SOWK 431 Week 2 Case Study 1 Example

Case Study 1: Attention-Deficit/Hyperactivity Disorder in a Nine-Year-Old, From DSM-5 Criteria to a Strengths-Based Plan

Introduction

Elijah, a composite nine-year-old in the third grade, is known at school for two things: he cannot stay in his seat, and almost everyone likes him. His teacher referred him to the school social worker after a semester of incomplete work, lost materials and frequent trips to the principal's office for interrupting. This case study applies the DSM-5 criteria for attention-deficit/hyperactivity disorder (ADHD) to Elijah, considers other explanations, assesses his risks and strengths in the manner of Corcoran and Walsh (2014) and proposes an intervention plan.

Case Summary

Elijah's mother is a nurse on twelve-hour shifts, and he lives with her, his stepfather and a four-year-old sister. His mother reports that he has been "on the go" since he could walk, that he loses jackets and homework weekly and that getting him through a morning routine takes constant reminders. At school, he blurts out answers, leaves his seat several times an hour and starts assignments but rarely finishes them. His reading is on grade level when tested one-on-one, and his teacher describes him as kind, funny and generous with classmates. His maternal uncle was diagnosed with ADHD as an adult. Elijah sleeps nine to ten hours a night, has no history of abuse or major loss and passed recent vision and hearing screenings.

DSM-5 Diagnosis

The DSM-5 requires at least six symptoms of inattention and/or six of hyperactivity-impulsivity for children, persisting at least six months, with several present before age twelve and in two or more settings, clearly interfering with functioning and not better explained by another disorder (American Psychiatric Association, 2013). Elijah shows seven inattentive symptoms, including failing to finish schoolwork, losing materials, being easily distracted and forgetfulness in daily activities, and seven hyperactive-impulsive symptoms, including leaving his seat, running about, talking excessively, blurting answers and interrupting. His mother and teacher both report them, and they date to early childhood. The diagnosis is ADHD, combined presentation, moderate.

Differential Diagnosis

Several conditions can mimic ADHD. Anxiety can produce restlessness and poor concentration, but Elijah shows no excessive worry or avoidance. A specific learning disorder can cause incomplete work, yet his reading and math are on grade level when tested individually, suggesting that attention rather than skill limits his performance. Trauma can resemble hyperactivity, but his history reveals none. Sleep deprivation is ruled out by his regular, ample sleep. Because many children with ADHD have co-occurring conditions, the social worker should keep watching for anxiety or learning problems over time.

Risk and Protective Factors

ADHD is strongly heritable, with the international consensus statement reporting a mean heritability of about 74 percent across twin studies, so Elijah's uncle's diagnosis is a meaningful biological risk factor (Faraone et al., 2021). Psychological risks include growing frustration and a self-image shaped by constant correction. Social risks include his mother's long shifts, which limit consistent routines, and a school record of discipline that could follow him. Protective factors are substantial: an engaged mother, a stable home, a supportive stepfather, normal intelligence and strong peer relationships.

The condition is common. Danielson et al. (2024) analyzed the 2022 National Survey of Children's Health and found that about 7.1 million U.S. children and adolescents, roughly 11.4 percent, had ever been diagnosed with ADHD, and that most children with current ADHD had at least one co-occurring condition. Elijah's family is far from alone.

Strengths

Elijah's warmth, humor and generosity win him friends and adult goodwill. He is persistent in activities he enjoys, such as building with blocks and soccer, where his energy is an asset. His mother's medical knowledge helps her manage appointments, and the family attends a church where Elijah's Sunday school teacher has noticed he does well with short, active lessons. These strengths give the plan something to build on.

Intervention Plan

For children aged six to eleven, the American Academy of Pediatrics guideline recommends FDA-approved medication paired with parent training in behavior management or classroom behavioral interventions, ideally both, and supported by school services (Wolraich et al., 2019). The plan therefore includes referral to his pediatrician to discuss medication, enrollment of his mother and stepfather in a behavioral parent training group, a daily behavior report card passed between school and home and a Section 504 meeting to set accommodations, for example seating near the teacher, movement breaks and assignments split into smaller pieces. Soccer and other physical activities should be protected rather than withheld as punishment.

The Social Worker's Role

The school social worker coordinates among the family, teacher and pediatrician, helps the parents understand the diagnosis without blame and monitors Elijah's mood and self-esteem. Corcoran and Walsh (2014) stress that assessment and intervention should build on strengths as well as reduce symptoms, so progress reports should note what Elijah does well. The worker should also check in with Elijah himself, asking what helps him focus and what makes school hard.

Biblical Reflection

In Psalm 139:14, David thanks God that he was formed in a way both fearful and wonderful (English Standard Version Bible, 2001/2016). Elijah's energy and warmth are part of that design, not defects to be eliminated. Treating his ADHD aims to help him flourish as the person God made, and adults around him should communicate that he is valued long before he can sit still.

Conclusion

Elijah meets the criteria for ADHD, combined presentation, and his symptoms are interfering with school and home. A plan combining medical evaluation, parent training, classroom supports and attention to his strengths offers him the best chance to succeed. The social worker should review the plan with the family and teacher at the end of each grading period, adjusting supports as Elijah grows and asking him, in words a nine-year-old can answer, whether school is starting to feel more manageable.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Corcoran, J., & Walsh, J. (2014). Mental health in social work: A casebook on diagnosis and strengths-based assessment (2nd ed.). Pearson.

Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD prevalence among U.S. children and adolescents in 2022: Diagnosis, severity, co-occurring disorders, and treatment. Journal of Clinical Child & Adolescent Psychology, 53(3), 343-360. https://doi.org/10.1080/15374416.2024.2335625

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., . . . Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789-818. https://doi.org/10.1016/j.neubiorev.2021.01.022

Wolraich, M. L., Hagan, J. F., Jr., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), Article e20192528. https://doi.org/10.1542/peds.2019-2528