Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders Essay

Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders Essay

Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders

Subjective:

Name: Sarah Higgins

Gender: Female

Age: 9 years old

Informant: The mother

CC (chief complaint):  The mother says, “I have brought the completed ADHD questionnaires filled out by two teachers and me.”

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HPI: Sarah Higgins is a 9-year-old African American female brought by her mother to the psychiatric clinic. The mother states that she has brought ADHD questionnaires, which were completed by two of her teachers and her. Sarah’s mother states that she has difficulties paying attention, remembering things, and often loses her items. Sarah admits that she rarely remembers to complete her homework and her class teacher prepares a list of the homework tasks. However, she ends up losing the list most of the time. The problems have persisted since kindergarten. In addition, Sarah’s teacher reported that she often gets into trouble because of fidgeting and leaving her chair during class sessions. Sarah has difficulties concentrating when reading books, with her concentration lasting a maximum of five minutes if she is interested in the book, but remembers very little after reading.

Sarah’s class teacher also reported that she has temper problems and gets annoyed when told by her teachers that she had been instructed to do something but did not listen. She daydreams in class generally about going home and playing with her dog. Besides, she admits to making numerous mistakes in her homework, which usually annoys her. Sarah’s teachers state that she sometimes fails to wait her turn and is rather difficult when in groups.

Past Psychiatric History:

• General Statement: Sarah was first brought for psychiatric assessment due to inattentiveness and hyperactivity.
• Caregivers (if applicable): Grandmother
• Hospitalizations: None
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: No history of substance abuse.

Family Psychiatric/Substance Use History: There is no family history of psychiatric or substance abuse disorders.

Psychosocial History: The client lives with her grandmother and is currently separated from her mother. She gets proper nutrition and sleeps 9hrs/night. Nonetheless, she has difficult feeding times as she cannot sit still during meals. Hobbies include art and visiting museums. She enjoys playing video games, but she plays for prolonged periods.

Medical History: No history of chronic or recurrent diseases. Immunization is up-to-date.

 

• Current Medications:
• Allergies: No known drug or food allergies.

• Reproductive Hx: Not applicable.

ROS:

• GENERAL: No weight changes fever, chills, or malaise.
• HEENT: No head trauma, changes in vision, ear discharge, rhinorrhea, hoarse voice, or sore throat.
• SKIN: No itching or bruises.
• CARDIOVASCULAR: No chest pain, palpitations, or SOB on exertion.
• RESPIRATORY: No cough, wheezing, sputum, or chest pain.
• GASTROINTESTINAL: No nausea/vomiting, epigastric/abdominal pain, or bowel changes.
• GENITOURINARY: No dysuria or urine color changes.
• NEUROLOGICAL: No headache, dizziness, muscle weakness, or tingling sensations.
• MUSCULOSKELETAL: No muscle pain or joint pain/stiffness.
• HEMATOLOGIC: No bruising or bleeding.
• LYMPHATICS: No swelling of lymph nodes.
• ENDOCRINOLOGIC: No hot/cold intolerance, polyuria, excessive hunger, or thirst.

Objective:

Physical exam:

Vitals: T- 97.4; P- 62; R-14; BP- 95/60; Ht- 4’5; Wt- 63lbs

 

Diagnostic results: No diagnostic tests were ordered.

Assessment:

Mental Status Examination:

The girl is neat and appropriately dressed for the weather. She is alert but easily distracted. She maintains minimal eye contact and often fidgets chair during the interview. Her speech varies from a low to a normal tone, and she at times speaks using syllables. The client has a coherent thought process. No obsessions, delusions, hallucinations, or suicidal ideations were noted. She is oriented to person, place, and time. Impaired recent memory and a shortened attention span.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a neurodevelopmental psychiatric disorder that manifests with hyperactivity and inattentiveness. Individuals have difficulties paying attention, controlling impulsive behaviors, and being overly active (Daley & Hollis, 2021). ADHD is a differential diagnosis based on the client’s positive symptoms in line with the DSM-V diagnostic criteria such as:  Inattention, short attention span, easy distractibility, losing items and assignment lists, and forgetfulness (APA, 2013). In addition, she has positive symptoms of hyperactivity like difficulties staying still, fidgeting, and inability to wait her turn.

Generalized Anxiety Disorder (GAD)

GAD manifests with persistent, unjustified, and unrealistic worry and anxiety. Excessive anxiety occurs together with one or more of the following symptoms: Restlessness, irritability, concentration difficulties, fatigue, easy distractibility, muscle tension, and sleeping disturbances (APA, 2013). The client’s symptoms in line with GAD include easy distractibility, concentration difficulties, difficulties staying still, and getting easily annoyed (Ströhle et al., 2018). However, the client has no excessive anxiety or worry symptoms, ruling out GAD as the primary diagnosis.

Oppositional Defiant Disorder (ODD)

ODD is a disruptive childhood behavioral disorder characterized by a consistent pattern of a child rejecting an adult’s authority. DSM-V diagnostic criteria include: Getting easily upset; Persistent fights and arguments; Deliberately irritating others; Refusing to abide by adults’ requests; Stubbornness; Blaming others for one’s mistakes; Trying adults’ limits (APA, 2013). The client’s symptoms consistent with the differential diagnosis of ODD include having tempers, getting easily annoyed by her teachers, difficulties waiting her turn, and when in groups (Roetman et al., 2021). However, there are no complaints of the client rejecting adults’ authority or trying adults’ limits ruling out ODD as the primary diagnosis.

Reflections:

            If I were to perform the assessment again, I would evaluate the child’s functional impairment at home, school, and relationships. For instance, I would ask her about how she interacts with her family members and if she has friends both at her and school. In addition, I would evaluate the child’s ADHD symptoms in the past six months using rating scales, such as the Childhood Symptom Scale by Barkley and Murphy and Wender Utah Rating Scale. Reading disorders co-exist with ADHD and would thus assess the child for reading disorders (Daley & Hollis, 2021). Legal/ethical considerations when examining and treating this patient include obtaining consent from the caregiver to examine the child and initiate treatment. The treatment plan should be based on evidence-based practice and have minimal side effects to uphold beneficence and nonmaleficence. Health promotion for ADHD should include teaching the client and her caregiver healthy lifestyle practices such as healthy nutritional patterns, active lifestyle practices, limiting video games, and having an adequate sleep (Daley & Hollis, 2021).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Daley, D., & Hollis, C. P. (2021). The World Federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. https://doi.org/10.1016/j.neubiorev.2021.01.022

Roetman, P. J., Siebelink, B. M., Vermeiren, R., & Colins, O. F. (2021). Classes of Oppositional Defiant Disorder Behavior in Clinic-referred Children and Adolescents: Concurrent Features and Outcomes: Classification Des Comportements Dans le Trouble Oppositionnel Avec Provocation Chez Des Enfants et des Adolescents Aiguillés à Une Clinique: Caractéristiques Co-occurrentes et Résultats. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 66(7), 657–666. https://doi.org/10.1177/0706743720974840

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Arzteblatt international, 155(37), 611–620. https://doi.org/10.3238/arztebl.2018.0611

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Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a 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.).

CASE STUDY
Name: Sarah Higgins
Gender: female
Age: 9 years old
T- 97.4 P- 62 R 14 95/60 Ht 4’5 Wt 63lbs
Background: no history of treatment, developmental milestones met on time, vaccinations up
to date. Sleeps 9hrs/night, meals are difficult as she has hard time sitting for meals, she does
get proper nutrition per PCP.
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