PSYC 645
CASE PRESENTATION TEMPLATE
I. Key Clinical Issues
A. Client Demographics
Our client is 9 year old Dustin, who has been referred by his pediatrician to speak
with a psychologist due to his history of low academic acheivement. Dustin’s
pediatrician is concern that Dustin’s low academic acheivement may be due to a
learning disability. Dustin lives with mom, dad, and younger brother who is 7years of
age. Dustin’s mother is a 3rd grade elementary school teacher and Dustin’s father is
an architect.
B. Presenting Problem
Dustin’s parents have indicated that his history of low academic achievement,
difficulty listening, and lack of attentiveness has started as early as 2nd grade. In
addition, the client’s parents have also indicated that Dustin’s lack of attentiveness
and difficulty listening are issues at home just as they are within his school
environment. Both Dustin’s parents and teachers have identified Dustin continuous
daydreaming and doodling when he is to be completing other tasks such as homework
and/or chores. Due to Dustin’s lack of attentiveness, Dustin’s finds himself missing
out on key instructions that would enable him to adequately complete assignments
within class. At home, Dustin’s parents are learning that it is taking Dustin an hour to
complete a 15min assignment or task. Dustin has been reprimanded by both his
parents and teachers regarding his lack of attentiveness. Despite being reprimanded,
neither the parents or teacher are seeing any change in Dustin’s behavior. Having
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being continuously reprimanded, Dustin has become uncomfortable with asking for
help or requesting additional time to complete his work within school. Dustin parents
and teacher convey that Dustin is a very bright student; however, he cannot sit still for
longer than 10 minutes without having to get up or wonder off into his own world.
This behavior was also observed by a referred psychologist during Dustin’s
psychological evaluation. During the psychological evaluation there were multiple
tests completed on Dustin such as an IQ test, academic achievement test, and several
executive functioning test.
II. Diagnosis
A. Diagnostic Impressions
1. Autism Spectrum Disorder: To meet diagnostic criteria for ASD according to
DSM-5, a child must have persistent deficits in each of three areas of social
communication and interaction, and at least two of four types of restricted
repetitive behaviors (F84.0) (American Psychiatric Association, 2013).
2. Attention Deficit/Hyperactivity Disorder: To be diagnosed with ADHD, a
person needs to fulfill the following criteria- A persistent pattern of inattention
and/or hyperactivity-impulsivity that interferes with functioning or development,
as characterized by (1) and/or (2) (American Psychiatric Association, 2013):
Inattention: Six (or more) of the following symptoms have persisted
for at least 6 months to a degree that is inconsistent with
developmental level and that negatively impacts directly on social
and academic/occupational activities (F90.0).
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PSYC 645
Hyperactivity and impulsivity: Six (or more) of the following
symptoms have persisted for at least 6 months to a degree that is
inconsistent with developmental level and that negatively impacts
directly on social and academic/occupational activities (F90.1).
3. Specific Learning Disorder: DSM-V criteria has characterized Specific
Learning Disorder by identifying persistent impairment in at least one of
three major areas: reading, written expression, and/or math and has for at
least 6 months despite targeted help (F81.0/F81.81) (American Psychiatric
Association, 2013).
B. Differential Diagnosis:
1. The client is most likely not experiencing ASD, as there has been no mention or
signs of deficits in communication or interaction. Also the clients does not meet
the criteria, as there is been no mention or displaying of restricted repetitive
behavior.
2. The client is most likely not experiencing Specific Learning Disorder, as his IQ
test shows that his overall intellectual functioning is within the high range. There
is no indication of persistent impairment within reading, mathematics, or writing
skills/comprehension for at least 6 months.
C. Full DSM Diagnosis
1. The most likely diagnosis for Dustin is Attention Deficit/Hyperactivity
Disorder, with Inattention (DSM-5, 2013).
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PSYC 645
a) The clients displays continuous daydreaming and doodling that impacts
his academic achievements, as well as impact in home responsibilies
(i.e., chores, daily hygiene, misplacing of items, etc.).
b) The client continuously ask for parents and teacher to repeat instructions
or request, as client does not pay attention when instructions or guidance
is conveyed to him.
c) The clients has now become uncomfortable with asking for help due to
being reprimanded for not paying attention, which the lack of seeking
assistance is having a major impact on his academic achievements
d) The client has become disorganized and forgetful of belongings, as well
as completing routine daily tasks and new tasks presented.
e) The client take extended time to complete short tasks due to
daydreaming and/or doodling.
III. Etiology of the Problem/Disorder
A. Biological Theory: With Attention Deficit/Hyperactive being identified as a
neurodevelopmental disorder, the client must exhibit six or more deficits in
communication and social interaction, as well as restricted repetitive behavior for
over the course of 6 months. Dustin has exhibited over six of the qualifying criteria
for ADHD (e.g. lack of attentiveness, trouble holding attention, disorganized,
misplacing of items, easily distracted, and forgetting of daily activities). “There are
also data suggesting that there is overlap in the genetic influences on learning
disorders and ADHD (Pennington, 2006)” (Parritz & Troy, 2018). Despite the success
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PSYC 645
of the parents, obtaining more information on the parents childhood journey can
provide a clearer picture of Dustin path. Identifying any similarities in behavior.
B. Psychosocial Theory: Dustin has indicated that he is aware of his inability to
concentrate while at school. In addition, because of his lack of attentiveness and
being reprimanded for it, this has position Dustin in a mindset where is feels that he is
unable to succeed. In such an environment and what feels to be a lack of support
from his teacher can create a continuous stressful situation for Dustin that may offset
other cognitive disorders. “Gene-by-environment research has identified several
promising interactions. For example, genetic variants that have an effect on the
regulation of dopamine and serotonin interact with psychosocial factors to influence
the severity of ADHD symptoms (Nigg, 2013; Nigg, Nikolas, & Burt, 2010)” (Parritz
& Troy, 2018).
IV. Treatment Recommendations:
A. Biological Intervention:
With Dustin finding it difficult to maintain organization and completing tasks, the
parents and teacher can work together to impliment a nonpharmological approach
such as behavior modification. Behavior modification enables both the parents and
teacher to set clear goals and limits for Dustin that will assist him on maintaining a
schedule and being rewarded when that schedule is maintained. However, there will
be consequences enforced if the schedule is not maintained as well (i.e., loss of video
games, riding bicycle, etc.). Dustin’s parents can discuss various rules/guidelines that
they had as children and found to be affective. Test those rules/guidelines on Dustin
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see if they work well with him; especially if either parent conveyed that they had
similar behavior as Dustin when they were children.
B. Psychosocial Intervention:
Dustin’s IQ tests, academic achievement tests, and overall intellectual functioning is
within the high average range. With that stated, Dustin’s parents may consider
seeking out a school that may be more challenging for Dustin and that offers
interactive teaching styles that may motivate Dustin to become more engaged.
Interactive teaching styles present the opportunity for children to be more mobile and
hands-on.
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