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Disruptive, Impulse-Control, and Conduct Disorders

angry teenLet's take a look at the Disruptive, Impulse-Control, and Conduct Disorders chapter of the DSM. How do you distinguish the diagnosis from one another? This could come in handy on the licensing exam. 

First, the criteria. Then some quick practice questions.

Oppositional Defiant Disorder

A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.

Intermittent Explosive Disorder

Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either verbal or physical aggression for a period of 3 months or three outbursts involving damage or destruction to property or physical injury within a 12-month period.

Conduct Disorder

A repetitive and persistent pattern of behavior in which the basic rights of others or major societal norms are violated in the past 12 months with criteria present in the last 6 months (aggression, destruction of property, deceitfulness or theft, serious violation of rules).

The other diagnoses in the chapter differentiate themselves: Pyromania (fire setting), kleptomania (stealing).

And then there's antisocial personality disorder, which requires a pervasive pattern of disregard for and violation of the rights of others occurring since before age 15. Not diagnosed before age 18.

So...got all that? There are some basic ideas that are easy to memorize, and several numbers that, depending upon your memory, might get confused. How many months required? What ages?

Here are some quick practice questions to test how well you've absorbed the above info. The choices for each:

A. Oppositional defiant disorder

B. Intermittent explosive disorder

C. Conduct disorder

D. Antisocial personality disorder

and let's throw in another option (one more that you'll get on the ASWB exam)

E. Doesn't meet criteria for a DSM diagnosis.

Your practice questions:

A social worker sees a client who...

1. ...is 17, has been caught torturing small animals with regularity since he was 14. He denies the behavior, even when caught in the act. He shows little remorse and has few friends.

2. ...is 18 and a member of a gang. He has been participating in fights, vandalism, and some drug dealing since he joined last year.

3. ...is 14 and refuses to listen to anything his parents ask him to do. When they insist that he do household chores, he covers his ears to avoid hearing, sometimes chanting or humming loudly to block them out.

4. ...is 13 and, while generally well-behaved, ever since entering puberty a year ago, throws huge tantrums when she doesn't get her way, sometimes smashing a plate or punching the wall.

5. ...is 15 and for the last year has skipped school regularly, instead smoking pot and hanging out in the local convenience store parking lot. Confronted by his mother, the moody teen demands to be left alone and sometimes has laughed when she begins to tear up.

What is the BEST diagnosis for these clients?

Scroll down for answers….


















Answers:

1. C. Conduct disorder. (Sounds like ADD, but ADD can't be diagnosed till age 18.)

2. C. Conduct disorder.

3. E. Doesn't meet criteria for a DSM diagnosis.

4. B. Intermittent explosive disorder.

5. A. Oppositional defiant disorder

How's you do?

If you found this helpful, please post and share. And just imagine how helpful complete practice exams will be. Smile

Happy studying and good luck on the exam!

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ASWB Exam Practice - "You two are really good are arguing."

couple fightHere's a free practice question to help get you ready to pass the ASWB exam.

A couple has been meeting with a social worker for three weeks. They report wanting to work on their marriage. Despite the social worker's attempts to set rules, they argue constantly over small details. The social worker responds by saying, "You two are really good are arguing. Can you continue arguing for the next five minutes? I'll set a timer." The social worker's response is an example of:

A. A paradoxical intervention.

B. Solution focused therapy.

C. Functional family therapy.

D. Unethical behavior.

What's your answer?

Let's go from the bottom up.

Unethical behavior? Nah. If you thought the social worker is being sarcastic, you might be tempted by this answer. But sarcasm isn't unethical.

Functional family therapy. First of all, if you've never heard of it, it's probably not the right answer on the social work licensing exam. Here's what functional family therapy is, according to fftllcom:

[A] short-term treatment strategy that is built on a foundation of respect of individuals, families and cultures, but that includes powerful treatment strategies that pave the way for motivating individuals and families to become more adaptive and successful in their own lives.

TL; DR? It's not the correct answer here.

Solution focused therapy you probably have heard of.  Here's the approach nutshelled via solutionfocused.net

SFBT is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy.

Also not what's going on in this quick vignette.

Which leaves us with one answer. Let's hope it's a good one.

A paradoxical intervention. What's that? It's when a therapist prescribes the behavior that is the target of the intervention. "Smoke more." "Sleep less." Or, in this case, "fight for the next five minutes."

Asked. Answered. And now you're that much more ready to go pass the exam.

For lots more questions and explanations, sign up for SWTP's complete exams.

Happy studying and good luck!

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Pod Save Your ASWB Exam Prep

listening to the social work podcast maybe We used to blognounce every time a new episode of the Social Work Podcast came out. Now, instead of all those posts, you get a once-in-a-while reminder about all the exam-prep-friendly free content that the podcast has in its archives. That's what this is. Reminder: The SWP archives hold hours and hours of material on topics that are at the center of the ASWB exam outlines. Social work essentials that you need to know.

It's an easy, pleasant way to get the material learned and locked in. Some licensing-exam friendly topics are listed below. And here's a complete list of the podcast's past episodes, divided by topic. Tune in, use the knowledge gained on a few practice tests, then go in and pass the exam. Good luck!

