Neurocognitive and Neurodevelopmental Disorders

Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders

Training Title- 48

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

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Subjective:

CC (chief complaint): The patient has issues paying attention

HPI: The patient is Sarah Higgins (S.H), an 11-year-old female who was brought in for an

evaluation by her mother after having issues paying attention. Sara’s mother presented completed

questionnaires filled by herself and some of the patient’s teachers. The patient reported that she

doesn’t remember when teachers tell her assignment in school. Her mother reported that the

teachers have to write down a list for Sara but she admitted to losing or forgetting where she put

the list sometimes. Her mother also reported that she forgets where her list it every day. The

patient’s mother reported the patient has had this problem since she started school in

kindergarten. S.H admitted that she fidgets in her chair at school and she gets into trouble for her

fidgeting. She reported difficulty remembering what she has read in a book or when a teacher

reads to her. The patient admitted to loosing things at home, for instance she lost her geography

book yesterday. She also lost a sentimental bracelet given to her by her grandmother which made

her sad because she loved the bracelet “lots”. She reported daydreaming at school sometimes

where she would think about going home and playing with her dog Conley and sometimes she

daydreams about sad things like missing her mom. S.H reported being frustrated when doing her

homework because she wants to do it right but she makes a lot of mistakes. Her teachers reported

that she has problems waiting her turn as indicated in the questionnaire. Her mother reported that

Sara us very polite but she has difficulty when in group settings. She also reported that loves art

and she loves video games since she spends hours playing. The client’s mother reported that she

gets injured sometimes but it is less frequent now compared to when she was younger. According

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to her mother, she would jump up on walls and one time she jumped in the pool before she

learned to swim when she was younger.

Past Psychiatric History:

 General Statement: Client has difficulty concentrating and sitting still at school.

 Caregivers (if applicable): Her mother who brought her for the evaluation Mrs. Higgins.

 Hospitalizations: No history of treatment.

 Medication trials: No medication trials named.

 Psychotherapy or Previous Psychiatric Diagnosis: No history of past psychiatric

diagnosis or treatment.

Substance Current Use and History: No current or history of substance use

Family Psychiatric/Substance Use History: No family history of substance use mentioned.

Psychosocial History: The patient was born and lives with her parents in Washington D.C. She

has a younger brother.

Medical History: She met her developmental milestones on time. She is up-to-date on her

vaccinations.

 Current Medications: no current medications were mentioned.

 Allergies: No allergies discussed

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 Reproductive Hx: Not applicable

ROS:

 GENERAL: No changes in weight, fever, chills, weakness, or fatigue.

 HEENT: Eyes: No visual loss, blurred vision, doubles vision, or yellow sclerae. Ears,

Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

 SKIN: No rash or itching.

 CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No

palpitations or edema.

 RESPIRATORY: No shortness of breath, cough, or sputum.

 GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain

or blood.

 GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

 NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or

tingling in the extremities. No change in bowel or bladder control.

 MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

 HEMATOLOGIC: No anemia, bleeding, or bruising.

 LYMPHATICS: No enlarged nodes. No history of splenectomy.

 ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or

polydipsia.

Objective:

Physical exam: T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs

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Diagnostic results: There were questionnaires filled by the patient’s mother and some of her

teachers which indicated that the patient has trouble paying attention and remembering things.

Assessment:

Mental Status Examination: The client is an 11-year-old female who was brought in for an

evaluation after having difficulty paying attention in school. She was well groomed and dressed

for the occasion. During the assessment, the patient would space out. The interviewer had to ask

her the same questions multiple times for her to answer. She had difficulty concentrating and she

forgot the questions she was asked during the evaluation. The patient is very polite and spoke in

a normal tone.

Differential Diagnoses:

Attention-Deficit/Hyperactivity Disorder

This is a mental disorder that interferes with an individual’s behavior. People with ADHD

may appear restless, struggle to focus, and act impulsively (Mahone & Denckla, 2017). The signs

of ADHD are typically identified at a young age and may worsen as a child's environment

changes, such as when they start school. The majority of instances are discovered in kids under

the age of 12, but occasionally it's discovered later in childhood. It can affect persons of all

intellectual levels, learning disabilities are more frequently associated with ADHD. The DSM-5

standards specify that the criteria must be met by six specific symptoms that impair with playing,

social life, education, and/or employment for at least six months. A few symptoms must have

manifested before the age of 12, exist in many contexts (such as at home, school, or work), and

not be the result of another mental health issue (Sanders et al., 2019). Among the signs of

inattention are a lack of attention to details or making careless errors in classwork, difficulty

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sustaining attention during tasks or play activities, a lack of direct listening to commands, a

failure to follow instructions, trouble planning tasks, a tendency to misplace items required for

tasks or activities, and forgetfulness in daily activities. Impulsivity and hyperactivity symptoms

include squirming or fidgeting in the chair, difficulty staying sitting, climbing in inappropriate

places, inability to engage in calm leisure activities, and excessive talking. The patient in the case

study presented with all the symptoms of ADHD and she met the DSM-5 criteria for ADHD in

children.

