The Case Study of Johnny

Grand Canyon University

Abstract

This essay contains a diagnosis for Johnny. The school counselor stated that Johnny might have ADHD or Bipolar Disorder, which is not true. The reasons that show why this diagnosis is not correct have been explained in this paper. Additionally, this essay outlines the reasons why Intermittent Explosive Disorder (ID) is a probable diagnosis. The other likely diagnosis is Unspecified Oppositional Defiant Disorder. This illness has the symptoms of Oppositional Defiant Disorder (ODD) but lacks a particular indicator that fits into the criterion for the diagnosis of ODD. Since Johnny’s case is a crisis and an emergency, the specific reason cannot be determined due to lack of adequate time for further investigation. Therefore, he should visit a child psychiatrist who would help establish his diagnosis accurately.

Keywords: ADHD, Bipolar Disorder, ID, ODD, Unspecified ODD

The Case Study of Johnny

Johnny’s case is quite complicated since his symptoms do not point to a specific mental ailment. Research has shown that most children who are aged nine years old; that is, those in late primary school, have a high probability of suffering from depression, habit disorders and anxiety (Lask et al., 2003). That must have been the reason why the school counselor misdiagnosed Johnny with Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder. However, these disorders are indicated by severe mood instability, which can be ruled out as possible diagnoses since Johnny’s symptoms do not reveal any shifts or effects on his moods. Based on his symptoms, Johnny is likely suffering from two disruptive impulse-control and conduct disorders. The most likely diagnosis is Intermittent Explosive Disorder, and he also has a lower probability of suffering from Unspecified Oppositional Defiant Disorder.

First, it is essential to explain why ADHD and Bipolar Disorders cannot be an accurate diagnosis. ADHD is characterized by inattentiveness such as lack of paying attention to academic work, difficulty in sustaining attention when performing tasks, easy distraction by extraneous stimuli, and regular forgetfulness in daily activities (Reynolds & Kamphaus, 2013). It is also characterized by hyperactivity that includes fidgeting, conducting of unexpected behavior such as climbing on seats or running about in environments where the patient is expected to remain calm and talking excessively (Reynolds & Kamphaus, 2013). Even though Johnny has indicators of inattentiveness, most of the above symptoms are not observed in him. Similarly, the symptoms of Bipolar Disorder include having mixed episodes constituting both manic and depressed moods. These signs include feeling very ‘high’ or ‘up,’ feeling jumpy, having trouble sleeping, chattering about multiple subjects, sleeping excessively, feeling very sad, and feeling worried (NIH, 2015). These indicators are not observed in Johnny. Furthermore, ADHD and Bipolar Disorder patients must illustrate severe mood instability; which mainly affects a person’s appetite, sleeping pattern, or significant mood fluctuations (Mayo Clinic, n.d). These are not observed in Johnny at all.

Therefore, there is a high probability that Johnny suffers from Intermittent Explosive Disorder (ID). It is associated with a person experiencing outbursts of extreme anger, which seem unreasonable for the particular situation, and it mainly occurs against someone they are close to. ID is characterized by symptoms such as verbal aggression, violent behavior, and unpremeditated responses that cause harm to people or property; and distress to the patient (Dziegielewski, 2015). Using criterion B for ID in the DSM-V then it is evident that Johnny exhibits these symptoms. His violent outburst of fury against his teacher is unexpected for such a situation since Johnny has committed a transgression. Moreover, Johnny uses vulgar language against the teacher, and his violent behavior is illustrated by him stabbing his teacher with a pencil, which also causes harm to the educator. Later at the hospital, Johnny cries as he explains that he never meant to behave the way he did, which proves that the actions were unpremeditated and they caused substantial distress to him. The DSM-V also sets the age of onset of this disease at past the age of six (Dziegielewski, 2015), which further proves Johnny’s diagnosis since his mother states that the symptoms started to appear when Johnny was eight years old.

The Unspecified Oppositional Defiant Disorder is a psychological ailment that has identical symptoms with the Oppositional Defiant Disorder (ODD) but lacks specific indicators that meet a particular criterion used to diagnose the disease. For a person to be diagnosed with ODD, they must exhibit at least four signs across three categories of “angry/irritable, argumentative/defiant, and/or vindictiveness” (Dziegielewski, 2015). Johnny illustrates angry/irritable characteristics with his furious reaction towards his teacher. He shows defiant behavior since his mother states that he has been challenging his mother’s and teacher’s authority. The DSM-V also says that the symptoms need to occur at least once a week over a six month period and the patient’s actions must cause them distress. Johnny’s tearful confession reveals distress and a look at the DSM-5 Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure Form shows that he has expressed the above symptoms more than twice over a two-week period, which brings it to an average of once a week. However, Johnny is not always defiant since he never challenges his father’s authority and no symptom shows vindictiveness. Additionally, the data collected is not enough to determine whether vindictive behavior has occurred over a six-month period. Therefore, the reason for Johnny not meeting the criteria for ODD diagnosis is not very clear, and a proper diagnosis would require more time, which is not available due to the crisis and emergency nature of his situation; hence the Unspecified ODD diagnosis.

Therefore, it is essential that Johnny visits a child psychiatrist. A child psychiatrist is a person who is specialized in the diagnosis and remedy of illnesses that involve thoughts, emotions, and conduct in children, adolescents, and their families (AACAP, 2008). Johnny’s condition requires personalized care and examination over an extended period from a specialist. This child psychiatrist would better determine the accurate diagnosis for Johnny and avail the best form of treatment.

The paragraphs above explain why Johnny does not have ADHD or Bipolar disorder. These two ailments are characterized by severe mood instability, which is not observed in Johnny. However, his symptoms indicate that there is a high probability that he suffers from ID or Unspecified ODD. Due to the Unspecified ODD diagnosis, Johnny should visit a child psychiatrist who would accurately determine his diagnosis.

References

AACAP. (2008). THE CHILD AND ADOLESCENT PSYCHIATRIST. American Academy of Child and Adolescent Psychiatry. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/00_the_child_and_adolescent_psychiatrist.pdf

Dziegielewski, S. F. (2015). DSM-5 in action. Hoboken, New Jersey: John Wiley & Sons, Inc.

Lask, B., Taylor, S., & Nunn, K. P. (2003). Practical Child Psychiatry: The clinician’s guide. BMA House, Tavistock Square, London WC1H 9JR: BMJ Publishing Group. Retrieved from www.bmjbooks.com

Mayo Clinic. (n.d.). Mood Disorders. Retrieved March 27, 2018, from https://www.mayoclinic.org/diseases-conditions/mood-disorders/symptoms-causes/syc-20365057

NIH. (2015, November). Bipolar Disorder. National Institutes of Health, National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/bipolar-disorder/tr-15-3679_152248.pdf

Reynolds, C. R., & Kamphaus, R. W. (2013). Attention-Deficit/Hyperactivity Disorder (ADHD). Diagnostic and Statistical Manual of Mental Disorders. Retrieved from https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf