NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Subjective:

CC (chief complaint): The mother states, “Sarah has some trouble paying attention. She hardly remembers things and often loses her items.”

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.
Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.
Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

HPI: Sarah Higgins is a 9-year-old female client accompanied by her mother, who reports that she has trouble paying attention. She hardly remembers things and often loses her items. Sarah admits that she rarely remembers her school assignments, and the teacher has to write down a list of the assignments, but she loses the list all the time. The problem has persisted since Sarah started school in kindergarten. She fidgets on her chair, and she often gets in trouble for fidgeting or getting out of her chair in class. Besides, she rarely concentrates when reading books and only lasts a maximum of five minutes if she likes the books. However, she does not remember much after reading the book.

Sarah also misplaces her books and pencils in school and does not usually remember where she left her items. In addition, she sometimes has problems losing her temper and usually gets angry when teachers say they asked her to do something, and she does not hear them. Sarah also reports daydreaming at school and dreams about going home and playing with her dog. Furthermore, she admits to making many mistakes when doing her homework, which frustrates her because she tries to do it right. Sarah’s teachers report that sometimes she has trouble waiting her turn and is quite difficult when in groups.

Past Psychiatric History:

General Statement: The client first came for psychotherapy with features of inattentiveness and hyperactivity.
Caregivers (if applicable): Grandmother
Hospitalizations: No history of hospitalization
Medication trials: None
Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: No history of substance abuse.

Family Psychiatric/Substance Use History: No family history of psychiatric disorder or substance abuse.

Psychosocial History: Sarah has lived with her grandmother since she was separated from her mother. She sleeps 9hrs/night, but meals are difficult as she has difficulties sitting for meals. She gets proper nutrition per PCP. Sarah loves art and museums. She also likes video games, which she plays for prolonged periods.

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Medical History:

Current Medications: Vaccinations are up to date.
Allergies: No drug or food allergies.

Reproductive Hx: Not applicable.

ROS:

GENERAL: Negative for fever, chills, weight changes, or fatigue.
HEENT: Denies head injury, excessive tearing, visual changes, hearing loss, ear discharge, nasal congestion,rhinorrhea, or swallowing difficulties.
SKIN: Denies skin color changes, itching, or bruises.
CARDIOVASCULAR: Denies palpitations, SOB, or chest pain.
RESPIRATORY: Negative for chest pain, cough, wheezing, or sputum.
GASTROINTESTINAL: Denies nausea, vomiting, abdominal pain, diarrhea/constipation, or rectal bleeding.
GENITOURINARY: Negative for dysuria or abnormal urine color.
NEUROLOGICAL: Denies headache, dizziness, muscle weakness, or tingling sensations.
MUSCULOSKELETAL: Denies joint pain or muscle pain.
HEMATOLOGIC: Denies bruising or bleeding.
LYMPHATICS: Negative for enlarged lymph nodes.
ENDOCRINOLOGIC: Negative for excessive sweating, hot/cold intolerance, polyuria, excessive hunger, or thirst.

Objective:

Physical exam: if applicable

Vitals: T- 97.4; P- 62; R-14; BP- 95/60; Ht- 4’5; Wt.- 63lbs

Diagnostic results: No diagnostic tests were requested.

Assessment:

Mental Status Examination:

The patient is neat and appropriately dressed for the weather. She is alert but appears distracted. She maintains minimal eye contact and fidgets on her chair. Her speech varies from low tones to normal, and she often speaks using syllables. She demonstrates a coherent and logical thought process. No hallucinations, delusions, obsessions, or suicidal ideations were noted. She is oriented to person, place, and time. The patient’s recent memory is impaired, and she has a short attention span. She demonstrates good judgment.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is characterized by a persistent pattern of inattention and hyperactive-impulsive behavior that is more severe than expected of a child at that similar age and level of development. The diagnosis is made when the behavior causes problems at school or other places (Schroer et al., 2021). ADHD is a differential diagnosis based on the patient’s pertinent symptoms of inattentive behavior, including attention that causes impairment, short attention span, easy distractibility, losing things necessary for school tasks, and forgetfulness (Schroer et al., 2021). Besides, she has hyperactivity symptoms such as fidgeting, leaving her seat in the classroom, inability to be still for extended periods, and difficulty waiting in lines. She also has explosive and irritable behavior, evidenced by losing her temper at school.

