Evidence-based assessment/Vignettes/Jay

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HGAPS Spring 2025: Mental Health and Resilience Resources for Squid Game

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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.

Conceptualization

Initial treatment plan

Assessment Findings

Checklist Scores

Extended content

Select more specialized scales to refine probabilities

Updating probabilities

Critical items

Diagnostic Interview findings

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

Risk and Protective Factors and Moderators

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)
	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
	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)
	Base Rate from Merikangas et al. (2010) NCS-A^[1]		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	No data about TRF scales for aggressive
	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%)
	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

Treatment Selection

Moderating Factors

Client Preferences

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?

Interpreting benchmarks

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.

↑ Merikangas, Kathleen Ries; He, Jian-ping; Burstein, Marcy; Swanson, Sonja A.; Avenevoli, Shelli; Cui, Lihong; Benjet, Corina; Georgiades, Katholiki et al.. "Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A)". Journal of the American Academy of Child & Adolescent Psychiatry 49 (10): 980–989. doi:10.1016/j.jaac.2010.05.017. PMID 20855043. PMC PMC2946114. https://dx.doi.org/10.1016/j.jaac.2010.05.017.

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[:0-1] Merikangas, Kathleen Ries; He, Jian-ping; Burstein, Marcy; Swanson, Sonja A.; Avenevoli, Shelli; Cui, Lihong; Benjet, Corina; Georgiades, Katholiki et al.. "Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A)". Journal of the American Academy of Child & Adolescent Psychiatry 49 (10): 980–989. doi:10.1016/j.jaac.2010.05.017. PMID 20855043. PMC PMC2946114. https://dx.doi.org/10.1016/j.jaac.2010.05.017.

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