NURSING CASE 1
Katy Diagnosis
Student Name
Course
NURSING CASE 2
Instructions
Review the interactivePediatric Case Studyand analyze the data to determine the
health status of the patient.
Follow the requirements posted in the rubric.
Use the Word document that is located within the case study to complete the case study
assignment.
Your case study should be between five to seven pages
Katy Transcript
Katy is a six-year-old girl, the second of two children of a middle-class family living
in a suburban area of a northwest city. Katy has one sister that is two years older
than her. Her mother’s pregnancy was normal and Katy’s birth was normal. Katy
had colic the first three months, cried extensively and was difficult to comfort. After
three months she became passive and cried very little with comfort from her
mother. Her growth and development appeared to be normal. She met all the
developmental milestones her first three years. She interacted normally with her
sister and parents, except that she would become tearful and anxious when her
parents would get a babysitter.
At age four, she was in nursery school and appeared to function normally except
during the first month when Katy had difficulty when her father would drop her off at
school. The nursery school was a small private school with a lot of personal
attention given to each child. Although shy, she made friends and liked going to
nursery school after she became adjusted to the new setting. Her parents liked the
school so much that they decided to keep Katy in kindergarten at this school with
her same teachers and friends. However, tuition at the school became a problem
after Katy’s mother became sick with lupus and was unable to work.
At age six, Katy’s parents enrolled her in first grade at the public elementary school
in their neighborhood. For the last two weeks, she has refused to go to school and
has missed six school days. She is awake almost all night worrying about going to
school. As the start of the school day approaches, she cries and screams that she
cannot go, chews holes in her shirt, pulls her hair, digs at her face, punches the
wall, throws herself on the floor, as well as experiences headaches, stomachaches,
and vomiting. Over the past two weeks, she has become gloomy, has stopped
reading for fun, and frequently worries about her mother's Lupus and that she may
die. In addition, Katy is phobic of dogs, avoids speaking and writing in public, and
wets the bed every night.
Her parents immediately made an appointment to see her PCP. Her doctor
conducted a thorough physical exam, found no physical abnormalities and then
referred her to you, a Family PMHNP.
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Family history of mental health includes the following: mother has a history of panic
disorder; her father has a history of treatment with medications for ADHD as a child;
and she has a cousin diagnosed with Asperger’s syndrome.
Family mental health history
Mother has a history of panic disorder
Father has a history of treatment with medications for ADHD as a child
Cousin diagnosed with Asperger’s syndrome
For your assignment, write a paper that addresses the following prompts using
evidence-based references to support your answers:
1. What is your provisional diagnosis, as well as the possible differentials?
2. Justify your answer with DSM-5 criteria (be short, brief and to the point).
3. Is Katy too young to diagnose, or is there a basis for early identification and
intervention?
4. What psychiatric scales or assessment tools might you use with this patient?
With the parents? List and describe briefly.
5. How would the typical symptom patterns and phases be manifested in children
this age? In adolescents?
6. What would be your treatment plan for medications, if any? If you do choose to
offer medication as part of the treatment plan, please address the following
medications issues:
a. Target symptoms
b. Receptors affected
c. Psychiatric and system effects
d. Possible parental concerns
7. What would be your school-based treatment plan, if any?
8. What would be the implications for the families of children and adolescents
with these diagnostic pictures?
9. How does the mother’s health play into the picture of Katy’s diagnosis? What
type of therapy would you recommend for Katy (and her family) to work
through her issues?
10.Identify resources for patients/families with this diagnosis in the form of
community groups, web-sites, advocacy, as well as treatment resources
available in your service area.
11.What are you worried about (if anything)? Consider this question in terms of
treatment, assessment, alliance, compliance, effectiveness, safety, and other
factors.
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Separation Anxiety Disorder
Separation Anxiety Disorder (SAD) is a condition where children become nervous and
fearful when they are separated from their loved ones or they are away from home. It is normal
for children to have separation anxiety between the age of 8 and 14 months because they have
developed attachment with the people they interact with every time. Children who show
separation anxiety beyond 6 years old and the conditions lasts for more than four weeks, they are
suffering from separation anxiety disorder (Lavallee & Schneider, 2019). Some of the symptoms
of such a disorder include stomachaches, headaches and distress when separated from loved
ones. These symptoms may interfere with normal activities like playing with other children or
going to school (Lebowitz, 2019). Other symptoms associated with SAD include unrealistic and
lasting worry of something bad happening to their parents or a loved one, worry of being left by
his/her parent, refusing to go to school in order to stay with his/her parents or caregiver, fearing
to go to sleep alone or staying alone, nightmares about being separated, bed wetting, and
repeated tantrums due to high temper (Lavallee & Schneider, 2019).
DSM-5 criteria (Separation Anxiety Disorder DSM-5 309.21 (F93.0)
Separation and anxiety disorder is a DSM-5 diagnosis that is assigned to Katy because
she exhibits an unusually strong fear and anxieties to separating from her mother. The severity
and prolonged nature of Katy symptoms authorize diagnosis for Separation and anxiety. Katy
suffers from Separation Anxiety Disorder because she has exhibited symptoms and reactions that
resemble the disorder. She had difficulties being dropped at school by her father. At first, she
was shy and feared the school environment until she adjusted to the new setting. After enrolling
in new elementary school, she began to fear the new environment, refusing to go to school. She
spends many hours awake in the night worrying about going to the new school she was enrolled
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in. She throws tantrums every morning through loud cries and screams as a reaction of refusing
to go to school. She also pulls her hair, digs her face, and throws herself on the flow, and has
been experiences headaches, stomachaches and vomiting every morning because she fears going
to school. She has stopped reading and become gloomy.
According to Diagnostic and Statistical Manual of Mental Disorders, four percent of
children and about 1.6 percent of adolescents usually experience separation anxiety disorder. The
disorder is common for children under 12 years old (Lebowitz, 2019). It is characterized by tears
at drop off at school because of being attached to their loved ones. The manual gives symptoms
of SAD such as sleep disturbance, school refusal, excessive distress when the child is about to be
separated from his/her parents and caregivers, and interference of normal daily activities.
Katy is not too young to be diagnosed with SAD because the disorder occurs to children
and adolescents too. For SAD diagnosis, the condition should last for more than four weeks and
cause distress that cannot be attributed to any other cause. A child psychiatrist or any other
professional mental health practitioner can easily diagnose SAD. The professional has to do
mental health evaluation of the child (Lebowitz, 2019). One of the notable reactions of children
with this disorder is school refusal which causes poor school attendance as well as poor school
performance. The condition also impairs social interactions and relationships as observed in
Katy. Early identification of this disorder include reactions of distress and prolonged periods of
fear of being left by those the child has developed attachment with. When the disorder is
diagnosed, treatment interventions should be initiated to prevent any further complications and
worsening of the condition (West, Wilbanks & Suveg, 2020).
Provisional Diagnosis and Possible Differentials:
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Based on the information provided in the case study, it appears that Katy is presenting with
symptoms consistent with generalized anxiety disorder (GAD) along with specific phobias and
symptoms suggestive of separation anxiety disorder. Here is a breakdown of the provisional
diagnosis and possible differentials:
Provisional Diagnosis:
Generalized Anxiety Disorder (GAD): Katy exhibits excessive worry and anxiety about
attending school, experiencing physical symptoms such as headaches, stomachaches, vomiting,
and difficulty sleeping. These symptoms have persisted for at least six months, indicating
chronic anxiety.
