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Incredibly Helpful

fireworks"I just want to say how excited I was to PASS my exam today. I must say that SWTP has been very helpful and, yes, taking the actual exam reminded me of taking the practice test. Thank you guys so much!!!!" -- Taniesha

"I am happy to say that I have passed the LCSW exam! The STWP website was incredibly helpful in preparing me for the types of questions to expect and, most importantly, becoming familiar with the timing. The practice exams were very similar to the real one!" -- Diane

Congratulations, Taniesha, Diane, and all recently licensed social workers!

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Sleep-Wake Disorders and the Social Work Exam

morning coffeeAnother day, another free practice question! This one comes from the Sleep-Wake Disorders chapter of the DSM. What's in that chapter? This is what's in that chapter:

  • Insomnia Disorder (dissatisfaction with sleep)
  • Hypersomnolence Disorder (excessive sleepiness)
  • Narcolepsy (recurrent, irrepressible need to sleep)

Then there are the Breathing-Related Sleep Disorders (Obstructive Sleep Apnea Hypopnea, Central Sleep Apnea, and Sleep-Related Hypoventilation). There're also Circadian Rhythm Sleep-Wake Disorders. And then, Parasomnias (Non-Rapid Eye Movement Sleep Arousal Disorders, Nightmare Disorder, Rapid Eye Movement Sleep Behavior Disorder, Restless Leg Syndrome). Then all the "others": Substance-induced this, unspecified that, other other.

It's enough to make you sleepy just reading through the list. And it raises a lot of questions--possible questions for the social work licensing exam. For instance, what's a parasomnia? Here's a quick definition: "a disorder characterized by abnormal or unusual behavior of the nervous system during sleep." Simple.

So, there are sleep problems that arise psych reasons, for breathing reasons, for nervous system reasons, and for other/unspecified reasons. There are a lot of ways to not get sleep. But there's only one good way to answer the following practice question. See you how you do:

A client tells a social worker that for the past several weeks, ever since getting promoted, she has been getting "terrible," dreamless sleep. She has a hard time falling asleep and wakes up "way before the alarm rings," her mind racing with thoughts about work. She reports difficulty focusing on the job--"I'm so exhausted." What is the MOST likely diagnosis for this client?

A) GAD

B) Non-Rapid Eye Movement Sleep Arousal Disorder

C) Insomnia

D) Adjustment Disorder

What do you think?

Let's do the usual process of elimination:

--GAD requires "excessive anxiety and worry" for at least 6 months. That's not what's being reported here. Strike that answer.

--Non-Rapid Eye Movement Sleep Arousal involves "recurrent episodes of incomplete awakening from sleep" with either sleepwalking or sleep terrors. With sleepwalking, some will engage in sleep-related eating or sleep-related sexual behavior, known as "sexsomnia." Not a fit here.

--Insomnia is an appealing answer. The client is reporting symptoms of insomnia. However, the client's sleep problems seem to be related to a recent stressor--a promotion. There may be something else going on. Or maybe it is insomnia, but that won't be diagnosable till the sleep problems have persisted for three months. If three months haven't passed  yet, it's not insomnia disorder.

--That leaves adjustment disorder. Adjustment disorder is "the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor." It's the best choice on the list.

A better diagnosis here might be no diagnosis at all. The client is losing sleep over a new job. That's not necessarily a disorder. But "No Diagnosis" isn't one of the choices offered, so you're stuck with the least-bad of the bunch: D) Adjustment Disorder.

To read up about sleep-wake disorders and adjustment disorders, try:

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Recurrent Temper Outbursts and the Social Work Exam

tantrumOur series of free practice questions to help you ready yourself for the social work licensing exam continues. The recurrent temper outbursts in the title don't refer to the ones you may be having as you study for the test, they're a key symptom in the following vignette:

A father brings his eight-year-old son to a social worker for help managing the son's repeated temper tantrums. The father reports that the tantrums, which can be set off by "the tiniest thing" have been happening every few days since the boy was six. The boy is otherwise bright, though often "a grouch." During tantrums, he throws himself on the floor, screaming and crying, inconsolable. Given the limited information offered, which of the following is the MOST likely diagnosis for the boy?

