[SOLVED 2023] For this Assignment you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder

Last Updated on February 20, 2023 by Admin

For this Assignment you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder

Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

For this Assignment you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder

Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2013). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities.

Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.

For this Assignment you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.

To Prepare:

Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 10

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

	Excellent	Good	Fair	Poor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint • History of present illness (HPI) • Past psychiatric history • Medication trials and current medications • Psychotherapy or previous psychiatric diagnosis • Pertinent substance use, family psychiatric/substance use, social, and medical history • Allergies • ROS	18 (18%) – 20 (20%) The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.	16 (16%) – 17 (17%) The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.	14 (14%) – 15 (15%) The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.	0 (0%) – 13 (13%) The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
In the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.	18 (18%) – 20 (20%) The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.	16 (16%) – 17 (17%) The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.	14 (14%) – 15 (15%) Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.	0 (0%) – 13 (13%) The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.	23 (23%) – 25 (25%) The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.	20 (20%) – 22 (22%) The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.	18 (18%) – 19 (19%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.	0 (0%) – 17 (17%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).	9 (9%) – 10 (10%) Reflections are thorough, thoughtful, and demonstrate critical thinking.	8 (8%) – 8 (8%) Reflections demonstrate critical thinking.	7 (7%) – 7 (7%) Reflections are somewhat general or do not demonstrate critical thinking.	0 (0%) – 6 (6%) Reflections are incomplete, inaccurate, or missing.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).	14 (14%) – 15 (15%) The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.	12 (12%) – 13 (13%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.	11 (11%) – 11 (11%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.	0 (0%) – 10 (10%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors	4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors	3 (3%) – 3 (3%) Contains several (three or four) grammar, spelling, and punctuation errors	0 (0%) – 2 (2%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100

Excellent

Good

Fair

Poor

Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS

18 (18%) – 20 (20%)

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

16 (16%) – 17 (17%)

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

14 (14%) – 15 (15%)

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.

0 (0%) – 13 (13%)

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.

In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

18 (18%) – 20 (20%)

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

16 (16%) – 17 (17%)

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

14 (14%) – 15 (15%)

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

0 (0%) – 13 (13%)

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

23 (23%) – 25 (25%)

The response thoroughly and accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

20 (20%) – 22 (22%)

The response accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

18 (18%) – 19 (19%)

The response documents the results of the mental status exam with some vagueness or innacuracy.

Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

0 (0%) – 17 (17%)

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.

Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

9 (9%) – 10 (10%)

Reflections are thorough, thoughtful, and demonstrate critical thinking.

8 (8%) – 8 (8%)

Reflections demonstrate critical thinking.

7 (7%) – 7 (7%)

Reflections are somewhat general or do not demonstrate critical thinking.

0 (0%) – 6 (6%)

Reflections are incomplete, inaccurate, or missing.

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

14 (14%) – 15 (15%)

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

12 (12%) – 13 (13%)

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

11 (11%) – 11 (11%)

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

0 (0%) – 10 (10%)

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.

Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors

4 (4%) – 4 (4%)

Contains a few (one or two) grammar, spelling, and punctuation errors

3 (3%) – 3 (3%)

Contains several (three or four) grammar, spelling, and punctuation errors

0 (0%) – 2 (2%)

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Total Points: 100

Name: NRNP_6635_Week10_Assignment_Rubric

Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Training Title 48 Transcript

00:00:00 BEGIN TRANSCRIPT:

00:00:00[sil.]

00:00:15 OFF CAMERA Well, thank you for bringing in these completed questionnaires on attention deficit hyperactivity disorder.

00:00:25 MRS. HIGGINS Yeah, you asked me to have some of her teachers fill out the forms, and so, I had two, and I filled out one.

00:00:35 OFF CAMERA Great, great, that’s wonderful, and these look very, yep, very completely filled out. How are you today, Sarah?

00:00:40 SARAH Fine, thank you.

00:00:45 OFF CAMERA Is it okay if I ask you some of the questions about how well you pay attention in school?