Separation Anxiety Disorder: Katy's extreme distress about going to school, coupled with
physical symptoms and nighttime bedwetting, suggests separation anxiety disorder. Her worries
about her mother's illness and fear of her mother's death also align with separation anxiety
symptoms.
Possible Differentials:
Specific Phobia: Katy's fear of dogs, avoidance of speaking and writing in public, and extreme
reactions to school may also indicate specific phobias. However, the breadth and intensity of her
symptoms suggest a more generalized anxiety disorder with specific phobic features rather than
isolated phobias.
Adjustment Disorder: Given the recent transition from a familiar private school to a public
school due to financial constraints and her mother's illness, Katy's symptoms could be attributed
to adjustment difficulties. However, the severity and duration of her symptoms, as well as the
presence of symptoms predating the recent changes, make this diagnosis less likely.
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Post-Traumatic Stress Disorder (PTSD): While there is no indication of a specific traumatic
event in Katy's history, her symptoms of extreme distress, avoidance behaviors, and physical
symptoms could resemble PTSD. Further exploration of any potential traumatic experiences in
Katy's life is necessary to rule out this diagnosis.
Attention-Deficit/Hyperactivity Disorder (ADHD): Given her father's history of ADHD and her
own difficulties with attention, concentration, and restlessness, ADHD could be considered a
differential diagnosis. However, Katy's symptoms appear more consistent with anxiety-related
disorders rather than primary ADHD.
Diagnostic Considerations:
It's important to conduct a comprehensive psychiatric evaluation, including a detailed assessment
of Katy's developmental history, family dynamics, and any potential stressors or traumas.
Collaboration with Katy's primary care physician (PCP) and obtaining relevant medical history
and physical examination findings is essential to rule out any organic causes for her symptoms.
Psychological testing, such as anxiety scales and standardized assessment tools, may help
quantify the severity of Katy's symptoms and guide treatment planning.
Given the family history of mental health disorders, including panic disorder and ADHD, genetic
predispositions and familial patterns should be considered in formulating a comprehensive
treatment plan.
In conclusion, while a provisional diagnosis of generalized anxiety disorder and separation
anxiety disorder seems most fitting based on the presented symptoms, it is crucial to consider
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other differentials and conduct a thorough assessment to ensure accurate diagnosis and
appropriate intervention for Katy's mental health concerns.
Specific Phobia:
Specific phobias involve an intense and irrational fear of specific objects or situations. In Katy's
case, her fear of dogs, avoidance of speaking and writing in public, and extreme reactions to
attending school may suggest specific phobias.
However, the intensity and breadth of Katy's symptoms, including generalized anxiety, physical
symptoms, and nighttime bedwetting, suggest a more pervasive anxiety disorder rather than
isolated specific phobias.
Adjustment Disorder:
Adjustment disorder occurs when an individual experiences significant distress or impairment in
functioning in response to a stressful life event or change.
Katy's recent transition from a familiar private school to a public school due to financial
constraints and her mother's illness could potentially trigger adjustment difficulties.
However, the severity and chronicity of Katy's symptoms, along with the presence of symptoms
predating the recent changes, make adjustment disorder less likely as the primary diagnosis.
Post-Traumatic Stress Disorder (PTSD):
PTSD typically arises following exposure to a traumatic event, characterized by symptoms such
as intrusive thoughts, avoidance behaviors, negative mood changes, and hyperarousal.
While there is no specific mention of a traumatic event in Katy's history, her extreme distress,
avoidance behaviors, and physical symptoms could resemble PTSD.
NURSING CASE 9
Further exploration of any potential traumatic experiences in Katy's life, such as witnessing her
mother's illness progression or experiencing significant stressors, is necessary to rule out this
diagnosis.
Attention-Deficit/Hyperactivity Disorder (ADHD):
ADHD is characterized by symptoms of inattention, hyperactivity, and impulsivity that
significantly impair functioning across multiple settings.
While Katy exhibits symptoms suggestive of attention difficulties, such as restlessness and
difficulty concentrating, these symptoms appear to be secondary to her anxiety and fear-related
behaviors rather than primary ADHD.
It's essential to differentiate between ADHD and anxiety disorders to ensure appropriate
treatment planning and intervention.
Generalized Anxiety Disorder (GAD) and Separation Anxiety Disorder:
GAD involves excessive worry and anxiety about various aspects of life, accompanied by
physical symptoms such as headaches, stomachaches, and sleep disturbances.
Separation anxiety disorder is characterized by extreme distress and anxiety related to separation
from attachment figures, leading to avoidance behaviors and physical symptoms.
Katy's symptoms, including chronic worry, school refusal, physical complaints, nighttime
bedwetting, and fears related to separation and specific situations, align with features of both
GAD and separation anxiety disorder.
In summary, while specific phobias, adjustment disorder, PTSD, and ADHD are important
differentials to consider in Katy's case, the constellation of symptoms suggests a primary
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diagnosis of generalized anxiety disorder and separation anxiety disorder. Further assessment
and collaboration with Katy's healthcare team are essential to confirm the diagnosis and develop
an individualized treatment plan tailored to her needs.
Generalized Anxiety Disorder (GAD):
GAD is characterized by excessive and persistent worry and anxiety about various aspects of
life, including school, family, health, and everyday events.
Individuals with GAD often find it challenging to control their worries, which can interfere with
daily functioning and cause significant distress.
Physical symptoms commonly associated with GAD include headaches, muscle tension,
stomachaches, fatigue, irritability, and sleep disturbances.
Children with GAD may express their anxiety through physical complaints, avoidance behaviors,
and difficulty concentrating, which can impact academic performance and social interactions.
GAD typically manifests with symptoms lasting for at least six months and can occur alongside
other anxiety disorders or mood disorders.
Separation Anxiety Disorder:
Separation anxiety disorder is characterized by excessive and developmentally inappropriate fear
or anxiety concerning separation from attachment figures, such as parents or caregivers.
Children with separation anxiety disorder often experience intense distress and worry when faced
with separation, which may manifest as school refusal, reluctance to sleep alone, and physical
symptoms such as stomachaches and headaches.
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These individuals may also exhibit clingy behavior, avoidance of separation-related situations,
and persistent fears about harm befalling themselves or their loved ones.
Separation anxiety disorder can significantly impair functioning in various domains, including
academic, social, and familial relationships.
Symptoms of separation anxiety disorder typically persist for at least four weeks in children and
adolescents, causing significant distress or impairment.
In Katy's case, her symptoms align closely with features of both generalized anxiety disorder and
separation anxiety disorder. Her chronic worry, physical complaints, school refusal, avoidance
behaviors, and fears related to separation from her parents indicate significant distress and
impairment consistent with these anxiety disorders.