Pediatric Generalized Anxiety Disorder (GAD)

GAD presents with persistent, excessive, and unrealistic worry and anxiety. Children with GAD worry more often and more deeply than other children in similar circumstances (Cho et al., 2019). In pediatric GAD, worry and anxiety are associated with one or more of the following symptoms: Restlessness or feeling keyed up or on edge, easy fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance (Cho et al., 2019). Pertinent positive symptoms consistent with Pediatric GAD include easy distractibility, concentration difficulties, and a temperamental mood. However, the client has no symptoms of excessive anxiety or worry, making GAD an unlikely diagnosis.

Pediatric Bipolar Affective Disorder

Bipolar is a mood disorder in which thoughts, feelings, behaviors, and perceptions are distorted in the context of mania and depression episodes. Classic symptoms of mania include an abnormal, often expansive, and elevated mood lasting for at least one week (Gautam et al., 2019). Other symptoms include racing thoughts, a decreased need for sleep, rapid and often pressured speech, distractibility, increased goal-directed activities or projects, hypersexuality, reckless behaviors, risk-taking, and delusions of grandeur (Gautam et al., 2019). Bipolar disorder is a differential diagnosis based on the patient’s symptom of distractibility. However, the patient’s symptoms do not meet the criteria for bipolar disorder.

Reflections:

If I were to conduct the session again, I would perform psychometric and educational testing, which is essential in diagnosing attention deficit disorder. I would also evaluate impulsivity and inattention using timed computer tests such as the Conners Continuous Performance Test and the Integrated Visual and Auditory (Keulers & Hurks, 2021). In addition, I would conduct a learning disability evaluation to assess for learning disorders, which usually occur with attention deficit disorder (Keulers & Hurks, 2021). Ethical considerations should center on promoting better outcomes for the patient by implementing interventions based on best practice, thus promoting beneficence. Autonomy should be upheld in this case by involving the patient’s caregiver in the treatment and seeking consent before conducting a test or initiating treatment (Keulers & Hurks, 2021). The caregiver should be formally educated about ADHD to understand the concept behind the diagnosis and how it is managed.

References

Cho, S., Przeworski, A., & Newman, M. G. (2019). Pediatric generalized anxiety disorder. In Pediatric anxiety disorders (pp. 251-275). Academic Press. https://doi.org/10.1016/B978-0-12-813004-9.00012-8

Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents. Indian journal of psychiatry, 61(Suppl 2), 294–305. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_570_18

Keulers, E. H., & Hurks, P. P. (2021). Psychometric properties of a new ADHD screening questionnaire: Parent report on the (potential) underlying explanation of inattention in their school-aged children. Child Neuropsychology, 1-16. https://doi.org/10.1080/09297049.2021.1937975

Schroer, M., Haskell, B., & Vick, R. (2021). Treating Child and Adolescent Attention-Deficit/Hyperactivity Disorder and Behavioral Disorders in Primary Care. The Journal for Nurse Practitioners, 17(1), 70-75. https://doi.org/10.1016/j.nurpra.2020.08.007

Subjective:

CC (chief complaint): “psychiatric evaluation of attention deficit hyperactivity disorder.”

HPI: The 9-year-old female patient was accompanied to the psychiatric department by her mother following the positive findings of the completed attention deficit hyperactivity disorder (ADHD) questionnaire. The patient’s teacher also got an opportunity to complete the ADHD questionnaire based on her behavior and habits at school. According to the patient’s mother, her daughter has displayed difficulties in paying attention and is always forgetful. The patient’s teacher also reports similar symptoms at school, as the patient frequently forgets her assignments. At school, the patient fidgets a lot, displaying difficulties in sitting still on a chair. Additional symptoms reported include daydreaming, temperamental, and engaging in injurious activities. The patient started experiencing the above symptoms when she joined the kindergarten. Her mother claims that no treatment approach has been used so far in the management of the patient’s symptoms.

