IDENTIFYING/DEMOGRAPHIC DATA:Aponi is a 9-year-old, Native American female in fifth grade. She lives with her parents and twin brother, Anakin, in Leitchfield, Kentucky. Aponi's dad is an attorney and her mom works in retail part time.

CHIEF COMPLAINT/PRESENTING PROBLEM:Aponi's parents are concerned about Aponi's schoolwork and behavior at home and school. Aponi's mother reports that Aponi is oftenirritable, negative and defiant. Mom states Aponi has frequent tantrums when she believes her brother is getting more than she is. She seems to always just want "her way." This is causing a lot of trouble in school since she bullies others and threatens her peers to get things from them.

HISTORY OF PRESENT ILLNESS:Aponihad been having troubles in school since she was 6 years old. Each year of school since first grade teachers reported trouble with her peers. This year her teacher reported to the family that she seemed to have a habit of provoking other students as well as the teacher by making noises, rocking in her seat, and whistling in class. If a student responds to her she attempts to initiate fights with them. She is now in serious academic trouble. After a psycho-educational evaluation at school, it was found that she had above-average intellectual ability. Aponi's mom worries that Aponi is intentionally acting out and annoys people because her and her husband have separated on two occasions over the years.

Mom reports Aponi hastantrums which consist of shouting, cursing, crying, slamming doors, and sometimes throwing books or objects on the floor for several years.Aponi does bring home report cards that seemingly fail to reflect her intelligence. Her work remains unfinished a lot and she seldom answers questions when called on in class.

PAST PSYCHIATRIC HISTORY:

Aponi's parents tried all kinds of ways to help their child focus on schoolwork. They have hired private tutors for the past two years to keep her focused. Aponi has challenges withsocial attachments, as evinced by her difficulty with peer relationships. She has always connected with a much younger person and got along okay. Mom has previously taken Aponi to a behaviorist for help and mom believed Aponi has a poor self-esteem. This was initiated when mom found out Aponi was taking other students lunch money and personal items for herself. The behaviorist reported Aponi had troubling skills in communicating in socially acceptable ways and appears to have little regard for the feelings, wishes, and welfare of others. Mom became angry and stopped the treatment.

SUBSTANCE USE HISTORY:

Aponi denies any use of drugs or alcohol.

PAST MEDICAL HISTORY:

Aponi has been fairly healthy throughout her life. Any illness was remedied through her parents' natural means and their religion.

FAMILY MEDICAL AND PSYCHIATRIC HISTORY:

This is a Native American family which adheres to the behaviors and parenting of their culture. There is no reported psychiatric history in the family. Any medical conditions were treated with herbal remedies or medicinal foods.

CURRENT FAMILY ISSUES AND DYNAMICS:

Aponi's parents are Native American and adhere to thatculture. The Prince's separated on two occasions over the past five years. They previously would have severe verbal fights that both Aponi and her brother were privy to due to Mr. Prince's drinking. The twins would both become angry since they have had nanny's and caretakers their entire life.The parents were not comfortable bringing Aponi in for an evaluation, but they were referred by the school system.

Aponi's mother reports that she has given up on asking her to help with chores, because it inevitably results in an argument.

MENTAL STATUS EXAM:

Aponipresents as a casually dressed female who appears her stated age of 9. She is a bit anxious during the interview andappears sullen and irritable. Her affect is appropriate but seems a bit defiant at times. Motor activity is appropriate. Speech is clear. There is no evidence of delusions or hallucinations. Aponi's intelligence appears average. She is oriented to time, place, and person. During the mental status exam Aponiwas kicking her foot against her mother's chair and mom asked her to stop. She looked at her and continued to kick mom's chair until she became angry. Aponi started yelling and stated that she wasn't doing anything and that her mother was just picking on her. She insists that her problems are all her mother's fault and she is always nagging her unfairly.

The diagnosis should appear on one line in the following order. Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.

Code + Name + Specifier (appears on its own first line) Z code (appears on its own line next with its name written next to the code)

Then,

• Explain how you support the diagnosis by specifically identifying the criteria from the case study.
  • Describe in detail how the client's symptoms match up with the specific diagnostic criteria for all the disorder that you finally selected for the client. Note: You do not need to repeat the diagnostic code in the discussion.
• Identify the differential diagnosis you considered.
• Explain why you excluded this diagnosis/diagnoses.
• Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
• Explain why you chose the Z codes you have for this client.