Case Study
Patient Demographic: Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through
Presenting Problem: You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.
Other Contexts:     book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends.  You want to confirm the psychologist’s diagnosis of autism spectrum disorder (ASD); therefore, you explore differential diagnoses

Question: You want to confirm the psychologist’s diagnosis of autism spectrum disorder (ASD); therefore, you explore differential diagnoses. All of the following are differential diagnoses for ASD, EXCEPT:
(A): Intellectual disability (ID)
(B): Reactive attachment disorder
(C): Attention-deficit hyperactivity disorder (ADHD)
(D): Schizophrenia

Correct Answer: Reactive attachment disorder
Explanation: Reactive attachment disorder is not a differential diagnosis for ASD. Reactive attachment disorder is often caused by insufficient care from a primary caregiver and is characterized by limited seeking of comfort or wants when distressed, limited positive affect, and unexplained irritability, sadness, or fearfulness. ID, ADHD, and schizophrenia are all appropriate differential diagnoses for ASD. ID can also present as a delay in development; however, it differentiates itself in older children because social skills are not as impacted as they are with ASD. ADHD can be similar to ASD due to attention difficulties, but these difficulties are secondary to the child’s hyperactivity. Schizophrenia with childhood onset can present similarly to ASD because social skills can be impacted in the early phases of this condition. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis