephrine in the brain.
Adderall and other central nervous system stimulants show positive affects on
symptoms of ADHD (Stroh et al., 2008).
B. Psychosocial Intervention: The first step in treating the psychosocial causes of the
client’s symptoms is to work with a qualified mental health professional such as a
Behavior Analyst in order to created an Individualized Education Plan. An IEP will
help Dustin succeed with the demands of school. Once goals are set for Dustin,
teachers and support staff can work together to accommodate Dustin’s unique
learning style. At home, the parents can implement other ABA techniques like a
reward system for Dustin completing tasks as well as using tangible markers for
things Dustin will need to remember. Addressing the psychosocial aspects of Dustin’s
symptoms involves collaboration among peers and Dustin in order increase his
productivity and quality of life (Parritz & Troy, 2018).
CASE PRESENTATION:DUSTIN 6
Resources
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
Fifth Edition. American Psychiatric Publishing.
Carpena, M., Munhoz, T., Xavier, M., Rohde, L., Santos, I., Del-Ponte, B., Barros, F.,
Matijasavich, A., Tovo-Rodrigues, L. (2019). The role of sleep duration in adolescence:
Findings from a population-based birth control. Journal of Attention Disorders. 24(4).
Parritz, R. A. & Troy, M. F. (2018). Disorders of childhood: development and psychopathology.
Third Edition. Wadsworth.
Rajendran, K., Trampush, J., Rindskopf, D., Marks, D., O'Neil, S., Halperin, J. (2013).
Association between variation in neuropsychological development and trajectory of
ADHD severity in early childhood. The American Journal of Psychiatry. 170(10).
Stroh, J., Frankenberger, W., Cornell-Swanson, L., Wood, C., Pahl, S. (2008). The use of
stimulant medication and behavioral interventions for the treatment of attention deficit
hyperactivity disorder: A survey of parents' knowledge, attitudes, and experiences.
Journal of Child and Family Studies. 17.
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