Evidence-based assessment/Vignettes/Jay

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Jay

Clinical description

Jay is a 22-year-old male undergraduate student at the University of North Carolina at Chapel Hill (UNC). Jay was previously diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). In college, Jay complained of having difficulties with sustaining attention, reading, inadequate study habits, and poor performance in his college courses (relative to his high school performance). He has been experiencing mood fluctuations. Jay has been feeling anxious for a long time. He says that he has "panic attacks" and "persistent worrying."

History of presenting a problem

Jay had previously been evaluated for Attention-Deficit/Hyperactivity Disorder (ADHD) and was diagnosed. In addition to attention and reading difficulties, Jay reported clinically significant disordered mood and fluctuations in mood (i.e., periods of “highs” and “lows”), and a strong family history of bipolar disorder. Finally, Jay reported a longstanding history of anxiety, including panic attacks and persistent worrying.

Assessment Findings

Checklist Scores

Extended content
Select more specialized scales to refine probabilities Updating probabilities Critical items

Cognitive and Achievement Testing

(Not done as part of the evaluation; may be able to match up information later)

Prediction Phase

Let's see how we would apply the EBA principles to Arlene:

Shortlist of Probable Hypotheses

Based on Jay's age and the common clinical issues, here are the possible issues:

• Attention problems
• Anxiety disorders
• Substance misuse should be another hypothesis, based again on its prevalence in his age group.
• A mood disorder

Updating Probability of Diagnoses

Could add table with DLRS and revised probabilities, or leave them blank and have a "key" section?

Jay	Common Dx Hypotheses (A)	Starting Prob. (B)	Broad Measure (D)				Cross-informant (E)			Confirmation (G)	Treatment Phase (I), (J), (K)
	Base Rate from Kessler et al. (2005) NCS-R		Scale & Score	DLR	Revised Prob.	EAY Check	Next Test score	DLR	Revised Prob.	MINI
	Specific Phobia	0.13
	PTSD	0.06
	GAD	0.04								Generalized Anxiety Disorder Current
	Panic Disorder	0.04								Panic Disorder Lifetime
	Social Phobia	0.14
	Separation Anxiety	0.02
Any Impulse Control Disorder	ODD	0.10
	CD	0.11
	ADHD	0.08								Adult ADHD
Any Mood Disorder	MDD	0.15	BDI							Major Depressive Episode w/ Melancholic Features, Past
	BP	0.06	MDQ				KSADS Mania Scale?			Hypomanic Episode
	Dysthymia	0.02
Any Substance Abuse Disorder		0.17

Answers

Arlene Common Dx Hypotheses (A) Starting Prob. (B) Broad Measure (D) Cross-informant (E) Confirmation (G) Treatment Phase (I), (J), (K) Base Rate from Merikangas et al. (2010) NCS-A Scale & Score DLR Revised Prob. EAY Check Next Test score DLR Revised Prob. Next Test score DLR Revised Prob. K-SADS Interview Any Anxiety Specific Phobia 0.19 Anxiety NOS (65%) PTSD 0.05 GAD 0.02 CBCL T Internalizing 59 0.98 0.02 0.02 Other measures are better than Achenbach Panic Disorder 0.02 Social Phobia 0.09 Separation Anxiety 0.08 Any Impulse Control Disorder ODD 0.13 CBCL T Aggressive 69 4.18 0.38 0.38 No data about TRF scales for aggressive ODD (70%) CD 0.07 CBCL T Aggressive 69 4.18 0.24 0.24 ADHD 0.09 CBCL T Attention 62 6.92 0.41 0.41 TRF T Attention 58 0.73 0.34 ADHD inattentive (75%) Any Mood Disorder MDD 0.12 CBCL T Anx/Dep 57 0.39 0.05 0.05 Haven't found data about TRF for internalizing MDD (85%) BP 0.03 CBCL T Externalizing 67 1.26 0.04 0.04 YSR T Externalizing 73 2.32 0.09 TRF T Externalizing 68 2.03 0.17 Bipolar I (85%) Dysthymia Included above Dysthymia (85%) Any Substance Abuse Disorder 0.11 CBCL #2 CBCL #99 CBCL #105

Cross Informant Perspectives

Mention that these have DLRs. Also unpack the implications of agreement and disagreement for the client (and add a section about treatment implications of disagreement on the Conceptual Model Pages)

Prescription Phase

Mental Status and Clinical Observations

add content

Process Phase

Clinically Significant Change

Reliable Change Index

Pick a treatment target and specify what the RCI would be for it. Discuss how you would explain to Arlene

Nomothetic Benchmarks

A, B, Cs of Jacobson definitions. General stuff about limitations would go on the main concept page. Here it is focused on the client -- what are the benchmarks they will focus on? How explained to them?

Minimum Important Difference (MID)

Note that this section is a dangler -- not originally called out in the 12 steps. Medium d as a rule of thumb from Streiner, Norman, & Cairney (2015). Could work from AUC to d to raw units as a way of estimating, since psychology hasn't done research on this yet. Might be able to back into it with studies that had CSQ and outcome data.

Client Goals & Tracking

These would be personal goals and idiographic measurement -- YTOPS, etc.

Process Measures

This would be traces such as coming to sessions, doing homework assignments. (Not sure of other specifics involved in current IPT protocols?)

Progress Measures

YTOPS again and goal setting.

Termination Planning and Maintenance

Revisit Jacobson benchmarks. Is there much chance of relapse? What things would the client need to pay attention to if they were going to nip that in the bud?