Case Study
Patient Demographic: Client Age: 9 Sex: Male Gender: Male Sexuality: Unknown Ethnicity: Caucasian Relationship Status: Not Applicable Counseling Setting: School Type of Counseling: Individual Presenting Problem: Severe Temper Outbursts Diagnosis: Disruptive Mood Dysregulation Disorder (DMDD), Provisional (F34.81)
Mental Status Exam: Mental Status Exam: The client’s affect is irritable and angry. He sits with his arms crossed and exhibits poor eye contact. His appearance is somewhat disheveled. Mother reprimands the client multiple times, requesting that he “sit up straight” and “answer the lady’s questions.” The client mumbles responses at his mother’s prompting and is otherwise minimally engaged. The client reports that he “gets mad” daily and feels unjustly “blamed for everything.” His motor activity is somewhat fidgety. Speech and language skills are developmentally appropriate. The client states he “sometimes” feels sad and denies feeling worried or scared. His appetite is good and his sleep is poor. The mother attributes his sleep difficulties to the client staying up late playing video games.
Presenting Problem: You are a school-based mental health clinical counselor conducting an initial intake evaluation. A 9-year-old 3rd-grade male is accompanied by his mother, who reports that the client has been in several school and neighborhood altercations. She states she is at her “wit’s end” with him and is about to lose her job due to constant calls from his school. The client’s teacher reports that the client has daily temper outbursts, and his mother says that his mood is irritable for most of the day, every day. The client was recently suspended from school for flipping over his desk when his teacher told him he lost recess privileges. The mother first noticed these behaviors when her son was in kindergarten. The client recently kicked a hole in his wall after losing a video game. His grades are poor, and the school is currently evaluating him for special education services. The client was reluctant to take part in the intake. He shrugged his shoulders when asked if he would agree to participate in counseling.
Other Contexts: The client is seen for the first time since the initial intake due to being suspended the previous week. He displays an angry affect, sits with his arms closed, and faces the wall. You begin to establish rapport by engaging the client in a game. The client starts to open up and discloses that he feels angry every day and attributes this to his mom “always bothering” him and “everybody always picking” on him. He believes that his teacher doesn’t like him, and he is unhappy that his desk is no longer with the other students but instead right next to the teacher. He states that when he feels angry, his heart races, he clenches his fists, and he feels a tightness in his chest

Question: Which assessment tool should you use to evaluate the client’s executive functioning, attention, and cognitive processing?
(A): The NEO-Personality Inventory (NEO-3)
(B): Denver Developmental Screening Test II (DDST-II)
(C): Cognitive Assessment System (CAS2)
(D): The Children’s Systemizing Quotient (SQ-C)

Correct Answer: Cognitive Assessment System (CAS2)
Explanation: This question tests your knowledge of developmentally appropriate assessment instruments. The Cognitive Assessment System (CAS2) is based on the PASS (planning, attention, simultaneous processing, and sequential processing) model of intelligence and can be administered to children between the ages of 5 and 18. Testing results provide information on specific learning and intellectual disabilities. The CAS2 also provides insight into symptoms of ADHD, which is a comorbid condition of DMDD. The Developmental Screening Test II (DDST-II) is a screening tool used with children aged 1 month to 6 years of age, therefore is not indicated. The NEO-Personality Inventory measures personality traits of adults ages 21-91 (with an additional revised version for adolescents). The Children’s Systemizing Quotient (SQ-C) is an assessment instrument for Autism Spectrum Disorder and is used with children ages 4-11. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis