What is the likely DSM-5 diagnosis for a Grade 1 student who has experienced recent bereavement, exposure to interpersonal conflicts, and episodes of physical discipline within the household, yet continues to demonstrate good academic and social functioning?

DSM-5 Diagnosis for Grade 1 Student with Bereavement and Household Stressors

Based on the clinical presentation, this child does not meet criteria for any DSM-5 mental disorder at this time. The student demonstrates continued good functioning across all domains despite experiencing significant life stressors, which is inconsistent with the DSM-5 requirement of "clinically significant disturbance" or "significant disruption of daily life" necessary for any psychiatric diagnosis 1.

Rationale for No Diagnosis

Core DSM-5 Diagnostic Requirements Not Met

• DSM-5 defines mental disorders as requiring "clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction" with resultant impairment 1.

• This child explicitly demonstrates preserved functioning across multiple domains:

  • Academic performance remains strong (understands lessons, completes tasks easily)
  • Social relationships intact (reports many friends, socially engaged)
  • No sleep disturbances or appetite changes
  • Continues to enjoy school attendance
  • Maintains play activities with siblings 1

Bereavement Considerations

• Normal grief reactions do not constitute Prolonged Grief Disorder unless symptoms persist for at least 6 months in children and adolescents with intense yearning, preoccupation, and at least 3 of 8 specified symptoms causing clinically significant impairment 2.

• The child's sadness and missing her deceased relative, occurring within the same year as the death, represents developmentally normative grief without the intensity, duration, or functional impairment required for diagnosis 2.

• The child's ability to maintain academic performance, peer relationships, and enjoyment of activities indicates grief is not causing "significant disruption of daily life" 2.

Trauma Exposure Assessment

• While the child witnessed physical discipline of siblings (hitting, punching, kicking) and experienced household displacement due to family conflict, she denies personal maltreatment and reports being treated well by paternal relatives 1.

• Exposure to violence alone, without accompanying symptoms and functional impairment, does not warrant a trauma-related diagnosis 1.

• The mother's report of "psychological impact" is not corroborated by objective evidence of impairment in the child's functioning across settings 1.

Differential Diagnosis Considerations

Anxiety Disorders Ruled Out

• Anxiety disorders require "excessive fear or worry" that is "developmentally inappropriate" and causes functional impairment 1.

• This child shows no evidence of:

  • Separation anxiety (continues attending school, no distress about separation)
  • Social anxiety (reports many friends, socially engaged)
  • Generalized anxiety (no excessive worries reported)
  • School refusal or academic decline 1

Adjustment Disorder Not Applicable

• While adjustment disorders can occur following identifiable stressors, they require emotional or behavioral symptoms causing marked distress or significant impairment in functioning 1.

• The child's continued good functioning across all domains excludes this diagnosis 1.

Somatic Symptom Disorder Not Present

• Somatic symptom disorder requires "one or more somatic symptoms that are distressing or result in significant disruption of daily life" with excessive thoughts, feelings, or behaviors related to symptoms 1.

• This child reports no somatic complaints, sleep disturbances, or appetite changes 1.

Clinical Recommendations

Monitoring and Preventive Approach

• Document the child's resilience factors: strong academic performance, intact peer relationships, continued engagement in activities 1.

• Schedule follow-up evaluation in 3-6 months to reassess for any emerging symptoms, particularly:

  • Changes in academic performance or school attendance
  • Social withdrawal or peer relationship difficulties
  • Development of sleep disturbances or somatic complaints
  • Behavioral changes at home or school 1

Risk Factor Documentation

• Record exposure to household stressors and witnessed violence as potential risk factors for future mental health concerns, even though they are not currently causing impairment 1.

• Assess family support systems and ensure the mother has resources for her own stress management, as parental distress can impact child functioning over time 1.

When to Reassess for Diagnosis

• Reevaluate if functional impairment emerges in academic, social, or daily living domains 1.

• Consider Prolonged Grief Disorder if grief symptoms intensify beyond 6 months post-loss with marked functional impairment 2.

• Screen for trauma-related symptoms if new information emerges about direct maltreatment or if the child develops avoidance, hyperarousal, or intrusive symptoms 1.

Common Pitfalls to Avoid

• Do not diagnose based solely on stressor exposure without documented functional impairment across settings 1.

• Do not pathologize normal grief reactions within the expected timeframe following bereavement 2.

• Do not rely exclusively on parental report of "psychological impact" when the child's objective functioning across multiple settings remains intact 1.

• Avoid premature diagnosis that could lead to unnecessary treatment or stigmatization when the child demonstrates resilience and adaptive coping 1.