It's important to recognize the interplay between generalized anxiety disorder and separation
anxiety disorder in Katy's presentation, as these conditions often co-occur and can exacerbate
one another's symptoms. A comprehensive assessment and formulation of an individualized
treatment plan, incorporating cognitive-behavioral therapy (CBT), psychoeducation, relaxation
techniques, and possibly pharmacotherapy, are essential to address Katy's complex needs and
promote her mental health and well-being. Additionally, involving her family in treatment and
addressing any environmental stressors or familial dynamics contributing to her anxiety is crucial
for long-term management and recovery.
Generalized Anxiety Disorder (GAD):
Characteristics and Symptoms:
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GAD is characterized by excessive and persistent worry or anxiety about various aspects of life,
including family, health, work, and everyday occurrences.
Children with GAD often worry excessively about their performance in school, relationships
with family and peers, and future events.
Symptoms of GAD can include restlessness, fatigue, difficulty concentrating, muscle tension,
irritability, sleep disturbances, and physical complaints such as headaches or stomachaches.
The worry and anxiety experienced by individuals with GAD are difficult to control and can
significantly impact their daily functioning and quality of life.
Developmental Considerations:
GAD can manifest differently in children compared to adults. Children may express their anxiety
through physical symptoms, behavioral changes, or avoidance behaviors.
School refusal, reluctance to participate in activities, and seeking excessive reassurance from
caregivers are common manifestations of GAD in children.
Children with GAD may also exhibit perfectionism, self-criticism, and difficulty relaxing or
enjoying activities due to persistent worry and anxiety.
Treatment Approaches:
Evidence-based treatments for GAD in children and adolescents include cognitive-behavioral
therapy (CBT), which helps individuals identify and challenge irrational thoughts and beliefs
contributing to anxiety.
Relaxation techniques, stress management strategies, and mindfulness practices can also be
beneficial in reducing anxiety symptoms and promoting emotional regulation.
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In some cases, pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) or other
anxiolytic medications may be considered for moderate to severe GAD symptoms that impair
functioning.
Separation Anxiety Disorder:
Characteristics and Symptoms:
Separation anxiety disorder is characterized by excessive fear or anxiety concerning separation
from attachment figures, such as parents, caregivers, or close family members.
Children with separation anxiety disorder may experience intense distress, worry, and fear when
faced with separation or anticipation of separation.
Symptoms can include reluctance or refusal to attend school or be apart from caregivers,
nightmares about separation, physical complaints (e.g., stomachaches, headaches), and excessive
reassurance-seeking behaviors.
The fear of harm befalling oneself or loved ones during separation is a hallmark feature of
separation anxiety disorder.
Developmental Considerations:
Separation anxiety is a normal developmental phase in early childhood; however, separation
anxiety disorder involves symptoms that persist beyond what is considered developmentally
appropriate.
Onset of separation anxiety disorder typically occurs in childhood, often between ages 7 and 9,
but symptoms can manifest earlier in some cases.
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Children with separation anxiety disorder may have difficulty adjusting to new environments,
changes in routine, or transitions that involve separation from attachment figures.
Treatment Approaches:
Treatment for separation anxiety disorder often involves cognitive-behavioral interventions
aimed at reducing separation-related fears and increasing coping skills.
Gradual exposure to separation situations, reinforcement of positive coping strategies, and
teaching relaxation techniques are key components of treatment.
Involving parents and caregivers in treatment is essential for providing support, implementing
consistent routines, and addressing any family dynamics that may contribute to the child's
anxiety.
In Katy's case, her symptoms of chronic worry, avoidance behaviors, physical complaints, and
fear of separation from her parents are indicative of both generalized anxiety disorder and
separation anxiety disorder. A comprehensive assessment by a mental health professional,
including consideration of developmental factors, family dynamics, and environmental stressors,
is necessary to formulate an accurate diagnosis and individualized treatment plan tailored to
Katy's needs. Collaboration with her family, school, and healthcare providers is essential for
supporting Katy's mental health and promoting her overall well-being.
Generalized Anxiety Disorder (GAD):
Characteristics and Symptoms:
GAD involves excessive, uncontrollable worry and anxiety about a wide range of everyday
concerns, including family issues, academic performance, friendships, and health.
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Children with GAD often experience persistent and pervasive worry that interferes with their
ability to function and enjoy daily activities.
Physical symptoms commonly associated with GAD include muscle tension, fatigue, irritability,
restlessness, difficulty concentrating, and sleep disturbances.
Children may express their anxiety through complaints of stomachaches, headaches, and other
somatic symptoms, especially in situations that trigger their worries.
Developmental Considerations:
In children, GAD may present differently than in adults, with symptoms often manifesting as
behavioral problems, academic difficulties, and social withdrawal.
Children with GAD may seek reassurance excessively, have difficulty making decisions, and
display perfectionistic tendencies.
GAD symptoms may fluctuate over time and can be influenced by environmental stressors,
changes in routine, or significant life events.
Treatment Approaches:
Cognitive-behavioral therapy (CBT) is a widely used and effective treatment for GAD in
children and adolescents. CBT helps children identify and challenge irrational thoughts and
beliefs contributing to their anxiety.
Relaxation techniques, mindfulness exercises, and stress management strategies can help
children learn to cope with anxiety symptoms and reduce physiological arousal.
NURSING CASE 16
In cases where symptoms are severe or significantly impair functioning, medication may be
considered, typically selective serotonin reuptake inhibitors (SSRIs) or other antidepressants
approved for pediatric use.
Separation Anxiety Disorder:
Characteristics and Symptoms:
Separation anxiety disorder involves excessive fear or anxiety about separation from attachment
figures, such as parents or caregivers.
Children with separation anxiety disorder may experience intense distress, worry, and fear when
faced with separation, anticipation of separation, or thoughts of being separated from their loved
ones.
Symptoms may include reluctance or refusal to attend school, nightmares about separation,
complaints of physical symptoms (e.g., stomachaches, headaches), and clinging behavior.
Developmental Considerations:
Separation anxiety is a normal part of development in early childhood, but separation anxiety
disorder involves symptoms that persist beyond what is typical for a child's developmental stage.
Onset of separation anxiety disorder usually occurs in childhood, often between the ages of 7 and
9, although symptoms may manifest earlier in some cases.
Children with separation anxiety disorder may have difficulty adjusting to new environments,
transitions, or changes in routine that involve separation from attachment figures.
Treatment Approaches:
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Cognitive-behavioral therapy (CBT) is considered the first-line treatment for separation anxiety
disorder in children. CBT interventions may include exposure therapy, cognitive restructuring,
and parent-child interventions.
Gradual exposure to separation situations, reinforcement of coping skills, and teaching relaxation
techniques are key components of treatment.
Involving parents and caregivers in treatment is crucial for providing support, implementing
consistent routines, and addressing any family dynamics that may contribute to the child's
anxiety.
In Katy's case, her symptoms of chronic worry, avoidance behaviors related to school, physical
complaints, and fear of separation from her parents suggest overlapping features of both
generalized anxiety disorder and separation anxiety disorder. A thorough evaluation by a mental
health professional is essential for accurate diagnosis and the development of an individualized
Generalized Anxiety Disorder (GAD):
Characteristics and Symptoms:
GAD is characterized by persistent and excessive worry and anxiety about various aspects of
life, such as school, family, health, and future events.
Children with GAD often experience difficulty controlling their worries, which may manifest as
restlessness, irritability, muscle tension, and difficulty concentrating.
