Differential Diagnosis
- Single most likely diagnosis
- Post-Traumatic Stress Disorder (PTSD): The patient's history of parental loss in a traumatic event, followed by behavioral difficulties, nightmares, and avoidance of social interactions, strongly suggests PTSD. His repetitive play with the toy truck ramming into a stuffed animal may be a reenactment of the traumatic event.
- Other Likely diagnoses
- Adjustment Disorder: The patient's behavioral difficulties and social withdrawal may be an adjustment reaction to the significant change in his life, including the loss of his parents and living with his grandmother.
- Attention Deficit Hyperactivity Disorder (ADHD): The patient's restlessness, poor eye contact, and impulsive behavior (hitting other kids and breaking toys) could be indicative of ADHD, although the history of trauma and loss should be considered as a contributing factor.
- Anxiety Disorder: The patient's nightmares, fear of monsters, and avoidance of social interactions may suggest an anxiety disorder, such as separation anxiety or generalized anxiety disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Traumatic Brain Injury: Although the patient's physical examination is unremarkable, it is essential to consider the possibility of a traumatic brain injury, especially given the history of a motor vehicle collision that killed his parents.
- Child Abuse or Neglect: The patient's behavioral difficulties and social withdrawal may be indicative of child abuse or neglect, which would require immediate attention and intervention.
- Rare diagnoses
- Disruptive Mood Dysregulation Disorder: This rare condition is characterized by persistent irritability and frequent episodes of extreme behavioral dyscontrol, which may be considered in this patient, although it is less likely given the history of trauma and loss.
- Pervasive Developmental Disorder: Although the patient's ability to ride a bike and draw complex shapes suggests adequate developmental progress, a pervasive developmental disorder, such as autism spectrum disorder, should be considered, especially if there are concerns about his social interactions and communication skills.