You will be asked to make three decisions concerning the diagnosis

Case #1 A young girl with di!culties in school

BACKGROUND In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your o!ce by her

mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD

medications. As you progress in your PMHNP program, the cases will involve more information for you to sort

through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to

Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will

consider other di"erential diagnoses and determine what information you need to accurately assess the

DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.

When parents bring their child to your o!ce, they may have read symptoms on the internet or they may have

been told by the school “your child has ADHD”. Your diagnosis will either con#rm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a

di"erential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based

on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

� Child Behavior Check List

� Conners’ Teacher Rating Scale

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at:

https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 ). This scale was #lled out by

Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the

scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her

schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span

is short, and she is noted to only pay attention to things she is interested in. She has di!culty interacting with

peers in the classroom and likes to play by herself at recess.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the

#rst born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar

score. The parents say that she met normal developmental milestones and possibly had some di!culty with

sleep during the pre-school years. They notice that Katie has di!culty socializing with peers, she is quiet at

home and spends a lot of time watching TV.

SUBJECTIVE You observe Katie in the o!ce and she is not able to sit still during the interview. She is constantly

interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and

“recess.” She states that she #nds some subjects boring or too di!cult, and sometimes hard because she

feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be

thinking about something else and not looking at the teacher or other students in the class.”

Katie reports that her home life is just #ne. She reports that she loves her parents and that they are very good

and kind to her. Denies any abuse, denies bullying at school. She o"ers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is #dgeting

with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem

attentive and straight forward in the interview process.

MENTAL STATUS EXAM The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is

clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed

appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or

tics. Self-reported mood is euthymic. A"ect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head

but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought

processes. Attention and concentration are somewhat limited based on Katie’s short answers to your

questions.

Decision Point One BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

In your write-up of this case, be certain to link speci!c symptoms presented in the case to DSM–5 criteria to support your diagnosis.

299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

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315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in

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Mathematics

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314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

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