Physical symptoms commonly associated with GAD include fatigue, sleep disturbances,
stomachaches, headaches, and sweating.
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The worry experienced by children with GAD may be disproportionate to the actual
circumstances and may interfere with their daily functioning and well-being.
Developmental Considerations:
In children, GAD may present differently than in adults, with symptoms often manifesting as
behavioral problems, academic difficulties, and social withdrawal.
Children with GAD may exhibit perfectionism, self-criticism, and an exaggerated sense of
responsibility.
GAD symptoms may fluctuate over time and may be influenced by environmental stressors,
changes in routine, or significant life events.
Treatment Approaches:
Cognitive-behavioral therapy (CBT) is considered the gold standard treatment for GAD in
children and adolescents. CBT helps children identify and challenge irrational thoughts and
beliefs contributing to their anxiety.
Relaxation techniques, mindfulness exercises, and stress management strategies can help
children develop coping skills to manage their anxiety symptoms.
In some cases, medication may be considered, typically selective serotonin reuptake inhibitors
(SSRIs) or other antidepressants, especially when symptoms are severe or significantly impair
functioning.
Separation Anxiety Disorder:
Characteristics and Symptoms:
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Separation anxiety disorder involves excessive fear or anxiety about separation from attachment
figures, such as parents, caregivers, or close family members.
Children with separation anxiety disorder may experience intense distress, worry, and fear when
faced with separation or the anticipation of separation.
Symptoms may include reluctance or refusal to attend school, nightmares about separation,
complaints of physical symptoms (e.g., stomachaches, headaches), and clinging behavior.
Developmental Considerations:
Separation anxiety is a normal developmental phase in early childhood, but separation anxiety
disorder involves symptoms that persist beyond what is typical for a child's developmental stage.
Onset of separation anxiety disorder typically occurs in childhood, often between ages 7 and 9,
although symptoms may manifest earlier in some cases.
Children with separation anxiety disorder may have difficulty adjusting to new environments,
changes in routine, or transitions that involve separation from attachment figures.
Treatment Approaches:
Cognitive-behavioral therapy (CBT) is the treatment of choice for separation anxiety disorder in
children. CBT interventions may include exposure therapy, cognitive restructuring, and parent-
child interventions.
Gradual exposure to separation situations, reinforcement of coping skills, and teaching relaxation
techniques are key components of treatment.
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Involving parents and caregivers in treatment is crucial for providing support, implementing
consistent routines, and addressing any family dynamics that may contribute to the child's
anxiety.
In Katy's case, her symptoms of chronic worry, avoidance behaviors related to school, physical
complaints, and fear of separation from her parents suggest overlapping features of both
generalized anxiety disorder and separation anxiety disorder. A comprehensive evaluation by a
mental health professional is necessary to accurately diagnose her condition and develop an
individualized treatment plan tailored to her specific needs and circumstances. Early intervention
and ongoing support can help Katy learn effective coping strategies and improve her overall
quality of life.
Treatment of SAD
Treatment of separation Anxiety Disorder in children should begin as soon as diagnosis is
done in order to have positive outcome. The treatment procedure depends in the child’s age,
symptoms and general health. It will also be informed by severity of the condition. Many
professionals use a mix of interventions and treatment procedures in children to ensure the
children overcome such disorders (Lavallee & Schneider, 2019). There are various treatment
interventions and psychotherapy that can be used which include cognitive behavior therapy
(CBT), family therapy, school input and play therapy, as well as medication in cases where the
conditions are severe.
Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is highly
recommended for treatment of SAD. This treatment approach involves helping children to learn
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how to understand and manage their distress and fears (Lebowitz, 2019). A specialized form of
CBT known as exposure therapy can be tailored to meet the needs of the child. This form of
CBT involves exposing the child to separation in small and controlled levels that help them
reduce the anxiety in bits over a period of time (West, Wilbanks & Suveg, 2020). The process of
CBT also involves helping the children to develop coping skills that they can rely on when at
times when they become anxious. Children are taught how to recognize anxious feelings or
triggers of fear as well as any associated thought patterns which may contribute to fear. This is
couple with training strategies on how to manage such feelings, emotions and thoughts.
Family therapy involve incorporating parents and family members into the process of
treatment in order to improve the outcome. Parents and siblings are taught ways in which they
can interact with the child through tease out patterns to help the child learn how to cope without
them. Additionally, they are taught useful strategies which they can use to help the children at
times of anxiety (Lavallee & Schneider, 2019).
Play therapy involves helping children learn how to develop and process their feelings
and emotions, as well as learn how to manage and cope with them. This is because children may
not understand or connect the dots between feelings, thoughts and also actions. As such, they
may not be able to interpret what they are required to do when fears come their way (Lebowitz,
2019). Relaxation training can be used for children and adolescents in order to reduce the effects
of separation anxiety disorder. This may include guided relaxation, deep breathing as well as
progressive muscle relaxation which helps the children to self-soothe anxious moments.
Parents’ Help
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Parents can help their children learn a number of things on how to cope and manage
anxious feelings and emotions while at home. In SAD treatment, parental involvement and
support is very crucial in help the child manger the feelings independently. The parent should
design a plan of making the child transition to school without much difficulties (Lebowitz,
2019). This may involve taking the child early to school and helping him/her play or exercise
before they begin classes. The parent can also help the child reframe his/her thoughts through
initiating positive thoughts to avoid the child developing fear (West, Wilbanks & Suveg, 2020).
It is also important for the parent to increase playtime, healthy sleep and downtime to help the
child rest well. The parent should also be able to help the child adjust to changes by informing
him/her any routine changes before time. The parent should also help the child through
empathizing with him/her and comment on progresses made.
Typical Symptom Patterns
Children and adolescents have similar symptoms of separation anxiety disorder.
Generally, children have separation anxiety when they are separated from the people they have
developed attachment with. The fears are common between 8 and 14 months but if they become
persistent and progressive, they become separation anxiety disorder (Lavallee & Schneider,
2019). Adolescents beyond 6 years may develop SAD if the anxiety goes beyond four weeks.
Common experiences include worry about separation, death or harm of a loved person, worry
about something bad happening to the child, fear of being alone or having nightmares and lack of
sleep (Lebowitz, 2019). Other physical symptoms include nausea, fatigue, muscle aches or quick
breathing.
In the treatment intervention for Katy, medication may not be used since the condition
has not worsened beyond treatment by normal psychotherapy. If the psychotherapy processes are
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followed well, Katy will manage the anxious feelings and lead a normal life. School-based
intervention for Katy may involve the parents taking the child early to school, spending some
time with child playing in the school compound, as well as encouraging the teacher to develop a
close relationship with child in order to remove most of the fears (Lebowitz, 2019). The teacher
should be able to develop attachment with the child by spending most of the time with her as
well as training her how to manage and cope with the condition.
Implications for Family
The family and parents of Katy should play a key role in the treatment intervention in
order to ensure Katy overcomes the anxious emotions. This will entail the parents helping the
child to keep all the appointments with the psychiatrist (Lebowitz, 2019). This should be done in
a way that the child realizes the support being given by the parent. The parent should encourage
the child to become more independent in order to overcome feelings of fear (Lavallee &
Schneider, 2019). The family should be able to recognize anything that may cause fear to the
child and plan ahead in order to prepare the child to transition successfully. The parent should
work closely with the healthcare professional as well as school in order to develop effective
treatment plan. The parent should reassure the child of their support towards the healing process.
