Solution Manual for Mental Health in Social Work: A Casebook on Diagnosis and Strengths Based Assessment, 3rd Edition

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Instructor’s Resource Manual
For
Mental Health in Social Work: A
Casebook on Diagnosis and Strengths-
Based Assessment
Third Edition
Jacqueline Corcoran, University of Pennsylvania
Joseph M. Walsh, Virginia Commonwealth University

Table of Contents
Instructions for Use iv
Chapter 3: Autism Spectrum Disorder 1
Chapter 4: Attention Deficit Hyperactivity Disorder 10
Chapter 5: Schizophrenia 19
Chapter 6: Bipolar Disorder 29
Chapter 7: Major Depressive Disorder 35
Chapter 8: The Anxiety Disorders 42
Chapter 9: Obsessive-Compulsive Disorder 49
Chapter 10: Post-Traumatic Stress Disorder 53
Chapter 11: Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, and
Binge Eating Disorder 62
Chapter 12: Oppositional Defiant Disorder and Conduct Disorder 72
Chapter 13: Substance-Related and Addictive Disorders 81
Chapter 14: Gender Dysphoria 95
Chapter 15: Alzheimer’s Disease 102
Chapter 16: Borderline Personality Disorder 115

Instructions for Use
Directions Part I, Diagnosis: Given the case information, prepare the following: a diagnosis, the
rationale for the diagnosis, and additional information you would like to know in order to make a
more accurate diagnosis.
Directions Part II, Bipsychosocial Risk and Resilience Factors Assessment: Formulate a risk and
resilience assessment, both for the onset of the disorder and for the course of the disorder,
including the strengths that you see for this individual.
Directions Part III, Goal Setting and Treatment Planning: Given your risk and protective factors
assessments of the individual, your knowledge of the disorder, and evidence-based practice
guidelines, formulate goals and a possible treatment plan for this individual.
Directions Part IV, Critical Perspective: Formulate a critique of the diagnosis as it relates to this
case example. Questions to consider include the following: Does this diagnosis represent a valid
mental disorder from the social work perspective? Is this diagnosis significantly different from
other possible diagnoses? Your critique should be based on the values of the social work
profession (which are incongruent in some ways with the medical model) and the validity of the
specific diagnostic criteria applied to this case.

Chapter 3
Autism Spectrum Disorder
Case 1
Questions to consider when formulating a diagnosis for Emmanuel
1. What are Emmanuel’s significant symptoms with regard to a possible mental disorder?
Emmanuel had a hard time separating from his parents at school and was continuously
crying, trying to run away, and throwing tantrums. He had difficulty with transitions at
school and did not follow directions well. He did not approach other children and did not
respond to their attempts to play or talk. Emmanuel used few of his own words but
repeated what others said. When upset, he made guttural noises or screams. He was
sensitive to loud noises and reacted by covering his ears and screaming. Emmanuel had
no interest in his peers. He preferred to play on his own. When Emmanuel got exited he
flapped his hands, clapped his thighs and crotch, and tapped his face. He appeared to be
in a world of his own. He was content with writing numbers and letters over and over,
and he frequently wrote down numbers to sooth himself when upset. He showed some
developmental delays in areas of self-help and adaptation. His parents report that
Emmanuel acted impulsively at times.
2. For how long have Emmanuel’s problem behaviors been evident?
The extent of Emmanuel’s problem behaviors and developmental difficulties were noted
immediately upon his enrollment in school, when he was five years old. While the family
may have minimized their prior suspicions of some of these difficulties, the formal
assessment revealed that they had begun having concerns about Emmanuel’s
development at 30 months of age, due to his language difficulties. It is possible that his
problems had been emerging before then.
3. Has there been any recent stressful event occurring in Emmanuel’s life that might account
for any of his symptoms?
There is no evidence of any recent stressors in Emmanuel’s life, although his beginning
kindergarten has placed him in a more structured environment than he experienced
before. Rather than accounting for his symptoms, however, this seems to have made them
more evident.
4. To what extents do Emmanuel’s (and his parents’) cultural traditions contribute to his
problem behaviors?
Because of their mixed Spanish and American heritage and lifestyles, the family did not
acknowledge Emmanuel’s developmental delays as evidence of any internal problem.
Rather, they perceived Emmanuel’s delays as being due to his need to live bi-culturally
and make a gradual transition between his two cultures.
5. Given that Emmanuel has a developmental disorder, with what other disorders of childhood
and adolescence (if any) do his symptoms overlap?
In addition to the autism spectrum disorders, Emmanuel’s inability to follow directions
and adhere to the demands of the structured environment could be seen as symptoms of
oppositional defiant disorder. His problems with attention and concentration could be
seen as symptoms of attention-deficit hyperactivity disorder. His academic limitations,
and slightly below-normal measured IQ, might make an observer suspect an intellectual
disability. Still, Emmanuel does not meet the full criteria for any of those disorders.

