Diagnosing Children

The Vignette of Marus

Marcus is a 10-year-old boy who has been struggling at school. During the past year he has frequently been in fights with other students during recess. He argues with his teacher and sometimes refuses to follow her requests. He has also been in trouble for taking items belonging to other students such as lunch snacks, a sweatshirt left on the playground, and some loose change that was sitting on a desk. During class time, Marcus has difficulty following instructions and completing his work. He is easily distracted, does not pay attention to details, and frequently leaves his seat to interrupt the work of other students.

Marcus is doing better at home. He spends the weekdays with his mother and two younger brothers whose ages are 5 and 7. He helps with many of the household chores his mother cannot attend to while she is at work full time. On the weekends, Marcus lives with his father, stepmother, his 11-year-old stepsister, and his 3-year-old half-sister. He describes his father and stepmother as being very strict, but he enjoys playing with two other boys his age who live in the neighborhood.

Marcus’ teacher has met with his parents on several occasions to discuss his poor academic progress. She has expressed concern with the level of his academic skills in writing and math, as well as with his ability to get along well with others. Both the teacher and school principal have recommended counseling for Marcus, and the parents’ insurance plan will pay for 10 visits. Marcus’ pediatrician has also suggested the possibility of medication.

Based on the information presented, address the following questions:What mental disorder would you consider for Marcus? List the specific criteria from the DSM-5that you believe Marcus meets, given the information you currently know about him. If Marcus does not meet all of the criteria needed for a diagnosis, what additional information would you need to gather?What score would you document for Marcus, if Marcus’ family completed the parent- or guardian-rated Level 1 cross-cutting symptom measure? Include the specific information you included when coming up with this score.What other factors (such as school system, family constellation, or medical and health care system) would you need to include when formulating a diagnosis and treatment plan for Marcus? In what way is his family system either helping him to cope at school or exacerbating the problems Marcus is having?How would you explain Marcus’ symptoms from a biological perspective? How would you explain his symptoms from a psychosocial perspective?

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