Students are given the opportunity to expand the knowledge base pertaining to psychiatric disorders and behavioral difficulties that are prominent in the pediatric population.
Upon successful completion of this discussion, you will be able to:
- Hypothesize a successful intervention plan for individuals diagnosed with neurodevelopmental disorders.
Hypothesize a successful intervention plan for individuals diagnosed with neurodevelopmental disorders.
Instructions
- Review the rubric to ensure you understand the criteria for earning your grade.
- Read the following:
- Textbook: Kaplan & Sadock’s Synopsis of Psychiatry – Chapter 32; pp. 883-905
- File: Assessment Tools for ADHD(Word document)
- Choose one of the two Pediatric Case Snapshots – Case Snapshot #1(Word document) or Case Snapshot #2(Word document). In the event that one of the cases is not chosen, the faculty will assign the case. This is necessary to expose students to both cases.
- Read the progress note for the Case.
- Review the three questions at the end of the case snapshot. Item #3 has two parts; a and b.
- Construct a well-organized written response to the questions by:
- Engaging in additional reading to help develop your responses, such as the course textbooks and the assigned workshop reading.
- Performing a literature search for the most current evidence-based research to help develop your responses regarding treatment.
Pediatric Case Snapshot #2
Date: December 2022
Client Name: TN
Client is a 9-year-old female, a home-schooled 4th grader. First visit today – this is a referral from the pediatrician. Mom and Dad are present for the evaluation. The pediatrician diagnosed the client with ‘Intermittent Explosive Disorder’ in August 2021. The client has been prescribed Risperidone 1 mg PO q bedtime, which has been effective until recently. Parents report that they administer the medication, so it seems the client has been 100% adherent. Parents brought the client today because they notice an increase in agitation and “verbal outbursts” similar to how TN was behaving before the start of the Risperdal.
Chief Complaint and HPI: The primary problem as reported by parents, is that the client seems to have difficulty transitioning during the school day from lunch break to the start of the afternoon period of her courses. This has not been a significant problem previously and started approximately one month ago. Mom is beside herself because she does not know how to manage this behavior. Dad works full-time, while mom is a full-time housewife – staying home with the three children. When it is time to end lunch and start courses, the client starts banging her fists on the table and “yelling at the top of her lungs” per mom. Mom has had to end the school day early 3-4 days each week over the past month. This is of course, affecting the client’s progress with her curriculum.
When TN was asked for her side of the story, she said she has difficulty separating from her UNO cards. She likes to hold the deck of UNO cards while she eats her lunch, but mom will not let her take them to her classes. When asked, TN does not play UNO but enjoys holding the deck of cards throughout the day.
Current Medications: Risperdal 1 mg PO bedtime
Allergies: NKDA
ETOH/SA Use: None
Review of Systems: Constitutional: neg Eyes: neg Ears/Nose/Mouth/Throat: neg
Cardiovascular: neg Respiratory: neg Gastrointestinal: neg Genitourinary: neg
Muscular: neg Integumentary: neg Neurological: neg Endocrine: neg Hematologic/Lymphatic: neg Allergies/Immune: neg Pregnant: No
Notes if Positive:
Psychiatric History: TN has only been treated for IED by the pediatrician, as noted previously, and has never received formal psychiatric treatment. Mom has noticed lately when client is upset during her outbursts, that she is picking at her skin on both arms and has some scabs on her arms as a result. Client has never voiced suicidal thoughts or homicidal thoughts out loud.
Social History: TN was born in Twin Falls, ID. The parents are from Idaho originally but moved the family to Indiana in January 2021 due to their dad’s job. Most of the extended family live in Idaho. The client has one brother – Daniel, aged 12, and one sister – Angel, aged 8. When inquiring directly, Mom and dad both have noticed that the client does not seem very interested in her siblings or others in general – Mom and dad say that they never really noticed this until they were asked directly about TN’s social interactions. For example, the client often asks to go to her room when there is a company at the house for dinner or the entire family is home together for some family outing or activity. The parents identify as Christian and are active in their church.
Developmental History: Mom noted that she had the flu during her pregnancy with TN. Otherwise there was nothing remarkable during the pregnancy or delivery. Mom thinks the client may have been somewhat delayed in speech production.
Abuse History: None known – inquired about sexual, physical and emotional
Past Medical History: Dr. Jill Doe is the Pediatrician. Last labs were completed in August 2022 and parents believe the results were normal. No significant medical or surgical history.
Mental Status Exam:
General Appearance (include gait): Client is wearing a skort and tank top. Hygiene and grooming are fair. Gait is regular and steady. TN has her deck of UNO cards, in the box.
Behavior (include motor movements): No signs of tics, tremors or other abnormal motor movement. TN tends to look at the ground when the provider interacts with her. She did not make eye contact and instead looks at her UNO cards or the ground.
Attitude: Fairly cooperative.
Speech: Not spontaneous. Slowed. Verbalizes words at times that are nonsensical or idiosyncratic.
Mood: “happy”
Affect: Constricted. Non-labile.
Thought Content: No evidence of SI. She remains focused on keeping her UNO cards throughout the session.
Thought Process: + mildly perseverative
Perceptions (hallucinations): None evident
Judgment and Insight (good, poor, impaired – examples): Unable to assess formally but appear to be somewhat impaired.
Impulsivity (good, poor – examples): Not exhibited during the interview. But she has recently been impulsive at home.
Cognition (Provide examples to support the interpretations): Not assessed formally. Concrete thinking. Oriented to self, general place.
QUESTIONS:
1. Does TN meet diagnostic criteria for IED? If not, is there another diagnosis or differential (s) that should be a higher priority – what is your rationale?
2. Based on parents’ report, what other problems or differentials do you suspect?
3. Using the workshop readings, course resources, and your literature search: provide details for the following:
a. Write about your thoughts regarding psychosocial – developmental and environmental influences in this client’s case. In other words, discuss developmental and environmental factors that may be contributing to the client’s problem at school and home. Be specific and provide citations for your statements.
b. What would be your course of action for treating this client? Include potential psychopharmacological, psychotherapy, other social support services, and referral or consultation with other mental health providers to aid your evaluation of this client. Provide your rationale along with citations.
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