00:00:50 SARAH Uh-huh.

00:00:55 MRS. HIGGINS Sarah, use full words.

00:00:55 SARAH Yes, sir.

00:00:55 OFF CAMERA You are very polite. Thank you. Some people your age have difficulty being polite. You are very polite. When teachers tell you assignments in school, how well do you remember what they said your assignments are?

00:01:10 SARAH Not very well.

00:01:10 OFF CAMERA Mm-hmm.

00:01:10 SARAH They have to write her down a list.

00:01:15 OFF CAMERA Okay. Does that list help?

00:01:20 SARAH Sometimes I lose the list.

00:01:20 OFF CAMERA Oh, do you forget where you put the list of assignments?

00:01:25 SARAH Uh-huh. I mean, yes, I forget.

00:01:25 OFF CAMERA Does that happen every time or sometimes or not very much?

00:01:30 SARAH It happens sometimes.

00:01:35 MRS. HIGGINS Actually, every day.

00:01:35 OFF CAMERA Okay. Do you think maybe your mom is right about that, that you forget your assignment list almost every day?

00:01:45 SARAH Yes.

00:01:45 MRS. HIGGINS Yeah, they have to leave me a list on my cell phone.

00:01:50 OFF CAMERA Oh, okay. How long has this been a problem?

00:01:55 MRS. HIGGINS Pretty much since she started school, kindergarten.

00:02:00 OFF CAMERA Uh-huh, let’s see what else is on this list. How well do you sit still in your chair at school?

00:02:10 SARAH Not very well.

00:02:10 OFF CAMERA Uh-huh, do you fidget?

00:02:10 SARAH (chuckles) Yes.

00:02:10 OFF CAMERA Do you get in trouble for fidgeting or getting out of your chair?

00:02:15 SARAH Sometimes.

00:02:20 OFF CAMERA Okay, and if you’re reading from a book or a paper, can you sit still then and read?

00:02:25 SARAH Sometimes.

00:02:25 OFF CAMERA Mm-hmm.

00:02:25 MRS. HIGGINS If she really, really likes it, she’ll last about five minutes or so.

00:02:30 OFF CAMERA Do you remember what you read? Sarah, do you remember what you read?

00:02:40 MRS. HIGGINS Sarah, he’s talking to you.

00:02:45 SARAH Uh.

00:02:45 MRS. HIGGINS Answer him. I think this is the longest she’s ever sat still.

00:02:50 OFF CAMERA Oh, when you read a book, that’s where I was asking, when you read a book, do you remember what you read?

00:03:00 SARAH Not much.

00:03:00 OFF CAMERA Mm-hmm. What if the teacher reads the book to you, do you remember what the teacher read?

00:03:05 SARAH No, sir.

00:03:05 OFF CAMERA Mm-hmm, you are very polite, and thank you for answering my questions. I have a few more. Is that okay if I ask you some more?

00:03:20 MRS. HIGGINS Sarah, he’s asking you a question, not me.

00:03:20 OFF CAMERA Is that okay if I ask you some more questions?

00:03:25 SARAH Yes.

00:03:25 OFF CAMERA Do you lose things at home like keys or books or pencils? Just anything. Do you lose or misplace things you need?

00:03:35 SARAH I lost my geography book yesterday.

00:03:35 OFF CAMERA Mm-hmm, did you find it?

00:03:40 MRS. HIGGINS I think she left it on the bus. The bus driver is very nice, and we put her name in the book, so we think we’ll get it back.

00:03:45 OFF CAMERA Well, that’s good.

00:03:50 SARAH I lost my bracelet, too.

00:03:50 OFF CAMERA Was that a bracelet you like?

00:03:55 SARAH Mimi gave it to me.

00:03:55 MRS. HIGGINS My mother.

00:03:55 SARAH My grandmother.

00:04:00 OFF CAMERA Where do you think you lost it?

00:04:00 SARAH On a trip, maybe in the bathroom at the restaurant.

00:04:05 MRS. HIGGINS Yeah, we think she took it off to wash her hands.

