The Psychiatric Diagnostic Evaluation Child
Student’s Name
Institutional Affiliation
The Psychiatric Diagnostic Evaluation Child
Summary and Identification of Data
Attention, Deficit Hyperactivity Disorder (ADHD), is the focus of this discussion. The essay analyzes a child aged below ten that suffers from the condition. ADHD is among the most challenging and common childhood neurobehavioral illnesses. It negatively affects children, communities, and their families, with the patient depicting persistent symptoms in their adult life. Within the discussion, different findings of a child’s physical and behavioral help analyze the disorder further. It entails a highlighting diagnosis and the possible causes of ADHD, such as neglect during childhood. The work also presents a case formation that analyzes the child’s diagnostic problem with multidimensional signs. The most effective treatment measures of the disorder are discussed. It is recommendable that the child benefits from a behavior therapy training accompanied by the parents. Finally, the discussion outlines the treatment measure outcome in which the child is meant to undergo therapy after every month until the problem is mitigated.
Background
Various research studies address the long-term impacts of neglect, trauma, and deprivation on an individual’s early life. ADHD is among the most challenging and common childhood neurobehavioral disorders with multifaceted effects on a victim, family, and community. Its treatment and diagnosis have consistently proved to be a source of debate. Studies have varied estimation for the ADHD prevalence. The disorder is an over-treated and over-diagnosed condition considering that reviews have risen with time (O’Connor, Downs, Shetty, & McNicholas, 2019). In contrast, many healthcare providers and child psychiatrists believe that the disorder is undertreated and underdiagnosed condition. Notwithstanding the arguments between different ADHD health practitioners and experts, the impact of ADHD continues to influence society as the number of its cases is on the rise. Hence, it is essential to understand how it can be mitigated, how children with ADHD should be treated, and its numerous risk factors.
Case Presentation
John is an eight-year-old male and lives with his parents. The parents have recently finished their post-graduate academics. John’s extended family has been reported to have a history of some mental health concerns despite their academic excellence. John is a caring and intelligent boy that depicts significant potential to excel in his academics. However, recently, his teachers and parents have observed several problems, resulting in them developing interest in consulting a psychiatrist. There were reports of John failing to submit his schoolwork, overlooking details. At the same time, he copies work from the provided notes on the board, and increased careless mistakes noted within his notebooks. He has not been concentrating in class, and most of the time, he appears to be lost in his thoughts. When anyone engages with him, it is hard for him to focus on whatever the individual tells him. He easily comprehends instructions, but he does not fulfil whatever is expected of him. His attention gets diverted to something else, and he quickly loses focus. Recently, John has been disorganized since he has been losing his belongings and books frequently.
Although John understands details and is intelligent, he has been unable to sustain his mental effort. In small tests, he performs well, while in more extended tests, he scores poorly. There are occasions when he forgets his parents’ and teachers’ instructions and fails to sit still long. In case he is left unmonitored, the eight-year-old is always climbing or engaging in running activities, resulting in injuries. At one point, he broke his right tibia while riding his bicycle on the roof. John does not play in groups mostly because he fails to follow the rules, intrudes, or interrupts other people’s activities, games, and conversations. The child blurts out answers even before a question is fully asked. One considers John to be impatient because he hardly waits for his turn. While at home, he has proven to be impulsive. He breaks his play toys and computer. With these habits, John has proven to be a threat to others and himself, thus taking effective treatment measures. John’s mother, Gracie, states that his father, Johnson, had symbolized similar characteristics of being inattentive and reckless. She also says that John’s father is against his son getting the appropriate medication. While screening for ADHD, the Vanderbilt ADHD Rating Scales can be utilized. The tool is useful to administer children between 6 and 12. It contains rating scales for behavioral and academic performance and symptoms of disorders. The instrument might not be meant for diagnosis, but it can be helpful in John’s case. It provides data regarding the symptoms present and their severity and personal performance in one’s social life, home, and classroom settings (Allsopp, 2017). One can use the tool for about ten minutes and determine John’s suffering.