Additionally, the parents should reach out for support from local community health care
providers in order to receive relevant support (West, Wilbanks & Suveg, 2020).
The health status of Katy’s mother is one of the triggers of anxiety and fears experienced
by Katy. It is important for the mother to reassure Katy of her health and stay close to her in
order to remove the fears that Katy has (West, Wilbanks & Suveg, 2020). This kind of therapy is
known as family therapy. It is crucial that this trigger be dealt with by Katy’s mother through
offering support in her healing journey. For further support in the treatment intervention, Katy’s
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family should seek help and support from local community professionals who deal with mental
health (Lebowitz, 2019). This will help the child to integrate properly with the community
through forming helpful relationships which enable her overcome the separation anxiety. Other
treatment resources in the area include healthcare institutions that deal with mental health,
volunteers or nurses in the community who run mental health groups, as well as private hospitals
that offer mental health services.
The worries that may come about in treatment procedure touches on the fact that Katy’s
condition may be biological. Katy may have inherited this kind of condition from her mother and
therefore it may take a mix of treatment procedures to deal with Katy’s condition. If the
condition arises again, the treatment will demand a combination of psychotherapeutic and
pharmacological treatment interventions (Lebowitz, 2019). This will help in suppressing any
hormones that may cause anxiety to Katy.
Justification with DSM-5 Criteria:
Generalized Anxiety Disorder (GAD): Katy meets DSM-5 criteria for GAD with excessive
worry and anxiety about school, physical symptoms, difficulty sleeping, and impairment in daily
functioning lasting at least six months.
Separation Anxiety Disorder: Katy also meets DSM-5 criteria for separation anxiety disorder
with excessive fear or anxiety about separation from her parents, avoidance behaviors, and
physical symptoms causing distress and functional impairment.
Age Considerations for Diagnosis and Intervention:
While there are age considerations for diagnosing mental health disorders in children, Katy's
symptoms are consistent with GAD and separation anxiety disorder, which can manifest in early
NURSING CASE 25
childhood. Early identification and intervention can help address her symptoms and prevent
further impairment.
Psychiatric Scales or Assessment Tools:
For Katy: Pediatric Anxiety Rating Scale (PARS), Screen for Child Anxiety Related Emotional
Disorders (SCARED), and Child Behavior Checklist (CBCL) may be used to assess anxiety
symptoms, behavior, and emotional functioning.
For the Parents: Generalized Anxiety Disorder 7-item (GAD-7) scale and Patient Health
Questionnaire-9 (PHQ-9) can help assess parental anxiety and depressive symptoms, facilitating
a comprehensive understanding of family dynamics and mental health needs.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Symptoms of anxiety disorders may manifest as physical complaints,
school refusal, separation anxiety, clinginess, nightmares, and difficulty concentrating. Children
may exhibit avoidance behaviors and seek reassurance from caregivers.
In Adolescents: Anxiety symptoms may resemble those in adults, including excessive worry,
rumination, avoidance of triggering situations, social withdrawal, and increased risk-taking
behaviors. Adolescents may also experience academic difficulties, substance use, and mood
disturbances as a result of untreated anxiety disorders.
Understanding these developmental differences and symptom manifestations is crucial for
accurate diagnosis and effective treatment planning in children and adolescents with anxiety
disorders like Katy.
Justification with DSM-5 Criteria:
NURSING CASE 26
According to the DSM-5, Generalized Anxiety Disorder (GAD) is characterized by excessive
anxiety and worry about a variety of events or activities. The individual finds it difficult to
control the worry, which leads to significant distress or impairment in social, occupational, or
other important areas of functioning. Katy's symptoms align with these criteria as she exhibits
excessive worry about school, physical symptoms, and impaired daily functioning.
Separation Anxiety Disorder involves excessive fear or anxiety about separation from attachment
figures, leading to significant distress when anticipating or experiencing separation. Individuals
with separation anxiety disorder may exhibit avoidance behaviors or physical symptoms such as
stomachaches or headaches. Katy's fear of separation from her parents, school refusal, and
physical complaints meet the DSM-5 criteria for separation anxiety disorder.
Age Considerations for Diagnosis and Intervention:
While age considerations are important in diagnosing mental health disorders, children can still
experience conditions like GAD and separation anxiety disorder. Early identification and
intervention are crucial to addressing Katy's symptoms and preventing further impairment.
Children as young as Katy's age can experience anxiety disorders, and it's essential to provide
support and treatment tailored to their developmental level.
Psychiatric Scales or Assessment Tools:
For Katy: The Pediatric Anxiety Rating Scale (PARS) assesses the severity of anxiety symptoms
in children. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-
report questionnaire assessing anxiety symptoms in children. The Child Behavior Checklist
(CBCL) helps assess emotional and behavioral problems in children.
NURSING CASE 27
For the Parents: The Generalized Anxiety Disorder 7-item (GAD-7) scale is used to assess the
severity of anxiety symptoms in adults. The Patient Health Questionnaire-9 (PHQ-9) measures
depressive symptoms in adults, which may co-occur with anxiety disorders.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Anxiety symptoms in children may manifest as physical complaints
(e.g., stomachaches, headaches), school refusal, clinginess, separation anxiety, nightmares, and
difficulty concentrating. Children may also exhibit avoidance behaviors and seek reassurance
from caregivers to cope with their anxiety.
In Adolescents: Adolescents with anxiety disorders may experience symptoms similar to adults,
including excessive worry, irritability, avoidance of triggering situations, social withdrawal, and
difficulty concentrating. They may also engage in risky behaviors or experience academic
difficulties as a result of their anxiety.
Understanding these nuances in symptom presentation and developmental differences is critical
for accurately diagnosing and effectively treating anxiety disorders in children and adolescents
like Katy. It ensures that interventions are tailored to their specific needs and developmental
stage.
Justification with DSM-5 Criteria:
Generalized Anxiety Disorder (GAD):
According to the DSM-5, GAD involves excessive anxiety and worry about various events or
activities. This worry is difficult to control and is accompanied by symptoms such as
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
NURSING CASE 28
Katy's symptoms align with the DSM-5 criteria for GAD. She experiences excessive worry about
attending school, physical symptoms such as headaches and stomachaches, difficulty sleeping,
and impairment in daily functioning due to her anxiety.
Separation Anxiety Disorder:
Separation Anxiety Disorder in the DSM-5 involves excessive fear or anxiety about separation
from attachment figures, leading to significant distress or impairment. Symptoms may include
recurrent excessive distress when separation from home or major attachment figures occurs or is
anticipated.
Katy displays symptoms consistent with Separation Anxiety Disorder, as she experiences
extreme distress about going to school, worries about her mother's illness, and exhibits avoidance
behaviors and physical symptoms when faced with separation from her parents.
Age Considerations for Diagnosis and Intervention:
While age considerations are important, mental health disorders like GAD and Separation
Anxiety Disorder can manifest in children as young as Katy's age. Early identification and
intervention are crucial for addressing her symptoms and preventing further impairment. There is
a basis for early identification and intervention, especially given the significant impact of anxiety
disorders on children's functioning and development.