00:04:05 OFF CAMERA Sarah, do you love that bracelet?

00:04:10 SARAH Lots.

00:04:10 OFF CAMERA Mm-hmm, so then that was sad for you?

00:04:15 SARAH Uh-huh, I mean, yes, it was sad.

00:04:15 OFF CAMERA Do you ever have problems losing your temper?

00:04:20 SARAH Sometimes.

00:04:20 OFF CAMERA Mm-hmm, what is something at school that makes you angry?

00:04:25 SARAH When the teachers say they asked me to do something, and I didn’t hear them.

00:04:30 OFF CAMERA Mm-hmm, do you daydream in school sometimes?

00:04:35 SARAH Yes.

00:04:35 OFF CAMERA What do you daydream about?

00:04:35 SARAH Going home and playing with Conley.

00:04:40 MRS. HIGGINS That’s her dog.

00:04:40 OFF CAMERA Oh, so you think about good times?

00:04:45 SARAH Yes.

00:04:45 OFF CAMERA Do you ever think about bad times, too, when you daydream?

00:04:50 SARAH Sometimes.

00:04:50 OFF CAMERA Mm-hmm, what sorts of bad times?

00:04:50 SARAH Missing Mom.

00:04:55 MRS. HIGGINS Yeah, we’re separated right now, and we’re split up, but Mom’s working on us being back together real soon.

00:05:05 OFF CAMERA Good, any time, Sarah, thinking about anyone, way anyone has hurt you or someone did something bad to you that they wish they didn’t do?

00:05:15 SARAH No, May Ann hit me one time at school, though.

00:05:20 OFF CAMERA Mm-hmm, do you daydream about her hitting you?

00:05:25 SARAH No.

00:05:25 OFF CAMERA Oh, when you do your homework or classwork, do you make mistakes?

00:05:30 SARAH Lots.

00:05:30 OFF CAMERA Mm-hmm, is that pretty frustrating?

00:05:30 SARAH Yes, ’cause I try to do it right.

00:05:35 OFF CAMERA Mm-hmm, that must not feel good.

00:05:35 SARAH It doesn’t feel good.

00:05:40 OFF CAMERA What are some of the questions I asked you today?

00:05:40 SARAH Uh, about my dog?

00:05:45 OFF CAMERA Yeah, okay. Anything else I asked you today?

00:05:50 SARAH Uh, I don’t know.

00:05:50 OFF CAMERA Mm-hmm, were you just thinking about something else?

00:05:55 SARAH I guess so.

00:05:55 OFF CAMERA What were you thinking about just then?

00:05:55 SARAH Your picture on the wall.

00:06:00 OFF CAMERA Ah, do you like that picture?

00:06:00 MRS. HIGGINS Sarah loves art, and she loves museums.

00:06:05 OFF CAMERA Uh-huh, do you stand and look at the paintings for a long time?

00:06:10 MRS. HIGGINS No, she runs from painting to painting, three or four times.

00:06:15 OFF CAMERA Oh, let’s see. I see in this form from your teachers that sometimes you have trouble waiting your turn, and yet, you are very polite today.

00:06:25 MRS. HIGGINS Yeah, she’s very polite, but in groups, she has a little bit more difficulty.

00:06:30 OFF CAMERA Uh-huh, is it difficult to sit still?

00:06:35 MRS. HIGGINS Answer his question.

00:06:40 OFF CAMERA Mm-hmm, we’ve been sitting still a pretty long time.

00:06:40 MRS. HIGGINS Yeah, this is the longest that I’ve seen her sit still.

00:06:45 OFF CAMERA Uh-huh, do you play video games?

00:06:45 MRS. HIGGINS Yeah, she likes her video games. She can stay on those for long periods.

00:06:50 OFF CAMERA Uh-huh, is that right, Sarah? Is that right, Sarah?

00:06:55 SARAH Is what right?

00:07:00 OFF CAMERA That you can play a video game for a long time. Do you get injured much?

00:07:05 SARAH Sometimes.