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ASWB Exam Pratice—Erikson’s Stages

gothHere's a quick practice question to keep you on your toes.

A man brings his 16-year-old son to a therapy appointment to have him assessed for depression. His son has started wearing black and has dyed his blond hair black. The boy denies he's depressed and says that all his friends dress the way he does. According to Erik Erikson's stages of psychosocial development, which crisis is the client experiencing?

A. Industry vs. inferiority.

B. Autonomy vs. shame and doubt.

C. Identity vs. role confusion.

D. Intimacy vs. isolation.

What do you think?

For a question like this, you can strip the stem down to its essentials: a teenager and Erikson. The question could be much simpler and ask the same thing: What is the central conflict for teenagers according to Erikson's stages of psychosocial development?

Either way, it's handy to know the stages. But even if you don't, you might be able to figure it out. Let's walk through the options together: Industry vs. inferiority. Sounds like middle school (it's actually 6-12). Autonomy vs. shame and doubt (sounds like infants or teens…let's leave that one for a second). Identity vs role confusion (sounds very teenage). Intimacy vs. isolation (sounds like the partnering years. 20s, say. And it is-20s-40s).

So, with this, we've narrowed down to autonomy vs. shame and doubt and identity vs. role confusion.

Which one sounds more like a teenager to you?

Think of the teenagers in your life. Think of  yourself as a teenager. Trying to develop a sense of self. Struggling with the question, "What do I want to do with my life?" Sounds like one of the options more than any of the others: C, identity vs. role confusion.

Sometimes "sounds like" is the best you can do on the ASWB exam. And that's fine. You don't need to have the answer immediately at your fingertips for every single question. If you can narrow to two options and take your best guess, that's sometimes the best you can do.

To avoid having the entire exam feel like mysterious guesswork, it's best to get to exposed to lots and lots of practice questions as you prep for the exam. And that's what we've got here (sign up to get started!).

Happy studying, good luck on the exam, and with whatever Eriksonian stage you're grappling with right now!

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What’s the difference between schizophrenia and schizoaffective disorder?

shadowThey sound alike and look alike. They're not the same thing. Here's how to tell the difference between schizophrenia and schizoaffective disorder.

The DSM devotes a chapter to Schizophrenia Spectrum and Other Psychotic Disorders. Included there: delusional disorder (delusions without other schizophrenia symptoms), brief psychotic disorder (psychotic symptoms present less than one month), schizophreniform disorder (symptoms lasting for less than six months), catatonia, and substance/medication-induced and due-to-another-medical-condition psychotic disorder (describe themselves).

What's left: schizophrenia and schizoaffective disorder. Here are the criteria for schizophrenia:

A. Two or more present for bulk of a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms.

B. Symptoms disturb level of functioning.

C. Signs of disturbance last for at least 6 months.

D. Schizoaffective and bipolar disorder ruled out.

E. Symptoms not due to the effects of a substance or medical condition.

Schizoaffective disorder is diagnosed when these criteria are met. Watch for the difference. It'll come up right away:

A. A major mood episode concurrent with criterion A of schizophrenia.

B. Delusions of hallucinations for two or more weeks without a major mood episode during the lifetime duration of the disorder.

C. A major mood episode is present for the majority of the illness.

D. Symptoms not due to the effects of a substance or medical condition.

Specifiers for schizoaffective disorder include bipolar type, depressive type, and with catatonia.

TL;DR? They're very similar. Both include some combination of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms. But in schizoaffective disorder, a major mood episode is present most of the time (though not 100% of the time). Why not 100%? Because then you'd be looking at MDD or bipolar I with psychotic features. A topic for another blog post

So how do you boil this down into something simple and memorable? How about this: Schizoaffective disorder is like schizophrenia, but includes a big mood component generally occurring alongside psychotic symptoms.

ASWB exam preppers, see if the above helps you answer this question correctly:

A social worker sees a client who reports a lifetime of "seeing things all the time, shadows." He also reports hearing voices, "probably the NSA," which tell him he's "useless and stupid." The voices leave him feeling "pretty sad and really annoyed." Given the symptoms the client describes, what is the MOST likely of the following DSM diagnoses?

A. Major depression with psychotic features

B. Schizophrenia

C. Schizophreniform disorder

D. Schizoaffective disorder

What do you think?

The client appears to meet criteria for some psychotic disorder, given that he reports a lifetime of psychotic symptoms (hallucinations and delusions). The lifetime duration means schizophreniform disorder isn't the correct answer. Narrowing down between the three left standing depends upon your reading of "pretty sad and really annoyed." Sounds like the client gets in a bad mood due to his symptoms. Does that bad mood rise to the level of MDD? It does not. So scratch A. And while you're at it, since schizoaffective disorder requires MDD or bipolar disorder symptoms alongside schizophrenia symptoms, scratch that one as well. Now you're left with one answer, the correct answer as it happens: B, schizophrenia.

For more practice questions from the DSM, about psychotic disorder diagnosis, and other close-call social work situations, sign up with SWTP!

 

[Post by Will Baum, LCSW]

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