Psychiatric Scales or Assessment Tools:
For Katy: The Pediatric Anxiety Rating Scale (PARS) assesses the severity of anxiety symptoms
in children. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-
NURSING CASE 29
report questionnaire assessing anxiety symptoms. The Child Behavior Checklist (CBCL) helps
assess emotional and behavioral problems.
For the Parents: The Generalized Anxiety Disorder 7-item (GAD-7) scale assesses the severity of
anxiety symptoms in adults. The Patient Health Questionnaire-9 (PHQ-9) measures depressive
symptoms. Assessing parental mental health is important as it can impact family dynamics and
children's well-being.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Anxiety symptoms may manifest as physical complaints, school
refusal, clinginess, separation anxiety, nightmares, and difficulty concentrating. Children may
also exhibit avoidance behaviors and seek reassurance from caregivers.
In Adolescents: Adolescents may experience symptoms similar to adults, including excessive
worry, irritability, avoidance, social withdrawal, and difficulty concentrating. They may also
engage in risky behaviors or experience academic difficulties due to anxiety.
Understanding these aspects is crucial for accurately diagnosing and effectively treating anxiety
disorders in children and adolescents like Katy. It ensures that interventions are tailored to their
specific needs, developmental stage, and family context.
Justification with DSM-5 Criteria:
Generalized Anxiety Disorder (GAD):
According to DSM-5 criteria, GAD involves excessive worry and anxiety about various events
or activities, occurring more days than not for at least six months. The worry is difficult to
NURSING CASE 30
control and is associated with symptoms such as restlessness, fatigue, difficulty concentrating,
irritability, muscle tension, and sleep disturbances.
Katy's symptoms align with GAD criteria. Her persistent worry about attending school, physical
symptoms like headaches and stomachaches, difficulty sleeping, and impaired daily functioning
due to anxiety indicate GAD.
Separation Anxiety Disorder:
Separation Anxiety Disorder is characterized by excessive fear or anxiety concerning separation
from attachment figures, leading to distress when separation occurs or is anticipated. Symptoms
may include recurrent excessive distress about separation, worry about harm to attachment
figures, refusal to go to school, and physical complaints.
Katy exhibits symptoms consistent with Separation Anxiety Disorder. Her extreme distress about
going to school, fear of her mother's illness, avoidance behaviors, and physical symptoms during
separation indicate separation anxiety.
Age Considerations for Diagnosis and Intervention:
While some mental health disorders may be challenging to diagnose in young children due to
developmental considerations, GAD and Separation Anxiety Disorder can manifest in children as
young as Katy's age. Early identification and intervention are crucial for preventing long-term
consequences and promoting healthy development.
Psychiatric Scales or Assessment Tools:
NURSING CASE 31
For Katy: The Pediatric Anxiety Rating Scale (PARS), Screen for Child Anxiety Related
Emotional Disorders (SCARED), and Child Behavior Checklist (CBCL) are commonly used to
assess anxiety symptoms, behavior, and emotional functioning in children.
For the Parents: The Generalized Anxiety Disorder 7-item (GAD-7) scale and Patient Health
Questionnaire-9 (PHQ-9) can help assess parental anxiety and depressive symptoms, providing
valuable insights into family dynamics and mental health needs.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Anxiety symptoms may manifest as physical complaints, school
refusal, separation anxiety, clinginess, nightmares, and difficulty concentrating. Children often
seek reassurance and exhibit avoidance behaviors in response to anxiety-provoking situations.
In Adolescents: Anxiety symptoms in adolescents may resemble those in adults, including
excessive worry, irritability, avoidance, social withdrawal, and risk-taking behaviors.
Adolescents may also experience academic difficulties and substance use as coping mechanisms
for anxiety.
Understanding these aspects enables clinicians to accurately assess and address anxiety disorders
in children and adolescents, tailoring interventions to their developmental stage and individual
needs for optimal outcomes.
Justification with DSM-5 Criteria:
Generalized Anxiety Disorder (GAD):
According to the DSM-5, Generalized Anxiety Disorder (GAD) involves excessive worry and
anxiety about various events or activities. This worry is difficult to control and is accompanied
NURSING CASE 32
by symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension,
and sleep disturbances.
Katy's symptoms align with the DSM-5 criteria for GAD. She exhibits excessive worry about
attending school, physical symptoms like headaches and stomachaches, difficulty sleeping, and
impairment in daily functioning due to her anxiety.
Separation Anxiety Disorder:
Separation Anxiety Disorder is characterized by excessive fear or anxiety concerning separation
from attachment figures, leading to significant distress or impairment. Symptoms may include
recurrent excessive distress when separation from home or major attachment figures occurs or is
anticipated.
Katy displays symptoms consistent with Separation Anxiety Disorder, as she experiences
extreme distress about going to school, worries about her mother's illness, and exhibits avoidance
behaviors and physical symptoms when faced with separation from her parents.
Age Considerations for Diagnosis and Intervention:
While age considerations are important in diagnosing mental health disorders, GAD and
Separation Anxiety Disorder can manifest in children as young as Katy's age. Early identification
and intervention are crucial for addressing her symptoms and preventing further impairment.
There is a basis for early identification and intervention, especially given the significant impact
of anxiety disorders on children's functioning and development.
Psychiatric Scales or Assessment Tools:
NURSING CASE 33
For Katy: The Pediatric Anxiety Rating Scale (PARS) assesses the severity of anxiety symptoms
in children. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-
report questionnaire assessing anxiety symptoms. The Child Behavior Checklist (CBCL) helps
assess emotional and behavioral problems.
For the Parents: The Generalized Anxiety Disorder 7-item (GAD-7) scale assesses the severity of
anxiety symptoms in adults. The Patient Health Questionnaire-9 (PHQ-9) measures depressive
symptoms. Assessing parental mental health is important as it can impact family dynamics and
children's well-being.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Anxiety symptoms may manifest as physical complaints, school
refusal, clinginess, separation anxiety, nightmares, and difficulty concentrating. Children may
also exhibit avoidance behaviors and seek reassurance from caregivers.
In Adolescents: Adolescents may experience symptoms similar to adults, including excessive
worry, irritability, avoidance, social withdrawal, and difficulty concentrating. They may also
engage in risky behaviors or experience academic difficulties due to anxiety.
Understanding these aspects is crucial for accurately diagnosing and effectively treating anxiety
disorders in children and adolescents like Katy. It ensures that interventions are tailored to their
specific needs, developmental stage, and family context.
Justification with DSM-5 Criteria:
Generalized Anxiety Disorder (GAD):
NURSING CASE 34
GAD is characterized by excessive and persistent worry and anxiety about various aspects of
life, including school, family, health, and future events. This worry is often difficult to control
and is accompanied by symptoms such as restlessness, fatigue, difficulty concentrating,
irritability, muscle tension, and sleep disturbances.
Katy's symptoms align with the DSM-5 criteria for GAD. Her persistent worry about attending
school, physical symptoms like headaches and stomachaches, difficulty sleeping, and impaired
daily functioning due to anxiety are indicative of GAD.