00:07:05 OFF CAMERA Mm-hmm.

00:07:10 MRS. HIGGINS Not so much now. When she was younger. We couldn’t even take her to the zoo. She used to stick her hand inside of the bars where the animals could bite her.

00:07:20 OFF CAMERA Oh.

00:07:20 MRS. HIGGINS And she was this little thing, and she would jump up on the walls, and she even jumped in a pool before she learned how to swim, and that, that really scared us.

00:07:30 OFF CAMERA Is that something that doesn’t happen so much now?

00:07:35 MRS. HIGGINS No, thank God.

00:07:35 OFF CAMERA So, Sarah, from what your mom told me, and what these teachers listed on these forms, it sounds like everyone is in agreement that you have some kind of trouble paying attention and with remembering things and about losing things and some other problems. Do you think you’d like help with all of that?

00:07:55 SARAH I guess so.

00:08:00 MRS. HIGGINS Yes, we would.

00:08:05[sil.]

00:08:05 END TRANSCRIPT

Expert Answer and Explanation

A Comprehensive Assessment of Sarah

Subjective:

CC: “My daughter forgets and losses things easily.”

HPI: Sarah Higgins is a 9-year-old African American female who comes to the office accompanied by her mother for psychiatric evaluation and treatment. The mother says that Higgins has been having attention problems and poor memory since kindergarten. She does not remember school assignments. She has bad sitting behaviors in school and at home.

She squirms in sits and fidgets. For instance, she hardly sits when eating. She cannot organize her work. She avoids hard tasks and hardly finishes her homework or chores. She cannot wait her turn in a group. Recently, there has been a complaint that she intimidates others during plays. She also reports feelings of anxiety when she is wrong. She gets restless and frustrated when she is wrong. Her anxiety is often triggered by being wrong.

Past Psychiatric History:

General Statement: No history of psychiatric conditions.
Caregivers (if applicable): Not applicable.
Hospitalizations: No hospitalizations.
Medication trials: No medical trials.
Psychotherapy or Previous Psychiatric Diagnosis: No psychiatric diagnosis or treatment.

Substance Current Use and History: No drug, tobacco, or alcohol use.

Family Psychiatric/Substance Use History: No family history of mental problems or substance abuse.

Psychosocial History:

She was born and raised by both parents in Washington, D.C. She is the only child and is in grade four. She loves art and visiting museums. She also likes video games. She denies a history of violence or trauma. She denies legal issues.

Medical History: No major medical issues. Vaccinations are up-to-date.

Current Medications: No medications.
Allergies:No allergies.
Reproductive Hx:No Menstrual cycle. Not sexually active.

ROS:

GENERAL: Positive for weight loss.
HEENT: Noncontributory.
SKIN: No rash.
CARDIOVASCULAR: No chest problems.
RESPIRATORY: No cough or difficulty breathing.
GASTROINTESTINAL: No nausea, abdominal pain, or diarrhea.
GENITOURINARY: No UTI or urinary problems.
NEUROLOGICAL: No change in bowel movements, dizziness, or headache.
MUSCULOSKELETAL: Denies muscle and joint swelling, stiffness, or pain.
HEMATOLOGIC: No bleeding.
LYMPHATICS: No swelling of glands.
ENDOCRINOLOGIC: No endocrinologic problems.

Objective:

Physical exam:

Vital Signs: Ht. 4’5, Wt. 63lbs, R 14, P 62, T 97, BP 95/60

HEENT: No scars on her head. Vision intact. Hearing intact. Normal nasal mucosa. No sore throat.
Skin: No rash
Cardiovascular: No murmurs. Regular heart rate and rhythm.
Respiratory: Chest clear. Lungs clear. No wheezes.
Neurological: Cranial nerves II- XII intact.

Diagnostic results:

Functional Magnetic Resonance Imaging (fMRI): fMRI is more accurate and valid in diagnosing people with ADHD and autism (Sen et al., 2018). The test shows that the patient has lower connectivity between the posterior and precuneus cingulate cortex and anterior cingular cortex, indicating the presence of ADHD (Sen et al., 2018).
Behavior Assessment System for Children (BASC-3)– The tool was used to assess the patient’s behavior because it is valid in diagnosing AHDH (Tan et al., 2021).

