26 Dec You will be asked to make three decisions concerning the diagnosis
Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
- Decision #1: Differential Diagnosis
- Which Decision did you select?
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
- Decision #2: Treatment Plan for Psychotherapy
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
- Decision #3: Treatment Plan for Psychopharmacology
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
- Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
Case #1 A young girl with di!culties in school
BACKGROUND In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your o!ce by her
mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD
medications. As you progress in your PMHNP program, the cases will involve more information for you to sort
through.
For this case, you see Katie and her parents again. The parents have reported that the medication given to
Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will
consider other di"erential diagnoses and determine what information you need to accurately assess the
DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.
When parents bring their child to your o!ce, they may have read symptoms on the internet or they may have
been told by the school “your child has ADHD”. Your diagnosis will either con#rm or refute that diagnosis.
Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a
di"erential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based
on interviews and observations of the child, her parents, and the assessment of the parents and teacher.
To start, consider what assessment tools you might need to evaluate Katie.
� Child Behavior Check List
� Conners’ Teacher Rating Scale
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at:
https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 ). This scale was #lled out by
Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the
scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her
schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span
is short, and she is noted to only pay attention to things she is interested in. She has di!culty interacting with
peers in the classroom and likes to play by herself at recess.
When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the
#rst born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar
score. The parents say that she met normal developmental milestones and possibly had some di!culty with
sleep during the pre-school years. They notice that Katie has di!culty socializing with peers, she is quiet at
home and spends a lot of time watching TV.
SUBJECTIVE You observe Katie in the o!ce and she is not able to sit still during the interview. She is constantly
interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and
“recess.” She states that she #nds some subjects boring or too di!cult, and sometimes hard because she
feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be
thinking about something else and not looking at the teacher or other students in the class.”
Katie reports that her home life is just #ne. She reports that she loves her parents and that they are very good
and kind to her. Denies any abuse, denies bullying at school. She o"ers no other concerns at this time.
Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is #dgeting
with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem
attentive and straight forward in the interview process.
MENTAL STATUS EXAM The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is
clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed
appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or
tics. Self-reported mood is euthymic. A"ect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head
but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought
processes. Attention and concentration are somewhat limited based on Katie’s short answers to your
questions.
Decision Point One BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?
In your write-up of this case, be certain to link speci!c symptoms presented in the case to DSM–5 criteria to support your diagnosis.
299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder
(1.html)
315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in
Mathematics
(2.html)
314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation
(3.html)
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