Previously, John’s parents took him to different psychiatrists who diagnosed him with a mood disorder, anxiety, and disruptive mood dysregulation. Amphetamine salts, methylphenidate, fluoxetine, and guanfacine were prescribed to minimize the inattention and mood symptoms. However, such a medication did not bring about any changes. Later, thioridazine, aripiprazole, and quetiapine were recommended, but they also failed to depict behavioral improvement. John has not been a victim of significant substance or drug interactions. There were no concerns about serum drug concentrations or adherence ordered during the patient’s analysis. While reviewing John’s medication history, methylphenidate and guanfacine did not affect his impulsive and hyperactive behavior or lack of focus. Her mother had to halt the amphetamine salts initiated during his previous treatment because of the increased irritability and aggressive behavior John displayed. Fluoxetine and aripiprazole had also to be stopped because they did not improve the child’s behavior. Because John’s condition continued deteriorating, it was a factor that made his parents seek a psychiatrist’s opinion.
Additional circumstances of familial setting surround John’s scenario. There are reported instances of marital relationship instability, alcoholism, and possible LD/ADHD characteristics within his heredity. One of his middle-aged aunts, Alicia, can be described as gifted. She is driven to excel within all her life’s domains and is highly motivated academically. However, at some point, she was diagnosed with a severe eating disorder. His grandmother, Mariana from his mother’s side, who suffers from obesity, was also diagnosed with ADHD in her 60’s. The genogram showing John’s three-generation linage is presented in see appendix I.
Case Formation
This case study analyzes a young boy’s diagnostic problem, John. He presents multidimensional signs managed by polypharmacy. The sub-threshold analysis of the child partially depicts challenges with his treatment. There is no doubt that family history has a significant impact on the child’s developmental outcomes. Dynamic factors complicate the clinical approach, which could explain the patient’s behavior. One can also rely on Erickson’s developmental stages for exploring this situation. Based on his years, John is categorized within competency versus inferiority phase. The stage characterizes effective or inadequate feeling. The critical analysis of John’s childhood life might suggest his patterns of engaging with his parents. However, he experiences neglect, which makes him regress, withdraw, and depict self-soothing behavior. His parents could have shown care because of his tender age, but they have divided attention towards him because of concentrating on academics, which child contributed to abandonment. This Erickson’s stage signals an individual’s connection to society to become a functional and valuable member. Accordingly, a child must benefit from the realization of own abilities based on various life experiences (Issawi & Dauphin, 2017). Chronological age depicts John to be in autonomy versus shame stage because he has to learn to explore what surrounds him through caregiver’s encouragement.
Diagnosis
John has proved to have a history of disrupted attachment. He is indiscriminate while associating with others. Moreover, he struggles with aggression and impulsivity. John is from a family with a strong case of psychiatric disease. His anxiety and mood issues suggest an underlying PTSD problem, while his prominent hyperactivity might be a result of ADHD. The ICD-10 codes for this situation are F33.1 (depressive disorder), F41.9 (anxiety disorder), F43.20 (adjustment disorder), F43.21 (adjustment disorder characterizing depressed mood), and F91.3(oppositional defiant disorder). As a viable diagnosis, the modern healthcare system poses challenges for the treatment of ADHD patients (Kostick, 2017). Given the complex transdiagnostic symptomatology, the guidelines surrounding the cure of ADHD are unavailable.
Discussion
Psychopharmacological intervention experiments for attachment problems are challenging to manage. The procedure typically emphasizes co-morbid with the aim of symptom minimization. John received four different neuroleptic medications (thioridazine, risperidone, aripiprazole, and quetiapine) for impulsivity and disruptive behaviors at a young age. Disorderly action is an indication of an increase in neuroleptics’ utilization among the children that depict challenging behaviors (Magellan Healthcare, 2017). However, there are promising results if risperidone is used in children with behavioral dyscontrol. Risperidone minimizes adverse behavioral problems while it aids in improving cognitive-motor activities among children (Magellan Healthcare, 2017). The current discussion aims to raise concerns about the neuroleptic medication side effects in a vulnerable population. Children seem to be more susceptible to the adverse of substance use than adults, gaining weight being the most common. Aripiprazole and quetiapine are also associated with increased rates of weight gain (Magellan Healthcare, 2017). Pharmacokinetics is challenging to assess in young children with ongoing kidney and liver development. Psychotropic medicines in children do not have a long-lasting effect on them. Thus, high doses might result in increased body weight. Furthermore, it is not yet known how early exposure to antipsychotics can affect neurodevelopment (Magellan Healthcare, 2017). The first three early years of development poses a substantial mind’s growth, such as an increase in neuronal myelination, pruning, and synaptic density. However, at this point, there is a vast lack of information, thus making it hard for a medical expert to make a conclusive determination of what conditions prevail and intervention needed.