Separation Anxiety Disorder:
Separation Anxiety Disorder involves excessive fear or anxiety about separation from attachment
figures, leading to significant distress when separation occurs or is anticipated. Symptoms may
include recurrent excessive distress about separation, worry about harm to attachment figures,
refusal to go to school, and physical complaints.
Katy exhibits symptoms consistent with Separation Anxiety Disorder. Her extreme distress about
going to school, fear of her mother's illness, avoidance behaviors, and physical symptoms during
separation indicate separation anxiety.
Age Considerations for Diagnosis and Intervention:
While age considerations are important, mental health disorders like GAD and Separation
Anxiety Disorder can manifest in children as young as Katy's age. Early identification and
intervention are crucial for preventing long-term consequences and promoting healthy
development.
Psychiatric Scales or Assessment Tools:
NURSING CASE 35
For Katy: The Pediatric Anxiety Rating Scale (PARS), Screen for Child Anxiety Related
Emotional Disorders (SCARED), and Child Behavior Checklist (CBCL) are commonly used to
assess anxiety symptoms, behavior, and emotional functioning in children.
For the Parents: The Generalized Anxiety Disorder 7-item (GAD-7) scale and Patient Health
Questionnaire-9 (PHQ-9) can help assess parental anxiety and depressive symptoms, providing
valuable insights into family dynamics and mental health needs.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Anxiety symptoms may manifest as physical complaints, school
refusal, separation anxiety, clinginess, nightmares, and difficulty concentrating. Children often
seek reassurance and exhibit avoidance behaviors in response to anxiety-provoking situations.
In Adolescents: Anxiety symptoms in adolescents may resemble those in adults, including
excessive worry, irritability, avoidance, social withdrawal, and risk-taking behaviors.
Adolescents may also experience academic difficulties and substance use as coping mechanisms
for anxiety.
Justification with DSM-5 Criteria:
Generalized Anxiety Disorder (GAD):
GAD is characterized by excessive and uncontrollable worry about various aspects of life,
including school, family, health, and future events. This worry is accompanied by physical
symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and
sleep disturbances.
NURSING CASE 36
Katy's symptoms closely match the DSM-5 criteria for GAD. Her persistent worry about
attending school, physical complaints like headaches and stomachaches, disrupted sleep patterns,
and impaired daily functioning due to anxiety indicate the presence of GAD.
Separation Anxiety Disorder:
Separation Anxiety Disorder involves excessive fear or anxiety about separation from attachment
figures, leading to distress when separation occurs or is anticipated. Symptoms include excessive
distress about separation, worry about harm befalling attachment figures, refusal to attend
school, and physical symptoms.
Katy's symptoms align with the criteria for Separation Anxiety Disorder. Her extreme distress
about going to school, fear of her mother's illness, avoidance behaviors, and physical symptoms
during separation indicate significant separation anxiety.
7. School-Based Treatment Plan:
Implement a gradual exposure program to school, starting with short visits and gradually
increasing duration.
Collaborate with school personnel to create a supportive environment and develop a plan for
managing Katy's anxiety during school hours.
Provide Katy with coping strategies such as deep breathing exercises, mindfulness techniques,
and positive self-talk to use when she feels anxious at school.
Offer school-based counseling sessions to address Katy's fears and help her develop effective
coping skills for managing anxiety in the school setting.
8. Implications for Families:
NURSING CASE 37
Families of children with anxiety disorders may experience stress, frustration, and guilt. They
may need education and support to understand their child's condition and how to best support
them.
Family therapy can help improve communication, reduce family stress, and strengthen coping
skills for managing anxiety within the family system.
9. Mother's Health and Therapy Recommendations:
Katy's mother's health condition may exacerbate Katy's anxiety and contribute to her separation
anxiety.
Family therapy, along with individual therapy for Katy, can help address the impact of her
mother's illness on Katy's anxiety and provide strategies for coping with uncertainty and stress.
Cognitive-behavioral therapy (CBT) is recommended for Katy to help her challenge irrational
thoughts, learn coping skills, and gradually face her fears in a supportive environment.
10. Resources for Patients/Families:
Community Groups: Local support groups for families of children with anxiety disorders can
provide valuable peer support and resources.
Websites: Websites such as Anxiety and Depression Association of America (ADAA) and Child
Mind Institute offer information, resources, and online support forums for families.
Advocacy: National Alliance on Mental Illness (NAMI) and Anxiety Disorders Association of
America (ADAA) advocate for mental health awareness, education, and support services.
NURSING CASE 38
Treatment Resources: Local mental health clinics, school-based counseling services, and private
practitioners specializing in child and adolescent mental health can offer therapy and support
tailored to Katy's needs.
11. Concerns:
Treatment Compliance: Ensuring Katy's engagement and compliance with therapy sessions and
homework assignments may be challenging due to her anxiety and avoidance behaviors.
Treatment Effectiveness: Monitoring Katy's progress in therapy and adjusting treatment
strategies as needed to ensure she is receiving the most effective interventions for her anxiety.
Safety: Addressing any safety concerns related to Katy's anxiety symptoms, such as self-harm
behaviors or severe panic attacks, and developing a safety plan to manage crises effectively.
Family Alliance: Building a strong therapeutic alliance with Katy and her family to foster trust,
collaboration, and active participation in the treatment process.
By addressing these concerns and implementing a comprehensive treatment plan, Katy and her
family can work towards managing her anxiety effectively and improving her overall well-being.
7. School-Based Treatment Plan:
Gradual Exposure: Implement a systematic desensitization approach where Katy gradually
exposes herself to the school environment. This can start with short visits to the school building
or classroom, gradually increasing the duration over time.
Cognitive-Behavioral Techniques: Teach Katy coping strategies such as deep breathing
exercises, positive self-talk, and mindfulness techniques to manage her anxiety when at school.
NURSING CASE 39
School Support: Collaborate with school staff to create a supportive environment for Katy. This
may involve educating teachers and classmates about anxiety disorders and implementing
accommodations to support Katy's needs.
School-Based Counseling: Offer Katy regular counseling sessions at school to address her
anxiety, provide emotional support, and help her develop coping skills specific to the school
environment.
8. Implications for Families:
Families of children with anxiety disorders may experience stress, confusion, and feelings of
helplessness. Providing psychoeducation to the family about anxiety disorders can help them
understand Katy's condition and learn how to support her effectively.
Family therapy can also be beneficial, as it helps improve communication, reduce family stress,
and teach parents and siblings how to best support Katy's recovery.
9. Mother's Health and Therapy Recommendations:
Katy's mother's health condition may exacerbate Katy's anxiety and separation fears. It's essential
to address this aspect in therapy sessions.
Family therapy can help Katy and her family explore how her mother's illness impacts their
dynamics and develop coping strategies to manage stress and uncertainty.
Cognitive-behavioral therapy (CBT) is highly recommended for Katy. It can help her challenge
negative thought patterns, develop coping skills, and gradually confront her fears in a controlled
manner.
10. Resources for Patients/Families:
NURSING CASE 40
Community Groups: Local support groups for parents and families of children with anxiety
disorders can provide emotional support, practical advice, and a sense of community.
Websites: Online resources such as the Anxiety and Depression Association of America
(ADAA) and Child Mind Institute offer information, articles, and online forums for parents and
children coping with anxiety.