DSM Diagnosis
F84.0 Autism Spectrum Disorder, without accompanying intellectual impairment, with
accompanying language impairment, requiring substantial support
Rationale
The diagnosis of Autism Spectrum Disorder was made because Emmanuel displays significant
deficits in his social interactions, such as reduced eye contact, lack of social reciprocity, and
failure to develop relationships with others. His communication skills are considerably limited;
he does not initiate or sustain conversations with others, and his language development has been
delayed since he was a baby. He also uses unusual forms of language, such as echolalia. For all
these reasons, he was given the additional specifier with accompanying language impairment.
Moreover, Emmanuel is unable to participate in imaginative play. Additionally, he exhibits
restricted interests, such as writing numbers repeatedly in an artistic, almost calligraphic manner.
Emmanuel displays repetitive motor mannerisms, including hand flapping and face tapping.
Further support for this diagnosis is evident in his impulsivity and difficulty with sensory
integration.
Emmanuel’s developmental and psychological testing has determined the absence of Intellectual
Disability. His IQ is 95. Therefore, the specifier without accompanying intellectual impairment
was added. He was assessed as Level 2, requiring substantial support because of his language
delays and lack of ability to interact socially.
A review of Emmanuel’s medical history indicates that he is a healthy five-year old with no
problematic medical condition. His mother reports that pregnancy and delivery were normal and

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4. What are the circumstances in which Emmanuel is most likely to engage in his artistic
pursuits, including calligraphy and listening to music?
5. What playground conditions does Emmanuel seems to enjoy the most? What are the
features of those times when he is most able to attend to his puzzles?
6. What are the circumstances that seem to encourage Emmanuel’s use of humor?
7. How can Emmanuel’s visits with family members be structured to maximize his positive
engagement with them?
Intervention Plan
In the case of autism spectrum disorder, it is necessary to develop and implement an intervention
plan as soon as possible, especially in light of Emanuel’s relatively late diagnosis. Emmanuel is
eligible for special education within his school district, and his parents and the special education
team will meet within the next two weeks to develop an IEP (Individualized Education
Program). As soon as this has been accomplished, Emmanuel will be able to join a class
appropriate to his needs. The elementary school he attends offers a class for children with autism
spectrum disorder, which is small in size and staffed with two special education specialists. This
class focuses on the development of social skills, as well as the reduction of stereotyped
behaviors. Speech therapy will also be necessary to enhance his pragmatic language skills.
In addition to these services it is important to educate Emanuel’s parents about the disorder,
relevant parenting practices, and resources in the community. Fortunately, the school district has
a Parent Resource Center, which offers an array of informational material in Spanish, as well as
workshops and classes on various disorders and their treatment. The social worker has provided
the parents with some basic information and has set up a meeting for the parents with Spanish-
speaking staff at the Parent Resource Center. Due to the parents’ difficulties with consistent
parenting, the social worker has already shared information on discipline and has introduced
them to a behavioral approach to reinforce desired and reduce problematic behaviors. She has

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are reached. In Emmanuel’s case, his parents had just found out about the disorder and he had,
up until that time, limited supports. It may not be fair to judge Emmanuel as “requiring very
substantial support” when he had not yet received intervention. For that reason, he was not given
that rating, although it my later become evident that he needs it.
Case 2
Questions to consider in formulating a diagnosis for Hao:
1. What are Hao’s significant symptoms with regard to a possible mental disorder?
Hao is unable to relate to other children in class or follow directions, and he frequently
engages in hand washing. He cannot follow classroom routines and only persists with
activities in which he is interested. He speaks with an inappropriately loud volume in
close proximity to others’ faces, and is unable to retain the teacher’s instructions about
standing back and speaking more quietly. Hao looks off into space while the teacher
speaks, and he does not react to comments she makes. At times he has temper tantrums at
school. His mother noticed in preschool that Hao was not connecting with other children
and only wanted to play alone. Hao is not developing socially. He does not follow the
rules set forth by his family, and tends to ignore his parents when they try to discipline
him. Hao tends to laugh inappropriately during activities at the park to a degree that his
father threatens to take him home.
2. For how long have Hao’s problem behaviors been evident?
Hao’s problem behaviors have only been evident for one year. They were formally
identified only when he enrolled in school and demonstrated an inability to function
within the structure of that institution. His parents had been concerned about his social
isolation one year before, when he entered preschool, but his teachers at the time did not
see Hao’s withdrawal and preference for playing alone as significant issues.
3. Have there been any recent stressful events occurring in Hao’s life that might account for

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