Treatment
John should participate in a coaching program that focuses on strategies that will enable him to concentrate on multiple environments and control and self-regulation. He should work on a capacity building program that promotes healthy habits, which allows him to build his performance. An educational center ought to implement policies to ensure that it accommodates individuals with special needs due to their behavior (Kemper et al., 2018). In school, John should be able to ask for assistance whenever he needs it, and, in turn, the school should help him become more. Moreover, John can take Concerta, Strattera, Vyvanse, and biphentin to help with his brain’s chemical balance. It is also recommendable that he should go for behavior therapy training in the company of his parents. If the latter are trained in behavior therapy, they might learn strategies and skills to enable them to address their son’s ADHD situation.
Outcome and Follow-up
John is to return to the psychiatrist after every month until he does not depict aggressive behavior. This arrangement will ensure that he is no longer impatient, restless, and has proven to show no harm to himself or the people around him.
Learning Points
- ADHD is among the most challenging and common childhood neurobehavioral disorders.
- Neglect experienced during one’s childhood is a risk factor for mental health issues.
- Mental health problems can be inherited.
- Medicines, psychotherapy, and suitable environments will help mitigate mental illnesses.
Changes in Interview/Assessment Approach
When I decided to disseminate my services as a PMNP, I acknowledged that the profession requires a personal capacity to handle different experiences. One must be aware of practical measures of bridging the gap between assessment and individual ability. Therefore, when enrolling for a psychiatric program, I knew that promoting the participation of different stakeholders (patient, family, community) was inevitable. The PMHNP’s profession not only necessitates emphasizing evidence-based psychiatric treatment, but it also obliges the expert to maximize on opportunities that help increase one’s skills and knowledge for efficient primary care delivery and professional satisfaction.
Nurses are skilful personnel that must cultivate partnership and collaborative efforts to achieve positive outcomes. Is there an identity crisis for psychiatric nurses? King (2017) examined this question to demonstrate that these practitioners must exploit different opportunities that promote professional satisfaction. I was quite aware of the importance of engagement in nursing care. When conducting an interview, I am now conversant with the fundamentals of the therapeutic method. A nurse is a central component in emphasizing therapeutic approaches for mental illness because one is responsible for nurturing curative culture (King, 2017). The PMHNP primary role is managing coexisting physical assessment and differential analysis within a care setting. I have learned that patient participation is core to the treatment plan while providing timely intervention for improving a victim’s physical health and reducing associated stigma. John’s parents may be branded to have failed in their role as caregivers. I have now learned how to approach such a situation. A PMHNP speeds the healing process of all involved parties within a mental case without blame.
Psychiatric assessment is complex, and a nursing practitioner in this field must recognize this fact. I have learned that a PMHNP must demonstrate primary care utility and experience in executing psychiatric evaluation comprehensively. A victim’s recovery to wellness, especially those associated with depressive disorders and its impacts, must be based on utilizing an all-inclusive evaluation method for diagnostic reliability.
References
Allsopp, K. (2017). The functions of psychiatric diagnosis (Master’s thesis, University of Liverpool). Retrieved from https://livrepository.liverpool.ac.uk/3012056/1/200999459_July2017.pdf
Issawi, S., & Dauphin, B. (2017). Industry versus inferiority. In V. Zeigler-Hill, T.K. Shackelford (eds.), Encyclopedia of Personality and Individual Differences. Springer International Publishing.
Kemper, A. R., Maslow, G. R., Hill, S., Namdari, B., LaPointe, N. M., Goode, A. P., … & Sanders, G. D. (2018). Attention Deficit Hyperactivity Disorder: Diagnosis and treatment in children and adolescents. Comparative Effectiveness Review, 203. Retrieved from https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-203-adhd-final_0.pdf
King, M. (2017). Psychiatric nursing: An identity crisis? British Journal of Mental Health Nursing, 6(6), 254-255.
Kostick, K. (2017). ICD-10-CM Coding for Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of AHIMA/ American Health Information Management Association, 88(9), 56-59.
Magellan Healthcare. (2017). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph: Important issues and evidence-based treatments [PDF file]. Retrieved from https://www.magellanprovider.com/media/55579/psychotropicdrugsinkids.pdf
O’Connor, C., Downs, J., Shetty, H., & McNicholas, F. (2019). Diagnostic trajectories in child and adolescent mental health services: Exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register. European Child & Adolescent Psychiatry, 29(8), 1111-1123. doi:10.1007/s00787-019-01428-z
Appendix I: John’s Genogram
John John
John’s parents