3. Differential Diagnosis.pdf

Differential Diagnosis Most carefully considered NEURODEVELOPMENTAL DISORDERS Intellectual Disability ASD (Autism Spectrum Disorder) It’s common for those w/ ASD to have ID, as well. Reassessment of IQ may be necessa...

Differential Diagnosis Most carefully considered NEURODEVELOPMENTAL DISORDERS Intellectual Disability ASD (Autism Spectrum Disorder) It’s common for those w/ ASD to have ID, as well. Reassessment of IQ may be necessary ID because IQ in ASD is unstable during early childhood. Childhood-Onset Fluency Disorder (Stuttering) Tourette’s Stuttering Difference in nature and timing of repetitions. Social (Pragmatic) Communication Disorder ASD (Autism Spectrum Disorder) SAD (Social Anxiety Disorder) ASD: RRPBs (restricted, repetitive patterns SAD: developed appropriate social of behavior) (even if they only happened in communication skills, these skills not used Pragmatic the past/early ages) Pragmatic: no because of anxiety/distress/fear Pragmatic: presence of RRPBS never had effective social communication Difference is in the timing of symptom onset. Autism Spectrum Disorder A/RFID (Avoidant/Restrictive Food Stereotypic Movement Disorder Intake Disorder) A/RFID: impairment (weight loss, nutritional deficiency, dependence on Stereotypic: stereotypies w/ self injury ASD: ASD supplements, interference w/ psychosocial stereotypies functioning) ASD: rigid eating behaviors, heightened sensory sensitivities If both diagnoses are met and restrictive If stereotypies w/ self-injury become a focus of food intake should be a focus of treatment, both diagnoses may be given. intervention, both diagnoses may be given. Differential Diagnosis 1  Attention-Deficit/Hyperactivity Disorder Stereotypic Movement Disorder BD (Bipolar Disorder) BD: episodic (increased activity/impulsivity, Stereotypic: fixed/repetitive motor behavior poor concentration), rare in preadolescents ADHD ADHD: fidget/restlessness are generalized ADHD: mood changes w/in the day, common in children & adolescents SCHIZOPHRENIA SPECTRUM DISORDERS Schizoaffective Disorder Schizophrenia Mood Disorders Schizophrenia: mood symptoms present for Mood: psychotic features occur during minority of active & residual phases mood episodes Shizoaffective: >2 weeks of Schizoaffective Schizoaffective: major mood eps present for delusions & hallucinations in the absence majority of active & residual phases of mood eps DEPRESSIVE DISORDERS Disruptive Mood Dysregulation Disorder ODD (Oppositional Defiant Disorder) BD (Bipolar Disorder) ODD: verbal, authorities DMDD: BD: episodic, mania/hypomania episode, verbal/behavioral (severe), more settings elevated/expansive mood or grandiosity DMDD (can be aggressive towards friends), DMDD: chronic, persistent/non-episodic, persistent mood disruption severe irritability If both criteria are met (alongside IED), If child experiences manic/hypomanic ep. >1 DMDD should be diagnosed. day, BD should be diagnosed. ANXIETY DISORDERS Specific Phobia Agoraphobia Situational type Agoraphobia: 2+ agoraphobic situations feared, avoid because help is escape might be difficult/help is not available Situational: 1 agoraphobic situation, avoid because they fear the Differential Diagnosis 2  phobic stimulus (eg., fear of hurting/hurting themselves) Example: > Individual fears airplanes, elevators (under “public transportation” agoraphobic situation) but does not fear other of these agoraphobic situations [DIAGNOSIS: Specific Phobia - SITUATIONAL] > Individual fears airplanes, elevators, crowds (under “public transportation” and “standing in line/being in crowd” agoraphobic situations) OCD & RELATED DISORDERS Obsessive Compulsive Disorder OCPD (Obsessive GAD BDD (Body Compulsive (Generalized Psychotic Dysmorphic Trichotillomania Personality Anxiety Disorders Disorder) Disorder) Disorder) Psychotic: presence of Trichotillomania: positive psychotic hair-pulling symptoms (eg., OCPD: excessive (compulsion), no delusions, perfectionism, rigid limited to obsession OCD: hallucinations) GAD: real-life control, no distress physical obsession OCD: no other concerns OCD: OCD OCD: true appearance precedes psychotic irrational, odd obsessions and/or (obsessions- compulsion (eg., symptoms (eg., obsessions compulsions, w/ compulsions) symmetry hallucinations, distress obsession - formal thought plucking disorder), may compulsion) have poor insight/delusional OCD beliefs If both criteria are met, both can be diagnosed. TRAUMA & STRESS-RELATED DISORDERS Reactive