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Diagnostic Psychiatric Evaluation

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PATIENT NAME:  Howard Smith

DATE OF BIRTH:  August 1st, 2003

DATE OF EVALUATION:  September 24th, 2015.

EVALUATED BY:  Zoe Blacksin, M.D.          

(Evaluation Report written by Miriam Vela Garcia)

AGE:  12 years

INFORMANTS:  Elias and Roberta Smith, biological parents, and patient.



Chief Complaint:

Howard’s mother expressed her concern by stating, “sometimes he gets a little anxious.” Both parents reported that Howard gets “extremely upset during many situations,” such as chores and homework. He “tantrums with the intensity of a toddler” and “whines when he has to do something he doesn’t want to do.” The mother claims said tantrums are often followed by general feelings of low self-esteem, such as feelings of regret, depression, and feeling like he “is a terrible person.” In general, Howard is a kid who is smart, but is having family troubles at home as well as problems in school, despite his intelligence.

History of Present Illness:

Howard is a 12 year-old Caucasian boy with a history of negative behavioral responses and, as his parents put it, “some anxiety.” This is the first time he has ever been evaluated. He comes from a family that shares a history of several undiagnosed mental illnesses. His parents decided to finally bring him in because the situation got to a “miserable” state. All three of them agreed that there is a lot of yelling and arguing happening at home. Howard says most arguments are about "stuff like homework or siblings.” As a further example he stated, “we are very precise about cookies,” and when he can eat them, as well arguments on one-car trips, where the whole family is sitting together and “someone starts singing.” His parents describe he lays on the floor and throws toddler-like tantrums “to prevent things.” His father marks that he has a strong, stubborn desire to win at arguments. Said arguments “will continue until they escalate to a punishment.” One of the main reasons the patient admitted he throws tantrums is he finds it hard to accept that just because his parents are his parents that they are right. Ultimately, he recognizes that they are in charge but finds it unfair that adults get to dictate. Howard confessed he purposefully finds himself starting arguments with his mother, but she "doesn’t realize [he is] trying to get something out of her.” The patient’s father reported Howard "doesn’t realize that he reacts badly” when he reflects on his tantrums afterwards.

His mother notes the main source of the arguments between her and her son to be misunderstandings. She reported he has had “a lot of very precise language acquirement.” Regarding this, Howard said he finds “certain words to have slightly different meanings, like sour and tangy, those two things are very different [for him], while most people would say they are the same.” The mother reasoned that this causes them to avoid the things they are really talking about, to which Howard defended himself by saying he does not “always say the whole thing right away." She also assumes that sometimes he ignores her on purpose. In addition she remembered that when he was younger “there were voices in his head,” but such occurrence has never manifested itself again ever since.

The patient’s mother also identified him as "a worrier". She explained that in car trips he gets remarkably concerned with whether or not they are going to right way. She also claimed he "worries about things at school and about growing up.” She indicated that the night before the first day of school was the closest thing he has had to a panic attack, although the father felt that was an exaggeration. 

His parents suppose the main possible sources of trauma for Howard were the death of his great grandmother, the birth of his sister, and most importantly, the new school placement. The patient recently switched schools to a place that according to his mother has “better administration” and is newer. However, at this middle school there is a particular teacher that both parents identify as a “trigger” for Howard, even though they recognize his resistance to doing homework has always been an issue. At school, he has been referred to as “an inflexible explosive child.” His mother recalled a particular time in which he was working on a project at home. The teacher was unclear about instructions, so Howard did not know how to proceed and hid himself in a closet. His father noticed that his “grades are good, but not outstanding,” and expressed that he believes his son can “step it up.”

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