General Anxiety Disorder

Children occasionally experience worry or anxiety, especially when they are starting

school or daycare or when they are relocating to a new place. But for other kids, worry interferes

with their daily behavior, thinking, and social, family, and academic lives. Finding it difficult to

concentrate, not getting enough sleep or having nightmares, skipping meals, becoming agitated

easily, worrying constantly, having negative thoughts, feeling agitated and fidgety, crying

constantly, being clingy, and complaining of stomach aches and feeling unwell are all signs of

anxiety disorder (Creswell et al., 2020). The Diagnostic and Statistical Manual of Mental

Disorders, Fifth Edition Text Revision (DSM-5-TR) criteria state that at least three of the six

core symptoms must be present in order to diagnose GAD in adults. These include agitation or

anxiousness, a tendency to get easily tired, poor focus, irritability, tightness in the muscles,

and/or sleep problems. When it comes to children, the diagnosis only needs one important

symptom. The patient met some of the criteria for the diagnosis of GAD but her symptoms most

likely indicate that she has ADHD.

Separation Anxiety Disorder

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Separation anxiety disorder is given to people who have an uncharacteristically high

dread or anxiety of separating from those to whom they have a deep bond. (Patel & Bryant,

2021) Only when the separation-related distress is atypical for the developmental stage of the

individual, persistent, and severe, is a diagnosis made. Children with this illness may find it

challenging to attend school, stay at friends' houses, or be alone in a room due to their need to be

close to caregivers. Normal developmental processes in adults, such as leaving home, getting

married, or becoming independent, may become exceedingly challenging. The following are

among the DSM-5 criteria for the diagnosis of separation and anxiety disorder: worry over being

separated from loved ones, disturbance results in clinically substantial suffering or academic or

social impairment, and reluctance is persistent in youngsters and lasts for at least 4 weeks.

Although the patient admitted to being sad when missing her mom, she doesn’t meet the criteria

for the diagnosis of Separation anxiety disorder.

Reflections:

The patient in the study was evaluated and I diagnosed her with ADHD. The one area that

I would change in the case study would be collecting all the information required to make a

diagnosis. information missing in the case study includes the family’s medical history. The topic

of ADHD has generated a lot of discussion and debate (Kazda et al., 2021). As such, there are

ethical considerations involved in evaluating the patient in the case study. The principles of non-

maleficence and beneficence are considered in provision of care for the patient by ensuring that

the patient’s best interest and safety is assured. Additionally, patient education must be conducted

for the patient, her parent and teachers. This is because, according to numerous research, those

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who are diagnosed with ADHD experience unfavorable stereotypes and social rejection (Aoki et

al., 2020).

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental

disorders: DSM-5-TR. American Psychiatric Association Publishing.

Aoki, Y., Tsuboi, T., Furuno, T., Watanabe, K., & Kayama, M. (2020). The experiences of

receiving a diagnosis of attention deficit hyperactivity disorder during adulthood in

Japan: a qualitative study. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-

02774-y

Creswell, C., Waite, P., & Hudson, J. (2020). Practitioner review: anxiety disorders in children

and young people – assessment and treatment. Journal of Child Psychology and

Psychiatry and Allied Disciplines, 61(6), 628–643. https://doi.org/10.1111/jcpp.13186

Kazda, L., Bell, K., Thomas, R., McGeechan, K., Sims, R., & Barratt, A. (2021). Overdiagnosis

of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. JAMA Network

Open, 4(4), e215335. https://doi.org/10.1001/jamanetworkopen.2021.5335

Mahone, E. M., & Denckla, M. B. (2017). Attention-Deficit/Hyperactivity Disorder: A Historical

Neuropsychological Perspective. Journal of the International Neuropsychological

Society, 23(9-10), 916–929. https://doi.org/10.1017/s1355617717000807

Patel, A. K., & Bryant, B. (2021). Separation Anxiety Disorder. JAMA, 326(18), 1880.

https://doi.org/10.1001/jama.2021.17269

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Sanders, S., Thomas, R., Glasziou, P., & Doust, J. (2019). A review of changes to the attention

deficit/hyperactivity disorder age of onset criterion using the checklist for modifying

disease definitions. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2337-7

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