The presented case of Carlos, a 19-year-old student, provides an opportunity to analyze his mental state and give appropriate arguments confirming the existence of individual disorders. Based on the case assessment, a specific treatment plan will be drawn up, short- and long-term goals within the SMART methodology will be identified, treatment and therapeutic interventions will be assigned, and the measurement of changes will be determined. As the main diagnoses identified during the analysis, attention-deficit/hyperactivity disorder (ADHD), depression, and adjustment disorder are proposed for consideration.
Justification of Diagnoses
Based on the assessment of Carlos’s condition and his medical history, ADHD is the primary diagnosis. According to the American Psychiatric Association (2013), its Z code is ICD-10; it refers to neurodevelopmental disorders, and its specification is 314.00 (F90.0), which is the manifestation of the disorder in the form of inattention as the main symptom. This disorder was diagnosed in the patient’s childhood, and it has not weakened over the years and continues to manifest itself during his college years, as evidenced by the reports of Carlos himself.
As another diagnosis, an unspecified depressive disorder may be mentioned. Its Z code in ICD-10 belongs to the category of depressive disorders; its unique specifier is 311 (F32.9) (American Psychiatric Association, 2013). As a rationale, one can pay attention to the recurrent depressive attacks that Carlos notes. At the same time, the patient does not use psychotropic drugs or other substances, does not have bad habits, and does not take potent medications. The oscillatory nature of depressive states explains the dynamic mechanism of the disorder and its fickle manifestations.
Finally, adjustment disorder can be referred to as a concomitant diagnosis. According to the American Psychiatric Association (2013), its Z code is ICD-10; the problem refers to the trauma- and stressor-related disorder subtype and its specifier is 309.28 (F43.23), which means a tendency to both depressive mood and anxiety. Carlos remarks that he cannot relax as much as his classmates and experiences a regular cyclical sensation of anxiety and excitement. All the three diagnoses presented are relevant to the patient in question and need to be addressed through an appropriate treatment plan.
Problems and Counseling Concerns of the Client
The key issues related to the case in question are the persistent states of depression and inattention reported by the patient himself. During the conversation with the clinician, Carlos behaves stiff and insecure, which confirms the manifestations of the problems. The situation is complicated by the fact that in his family history, cases of mental problems have been encountered, and the patient mentions the story of his late father who was dyslexic and could not complete his college education. As a result, the hereditary nature of the current issues can be one of the reasons for the manifestations of depressive disorders, anxiety, and inattention that worry Carlos. The characteristic stigma and behavioral patterns of finger tapping and closed posture confirm the patient’s stiffness. At the same time, due to Carlos’s awareness of his problems and the absence of thoughts of suicide or other forms of escape from reality, drawing up an effective treatment plan can be simplified.
SMART Short-Term and Long-Term Goals
Given the patient’s current condition, setting short- and long-term goals by the SMART methodology is a valuable intervention planning tool. As Prevatt et al. (2017) state, for people with the aforementioned mental disorders, short-term goals involve overcoming barriers and constraints. In this case, as these objectives, one can mention creating a treatment plan lasting for several weeks to carry out the necessary interventions, identifying motivational drivers during the therapy sessions, and applying relevant practices of communication with the patient throughout the entire period of treatment. These aims can allow determining current progress and comparing its state of Carlos with that before the intervention. As long-term goals, one can mention the patient’s adaptation to a new mode of life, the implementation of the learned improvement practices in everyday life, and the coordination of behavioral patterns on one’s own. These objectives can be measured by analyzing the patient’s level of anxiety and inattention, and in case of positive changes, the treatment plan will prove its relevance.
Treatment and Therapeutic Intervention
The treatment plan for Carlos should be individualized since the symptoms of his mental health problems are not standard. Mochrie et al. (2020) argue that in most college students, ADHD and similar mental disorders manifest due to substance abuse. However, Carlos notes that he has no bad habits and does not use any drugs or other substances. As a medical treatment mode, taking stimulants may be offered. The maximum daily dose should be no more than 5 mg twice a day. Raising the patient’s attention and stimulating his zest for life are the key objectives of the intervention, and prescribed medications can be useful in combination with behavioral therapy.
Behavioral therapy is the preferred form of intervention to help the patient. One of the tools is the organization of coaching sessions where Carlos can get the necessary information about what factors prevent him from focusing on achieving high academic results and what methods of dealing with them exist. During several weeks, the patient may attend mixed group and individual sessions to learn about the experiences of others with the same diagnoses. As an additional tool of influence, family therapy should be promoted. Carlos’s loved ones should receive the necessary instructions on how support can be manifested, in particular, through stimulating progress and helping the young man carry out routine duties. In the case of productive joint activities, the patient may feel better after several weeks of combination therapy.
Measuring the Changes
The success of the proposed intervention program will be measured by comparing the clinical data from the patient with those obtained before the start of the therapy sessions. In addition, as assessment tools, Carlos’s academic outcomes will be reviewed to determine if the treatment he has received has a positive impact on his college performance. Behavioral characteristics and attention rating will be analyzed through special questionnaires designed to identify the views of patients with ADHD and depressive disorders on their conditions. In case of positive developments, a follow-up care program will be compiled, and appropriate recommendations will be given to Carlos regarding maintaining a normal mental state.
Carlos’s case is examined in terms of the importance of addressing three diagnoses – ADHD, adjustment disorder, and depression. The rationale for these diagnoses is given based on the existing clinical base, and the relevance is explained about the patient. Carlos’s counseling confirms that he has specific problems, and once short and long-term goals have been set, an appropriate treatment plan should be implemented. Medication therapy includes taking stimulants, but behavioral therapy is seen as a more valuable intervention. The patient’s academic outcomes and individual perception will be the key factors in assessing the success of the treatment performed.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) (5th ed.). American Psychiatric Publishing.
Mochrie, K. D., Whited, M. C., Cellucci, T., Freeman, T., & Corson, A. T. (2020). ADHD, depression, and substance abuse risk among beginning college students. Journal of American College Health, 68(1), 6-10.
Prevatt, F., Smith, S. M., Diers, S., Marshall, D., Coleman, J., Valler, E., & Miller, N. (2017). ADHD coaching with college students: Exploring the processes involved in motivation and goal completion. Journal of College Student Psychotherapy, 31(2), 93-111.