This week’s Hot Topic is a little different – there are many clinicians out there who have never (and will never) treat or work with an infant, child, or adolescent…so why do we have to know about disorders that are usually diagnosed duriThis week’s Hot Topic is a little different – there are many clinicians out there who have never (and will never) treat or work with an infant, child, or adolescent…so why do we have to know about disorders that are usually diagnosed during this time? There are probably lots of answers to that, but for me, it’s important because they are a particularly vulnerable population. Even if you don’t set out to work with children, you may come across one in the scope of your practice, and you should be able to identify the major signs and symptoms of a mental disorder. Also, mental health issues often ‘look’ different in children, making it especially important for clinicians to recognize symptoms when they present. This topic is huge – here’s just one way it might show up in a test item:
A social worker in private practice receives a referral for a 2 year-old girl. During the assessment, the social worker notices that the girl has no functional language, does not respond to prompts from her mother, and sits listlessly while wringing her hands. Her mother is very upset and reports that she doesn’t understand her daughter’s behavior. She states, “she used to play and have fun…now she can’t even feed herself.” What is the most likely diagnosis in this case?
A. Rett’s Disorder
B. Autistic Disorder
C. Childhood Disintegrative Disorder
D. Mixed Receptive-Expressive Language Disorder
Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence takes up nearly 100 pages in the DSM IV-TR and encompasses 10 different categories of disorders. While you need not memorize every criteria of every disorder (for test-taking purposes OR real life, unless this is your niche, and perhaps not even then), it is important to know enough about each disorder to be able to give a differential diagnosis when presented with information. In this case, let’s look at Rett’s Disorder. Right out of the gate, one major distinguishing characteristic of Rett’s is that it has only been found in females. So, if a test question is about a male child and Rett’s is an answer: cross it out IMMEDIATELY. In terms of criteria, you would be looking for apparently normal prenatal, perinatal and early infant development (for at least the first 5 months). This would be followed by: the loss of previously acquired purposeful hand skills (play or feeding are examples) with the subsequent development of stereotyped hand movements (hand wringing is a BIG clue in test questions); loss of social engagement early in the course; appearance of poorly coordinated gait or trunk movements; and severely impaired expressive and receptive language development with severe psychomotor retardation. There is also the criteria of normal head circumference followed by a deceleration of head growth, but most clinicians aren’t going to measure a client’s head or have access to this information, so I think we can safely let ourselves off the hook in terms of what we commit to memory.
It’s no surprise then, that in this question, the answer is A, based on the hand-wringing, the receptive and expressive language problems and the loss of previously held social and fine motor skills. We see components of B, C, and D in the stem, but not in the combination needed for any of these to be the best answer. Think our practical approach could help you pass? Check out the “LCSW Exam Prep” and “MFT Exam Prep” tabs on our website to learn more about our workshops and materials.
Coming up next week: Psychotic Disorders
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