A .Disruptive Mood Dysregulation Disorder

B. Major Depressive Disorder

C. Intermittent Explosive Disorder

D. Childhood Bipolar Disorder

Know the answer? Hint: We've written about the diagnosis on the SWTP blog before (just not in question form). The diagnosis is new in DSM-5. Here are the full criteria:

A. Severe recurrent temper outbursts that are grossly out of proportion in intensity of duration to the situation or provocation.

B. The temper outbursts are inconsistent with developmental level.

C. The outbursts occur, on average, three or more times per week.

D. The mood between outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (parents, teachers, peers).

E. The above criteria have been present for 12 months or more (with no break lasting 3 months or more).

F. Criteria A-D are present in at last two settings (home, school, with peers).

G. The diagnosis should not be made before 6 years or after age 18.

H. Onset of A-E began before age 10.

I. There has never been a distinct period, lasting more than 1 day, that meets full criteria for a hypomanic or manic episode.

J. Behaviors do not occur during a major depressive episode.

Now can you name it? Let's narrow it down, starting at the bottom. Childhood bipolar disorder is not a diagnosis in DSM-5. Scratch it out. Intermittent explosive disorder is closer, but it is characterized by "recurrent behavioral outbursts representing a failure to control aggressive impulses." With IED, tantrums are rage-filled, involving verbal and physical aggression toward people, property, and animals. What's described in the vignette sounds more a like typical toddler tantrums (though in an eight year old). MDD is worth considering. Given the focus here on tantrums, it's not the most precise of the offered diagnoses. Yes, the boy is apparently sad and acting out, but the frequency and duration of the acting out (over three times a week for more than a year) point to the last diagnosis standing. The answer is A) Disruptive Mood Dysregulation Disorder.

Did you get it?

For more about DMDD, try the SWTP post on the topic, which also links out to these sites:

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Last-Minute Social Work Exam Prep

last-minute social work exam prepNearing the big day when you take the social work licensing exam? Time to dig in and get hyper-focused. Or is it? There's lots of different thinking about how best to handle the final run-up to a giant test. And this a giant test, any way you slice it. Long (4 hours!). Lots of questions (170!). Lots of content to know (so much!). Real-life consequences (a possible job, raise, or promotion, to name a few!).

There's not a whole lot of agreement about how best to handle the final days and hours before the licensing exam. A few items show up on all the lists of good, pre-exam behaviors. They happen to overlap with the good behaviors that you'll find on any "how to improve your ___________" list. Want to be happier? Have better sex? Improve your self-esteem? Get more sleep. Eat well. Exercise.

There's very little chance you're reading those suggestions and slapping your forehead saying, "Why didn't I think of that?" You've been a person for a while. Plus, you're a social worker. You've likely tracked these very items in clients. Sleeping, eating, moving around--okay, we'll all try. Thanks!

But how to study? Should you cram or should you set studying aside right before exam day? Should you write out hard-to-recall content in a last-ditch effort to jam it into your brain? Read it out loud? Discuss it with others in a study group? Stand on your head and read it backwards? Google around to find articles supporting most of and none of the above.

One guideline to take seriously: your past. How did you get through high school...through undergrad...through your Master's program? You know what worked and what didn't. Are you a successful all-night crammer? Then all-night cram. Are you a tea and flash cards type student? Then get water boiling. No list writer knows anything better than you know your test-taking history. Look back, take advice from yourself, and go pass this exam just like you've passed so many exams before this one.

Meanwhile, if you'd really like a suggestion list to review, here's a long one from Greatest.com: "22 Science-Backed Study Tips to Ace a Test."

Enjoy and good luck on the exam!

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"Thanks to your practice exams I passed with flying colors!"

passed with flying colorsA couple of nice notes fresh from Facebook. (You've added us on Facebook, haven't you?)

This site was very helpful! I appreciated the practice questions and, even more so, the rationales. Thank you for the helpful tools and study aides! I recommend this site to friends who are preparing for the exam. I passed my licensing exam on the first try! :)

--Amy

This was THE BEST study aid I found while studying for my LCSW exam. Not only did the practice tests give rationales for the answers, each question also has an article linked so you can read further about the topic. Thanks to your practice exams I passed with flying colors!

--Loren

Congratulations, Amy, Loren, and all recently licensed social workers!

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