Counselors of children and adolescents typically receive informal information about their client before the first meeting. Someone has become concerned enough about the young person to suggest counseling.

Counselors of children and adolescents typically receive informal information about their client before the first meeting. Someone has become concerned enough about the young person to suggest counseling.

Counselors use this background information to develop questions for themselves that they try to answer in their first interview with a child. The answers lead the counselor through a process called differential diagnosis, whereby various plausible alternatives are ruled out to form an initial diagnosis. The initial diagnosis is the basis for the initial treatment plan. The initial diagnosis and treatment plan may be changed later as more facts come to light, but they are very important because they offer a counselor a place to start. Your task for this assignment is to develop a differential diagnosis.

Choose either the case of Luis, the child, or the case of Crystal, the teen. Decide upon your diagnosis by working through these six specific steps, as described in the DSM-5 Handbook of Differential Diagnosis, linked in Resources (see pages 1–16).

1. Rule out malingering and factitious disorder. (Are the symptoms genuine?)

2. Rule out substance etiology. (Are the symptoms a result of the consumption of drugs or alcohol?)

3. Rule out an etiological medical condition. (Is there a medical condition that explains the symptoms?)

4. Determine the specific primary disorder(s). (What appears to be the most accurate initial diagnosis?)

5. Differentiate Adjustment Disorder from the residual Other Specified or Unspecified Disorders. (Have the symptoms developed into a sufficiently maladaptive response meriting a primary disorder, or are they better described with one of these other diagnoses?)

6. Establish the boundary with “no mental disorder.” (Is a primary diagnosis merited due to “clinically significant” symptoms, or are the concerns better described as “Other Conditions that May Be a Focus of Clinical Attention“? Not all counseling involves treating a mental disorder.)

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