Assessment:

Mental Status Examination: She is not well-nourished. She appears her age. She has poor attention but is oriented. She was cooperative during the interview. Speech is slow and polite. She reports a happy mood and positive affect. Thought content and process are intact. She has memory problems. She denies delusions, illusions, or hallucinations. She also denies suicidal thoughts.

Differential Diagnoses:

Attention-Deficit/Hyperactivity Disorder-predominantly inattentive type (ADHD-I). 314.00 (F90. 0) Primary disorder
Anxiety disorder, unspecified. Code.9
81 (F91.1) Conduct Disorder, Childhood-Onset Type

ADHD-I is the primary disorder impacting the mental health of this patient. According to Ayano et al. (2019), ADHD-I occurs when inattention is recorded at a higher level. The DSM-5 also notes that ADHD-I when a patient has six or more symptoms of inattention. The patient is forgetful, inattentive, loses things easily, hardly finishes her homework and chores, cannot organize their tasks, and engages in challenging activities.

She has been experiencing the symptoms since kindergarten. Based on the American Psychiatric Association (2013) ‘s DSM-5 criteria, the patient has ADHD. The diagnosis is also supported by fMRI and BASC-3 results.

The second diagnosis is anxiety disorder-unspecified. Anxiety disorder is known for causing restlessness and extreme worries or anxiety feelings (Adwas et al., 2019). This patient often feels anxiety when she is wrong. She also reports restlessness. However, the patient’s symptoms do not meet DMS-5’s criteria for anxiety disorder, making the disease a secondary diagnosis.

The last diagnosis is conduct disorder, a childhood-onset type. This diagnosis was made because the patient intimidates others when playing (Fairchild et al., 2019). She does not wait for her turn. However, the disease is a secondary disorder because it does not meet DSM-5 criteria. According to APA (2013), conduct disorder, childhood-onset type, can be confirmed if the patient has experienced at least a symptom in 12 months.

Reflections:

I agree with the diagnosis. The patient’s symptoms meet the DSM-5 criteria for ADHD, inattentive type. I have learned in this case that neurological disorders are related to conduct and anxiety disorders. The feelings of a patient with a neurological disorder should also be examined. If I handled the case again, I would include ADHD hyperactive type because the patient also shows hyperactive symptoms. The ethical consideration, in that case, is informed consent. The child’s mother has the explicit right to decide whether she should take drugs or not.

References

Adwas, A. A., Jbireal, J. M., & Azab, A. E. (2019). Anxiety: Insights into signs, symptoms, etiology, pathophysiology, and treatment. East African Scholars Journal of Medical Sciences, 2(10), 580-591. http://www.easpublisher.com/easjms/

American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01

Ayano, G., Yohannes, K., & Abraha, M. (2020). Epidemiology of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Africa: a systematic review and meta-analysis. Annals of General Psychiatry, 19(1), 1-10. https://doi.org/10.1186/s12991-020-00271-w

Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., … & De Brito, S. A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 1-25. https://www.researchgate.net/profile/Graeme-Fairchild/publication/337992065_Fairchild_et_al_2019_Conduct_disorder_primer/links/5df93d94299bf10bc3634c98/Fairchild-et-al-2019-Conduct-disorder-primer.pdf

Sen, B., Borle, N. C., Greiner, R., & Brown, M. R. (2018). A general prediction model for the detection of ADHD and Autism using structural and functional MRI. PloS One, 13(4), e0194856. https://doi.org/10.1371/journal.pone.0194856

Tan, A. T. S., Kraska, J., Bell, K., & Costello, S. (2021). Confirmatory factor analyses of the Behavior Assessment System for Children–Third Edition among an Australian sample. The Educational and Developmental Psychologist, 1-12. https://doi.org/10.1080/20590776.2021.1907181

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