Advocacy Organizations: Organizations like the National Alliance on Mental Illness (NAMI)
and Anxiety Disorders Association of America (ADAA) advocate for mental health awareness,
provide resources, and support legislation to improve access to mental health services.
Treatment Resources: Local mental health clinics, school-based counseling services, and private
practitioners specializing in child and adolescent therapy can provide therapy, medication
management, and support services tailored to Katy's needs.
7. School-Based Treatment Plan:
Gradual Exposure Therapy: Katy can be gradually exposed to school-related stimuli in a
controlled and supportive environment. This can involve short visits to the school, spending time
in the classroom, and engaging in activities with peers under the supervision of a supportive
teacher or counselor.
Cognitive-Behavioral Interventions: Teaching Katy cognitive-behavioral techniques such as
relaxation exercises, cognitive restructuring, and coping skills to manage her anxiety symptoms
while at school.
NURSING CASE 41
Individualized Education Plan (IEP): Collaborating with the school to develop an IEP tailored to
Katy's needs, including accommodations such as extended time for assignments, breaks during
the school day, and access to a quiet space if needed.
School-Based Counseling: Offering regular counseling sessions at school to provide emotional
support, teach coping strategies, and address any underlying issues contributing to Katy's
anxiety.
8. Implications for Families:
Families of children with anxiety disorders may experience stress, uncertainty, and feelings of
helplessness. Providing psychoeducation to the family about anxiety disorders and effective
coping strategies can help reduce stress and improve family dynamics.
Family therapy can offer a safe space for family members to express their concerns, improve
communication, and learn strategies to support Katy's recovery.
9. Mother's Health and Therapy Recommendations:
Katy's mother's health condition may exacerbate Katy's anxiety and separation fears. It's
important to address this aspect in therapy sessions and explore how Katy's anxiety is influenced
by her mother's illness.
Family therapy can help Katy and her family develop strategies to cope with stress related to her
mother's health condition and enhance family resilience.
Cognitive-behavioral therapy (CBT) is a recommended treatment approach for Katy, focusing on
identifying and challenging maladaptive thoughts, developing coping skills, and gradually
confronting anxiety-provoking situations.
NURSING CASE 42
10. Resources for Patients/Families:
Local Support Groups: Connecting with local support groups for parents and families of children
with anxiety disorders can provide valuable peer support, information, and resources.
Online Resources: Websites such as the Anxiety and Depression Association of America
(ADAA), Child Mind Institute, and NAMI offer information, articles, and online forums for
families coping with anxiety disorders.
Advocacy Organizations: National advocacy organizations like NAMI and the ADAA advocate
for mental health awareness, provide resources, and support legislation to improve access to
mental health services.
Treatment Resources: Local mental health clinics, school-based counseling services, and private
practitioners specializing in child and adolescent therapy can offer therapy, medication
management, and support services tailored to Katy's needs.
11. Concerns:
Treatment Adherence: Ensuring Katy and her family are committed to attending therapy sessions
regularly and actively participating in treatment.
Assessment Accuracy: Continuously monitoring Katy's symptoms and progress to ensure her
diagnosis remains accurate and treatment remains effective.
Safety: Developing a safety plan to address any potential self-harm behaviors or suicidal
ideation. Providing emergency contact information and crisis intervention resources is vital.
Family Engagement: Building a strong therapeutic alliance with Katy's family to ensure they
actively participate in her treatment and feel supported throughout the process.
NURSING CASE 43
11. Concerns:
Treatment Compliance: Ensuring Katy attends therapy sessions regularly and completes
homework assignments is crucial for her progress. Addressing any barriers to treatment
adherence, such as transportation or scheduling issues, is essential.
Assessment Accuracy: Continuously monitoring Katy's symptoms and progress to ensure her
diagnosis remains accurate and treatment remains effective.
Safety: Developing a safety plan to address any potential self-harm behaviors or suicidal
ideation. Providing emergency contact information and crisis intervention resources is vital.
Family Engagement: Building a strong therapeutic alliance with Katy's family to ensure they
actively participate in her treatment and feel supported throughout the process.
By addressing these concerns and utilizing appropriate resources and interventions, Katy and her
family can work towards managing her anxiety effectively and improving her overall quality of
life.
Age Considerations for Diagnosis and Intervention:
While some mental health disorders may be challenging to diagnose in young children due to
developmental considerations, GAD and Separation Anxiety Disorder can manifest in children as
young as Katy's age. Early identification and intervention are crucial for preventing long-term
consequences and promoting healthy development.
Psychiatric Scales or Assessment Tools:
NURSING CASE 44
For Katy: Assessment tools such as the Pediatric Anxiety Rating Scale (PARS), Screen for Child
Anxiety Related Emotional Disorders (SCARED), and Child Behavior Checklist (CBCL) are
commonly used to evaluate anxiety symptoms, behavior, and emotional functioning in children.
For the Parents: The Generalized Anxiety Disorder 7-item (GAD-7) scale and Patient Health
Questionnaire-9 (PHQ-9) can help assess parental anxiety and depressive symptoms, providing
valuable insights into family dynamics and mental health needs.
Manifestation of Symptom Patterns and Phases:
In Children (Katy's age): Anxiety symptoms may manifest as physical complaints (e.g.,
stomachaches, headaches), school refusal, clinginess, separation anxiety, nightmares, and
difficulty concentrating. Children may also exhibit avoidance behaviors and seek reassurance
from caregivers to cope with their anxiety.
In Adolescents: Adolescents may experience symptoms similar to adults, including excessive
worry, irritability, avoidance, social withdrawal, and difficulty concentrating. They may also
engage in risky behaviors or experience academic difficulties due to anxiety.
Understanding these aspects enables mental health professionals to accurately assess and address
anxiety disorders in children and adolescents like Katy, tailoring interventions to their
developmental stage and individual needs for optimal outcomes.
School-based Treatment Plan
Good mental well-being is critical to children’s performance in school and life in general.
For this reason, Katy will be supported through several school-based treatment interventions.
NURSING CASE 45
Noteworthy, a multi-tiered systems of support consisting of indicated interventions, selective
interventions and universal school-wide prevention interventions. Firstly, teachers should create
a safe and conducive environment for Katy and other students who may suffer mental disorders.
This includes helping Katy build good peer and teacher relationships in order to create a sense of
belonging. The second intervention is introduction of CBT-based interventions at the school.
NURSING CASE 46
References
Lavallee, K. L., & Schneider, S. (2019). Separation Anxiety Disorder.GPediatric Anxiety
Disorders, 151–176. doi: 10.1016/b978-0-12-813004-9.00008-6
Lebowitz, E. R. (2019). Child with Separation Anxiety Disorder.GAddressing Parental
Accommodation When Treating Anxiety In Children, 117–126. doi: 10.1093/med-
psych/9780190869984.003.0011
West, K. B., Wilbanks, J., & Suveg, C. (2020). Exposure therapy for separation anxiety
disorder.GExposure Therapy for Children with Anxiety and OCD, 143–163. doi:
10.1016/b978-0-12-815915-6.00007-x
Substance, A., & Mental, H. S. A. (2016). DSM-5 Changes: Implications for Child Serious
Emotional Disturbance.