Attachment Disorder (RAD) ASD (Autism Spectrum Depression (Major Depressive ID (Intellectual Disability) Disorder) Disorder) RAD ASD: RRPBs, deficits in social ID: socio-emotional skills Depression: no impairments, no communication RAD: social comparable to cognitive skills attachments (children still seek & communication is functioning, (impaired), no profound respond to comfort by Differential Diagnosis 3  social neglect, selective reduction in positive caregivers) RAD: social neglect, attachment affect/emotion regulation RAD: selective attachment functioning (overall level), social neglect, selective attachment Disinhibited Social Engagement Disorder (DSED) ADHD (Impulsivity) (Attention-Deficit Hyperactivity Disorder) DSED ADHD: diff. w/ inattention/hyperactivity DSED: impulsivity is social Posttraumatic Stress Disorder (PTSD) Adjustment Disorder Acute Stress Disorder Acute Stress: 3 days - month Adjustment: stressor (tho pwede rin traumatic event) PTSD: PTSD PTSD: >1 month, sleep traumatic event disturbance: >1 month Adjustment Disorder diagnosis is given when: (a) meet A but not full criteria of PTSD [meaning, traumatic event pero sub- threshold symptom diagnosis], or (b) meet symptom pattern of PTSD but not A [meaning, stressful event only but full diagnostic threshold sana of PTSD and Acute Stress] Psychotic Disorders TBI (Traumatic Brain Injury) Psychotic: illusions/hallucinations/delusions - TBI: persistent disorientation, confusion PTSD: PTSD perceptual disturbance PTSD: reexperiencing, avoidance traumatic event If client experienced head trauma during traumatic event, PTSD requires that that event is held as a PSYCHOLOGICAL traumatic event Acute Stress Disorder Dissociative Disorders TBI (Traumatic Brain Injury) Dissociative: traumatic event, dissociation, no acute stress symptoms TBI: persistent disorientation, confusion Acute Acute Stress Acute Stress: traumatic event, Stress: reexperiencing, avoidance, remit after 1 dissociation, presence of acute stress month symptoms If client experienced head trauma during traumatic event, PTSD requires that that event is held as a PSYCHOLOGICAL traumatic event Adjustment Disorder Differential Diagnosis 4  Acute Stress Disorder Acute Stress: involuntary intrusive memories, traumatic event Adjustment: rumination Adjustment (voluntary), stressful event DISSOCIATIVE DISORDERS Dissociative Amnesia PTSD (Posttraumatic Stress Disorder) Dissociative Amnesia Some clients w/ PTSD report forgetting traumatic event. If forgetting certain events involve others aside from traumatic event, Dissociative Amnesia may also b diagnosed. They can be comorbid. Dissociative Identity Disorder (DID) PTSD only (Posttraumatic Stress Disorder) PTSD: dissociative flashbacks —> relive trauma, trauma-content; intrusions —> focused on DID w/ PTSD traumatic event DID w/ PTSD: dissociative flashbacks —> amnesia/don’t remember the content; intrusions —> unrelated to trauma; infrequent changes of diff. personalities DID usually co-occurs w/ PTSD so, it’s important to differentiate if diagnosis is PTSD only. Depersonalization/Derealization Disorder Anxiety Disorders Substance/Med-Induced Anxiety: deper/dereal symptoms may occur during Substance/Med: deper/dereal symptoms Depersonalization/ panic attacks Deper/Dereal: persists after Panic can start after intoxication Deper/Dereal: Derealization Disorder is treated/remitted, if it clearly exceeds sypmtoms persist in absence of further duration & intensity of panic attack substance/med use IMPULSE-CONTROL DISORDERS Oppositional Defiant Disorder DMDD Mood IED (Intermittent ADHD (Attention- (Disruptive CD (Conduct (Depressive Explosive Deficit/Hyperactivity Mood Disorder) and Bipolar Disorder) Disorder) Dysregulation Disorders) Disorder) Differential Diagnosis 5  CD: severe (aggression towards Both are chronic people/animals, IED: Difference is in destruction of verbal/behavioral, severity, property, ODD serious Often comorbid frequency, theft/deceit) aggression ODD: chronicity ODD: less verbal (DMDD: 3x a severe, week) problems of emotional dysregulation If hiwalay yung If symptoms are diagnosis, defiance ODD should not severe enough of authority should be given if and meet criteria not be observed only symptoms occur for DMDD, ODD in situations that exclusively is dropped (even demand sustained during a mood if all criteria are effort or forced to sit ep. met). still. Conduct Disorder Antisocial Personality Disorder CD Antisocial: - at least 18 years of age - evidence of CD