Past Psychiatric History:

General Statement: The patient presents with attention deficit and memory problems which affect her academic performance and other daily activities.
Caregivers (if applicable): The 9-year-old girl is under the care of one of her mothers.
Hospitalizations: No history of hospitalization was reported.
Medication trials: No medication has been used to manage the patient’s current symptoms.
Psychotherapy or Previous Psychiatric Diagnosis: The patient has never been diagnosed with a mental disorder or taken part in therapy.

Substance Current Use and History: The patient lives and studies in a drug-free environment, with no exposure to cigarette or marijuana smoke.

Family Psychiatric/Substance Use History: No history of mental disorder or use of substances has been reported among any family member.

Psychosocial History: The patient is the only kid, who was being raised by her two moms. However, they recently got separated to resolve their marital issues, leaving the patient to stay with one, the current historian. The patient is in the 3^rd grade, with poor performance due to her mental condition. She gets adequate sleep every night, for about 9 hours. Her PCP reports that the patient displays difficulties in consuming an entire meal as a result of being unable to sit down but she manages to get proper nutrition. She has a dog and also likes visiting art galleries and playing video games.

Medical History: No history of any chronic medical condition was reported.

Current Medications: The patient is not on any medication.
Allergies: No known food, environmental, or drug allergies.

Reproductive Hx: Mother reports normal birth, with no birth defects. No family history of reproductive disorders.

ROS:

GENERAL: Generally healthy with no recent changes in body weight. Denies fever, chills, fatigue, headache, lethargy, or dizziness.
HEENT: Head: denies headache. Even distribution of hair. No signs of injury or trauma. Eyes: No redness, excessive tearing, itchiness, polyploidy, or pain. Ears: No tinnitus, hearing loss, inflammation, itchiness, or exudates. Nose & Throat: No congestion, sinus problems, bleeding nose, running nose, inflammation, or itchiness. No sore throat, swallowing difficulties, or bleeding gums.
SKIN: Warm but somehow dry. No lesions, bruises, lumps, redness, inflammation, or eczema.
CARDIOVASCULAR: No palpitations, murmurs, chest tightness, cyanosis, syncope, arrhythmias, or hypertension.
RESPIRATORY: No running nose, congestion, breathing difficulties, sneezing, wheezing, cough, sputum production, asthma, or chest discomfort.
GASTROINTESTINAL: No tenderness, hernia, abdominal distension, diarrhea, constipation, nausea, or vomiting.
GENITOURINARY: No urgency, frequency, or burning sensation when urination or incontinence. Has not yet experienced her first menses.
NEUROLOGICAL: No ataxia, headache, heat or cold intolerance, reduced appetite, paresthesia, or dizziness.
MUSCULOSKELETAL: No muscle or joint tenderness, stiffness, or inflammation. Confirm full range of movement in both lower and upper extremities.
HEMATOLOGIC: Denies easily bruising, bleeding gums, nose bleeding, anemia, or any other hematological disorder.
LYMPHATICS: No lymphadenopathy or splenectomy.
ENDOCRINOLOGIC: No hypothyroidism, hyperthyroidism, polyphagia, polyuria, or polydipsia.

Objective:

Physical exam: Vitals: Temp- 97.4 Pulse- 62 RR 14 95/60 Ht 4’5 Wt. 63lbs

Diagnostic results: To assess the patient for any underlying diseases complete blood count was ordered. Additional tests ordered for routine assessment include blood sugar tests, ELISA tests, basic metabolic panel, lipid profile, Hb test, and urine test for drugs. Imaging studies such as CT scans and X-rays of the head are also ordered to check for any anatomical deformities or signs of trauma, that may lead to the present symptoms. For further assessment of the patient’s signs of ADHD, the following screening tools were utilized, Conners Comprehensive Behavior Rating Scale (CBRS), National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, and ADHD parent-teacher questionnaire (Halperin & Marks, 2019).

Assessment:

Mental Status Examination: The patient appears healthy and well-groomed in age-appropriate clothing. Her orientation is compromised as she keeps forgetting where she is, and why she is there. She however fidgets a lot. She is also impulsive and unable to sit still for quite a short period. She is very forgetful and seems distracted most of the time. Her mood is slightly elevated. She is very irritable. She speaks with a normal tone rate but is sometimes loud. Her thought process is intact. Denies hallucinations or delirium. Her thought content is appropriate for her age. Denies suicidal or homicidal or psychotic symptoms.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD): The diagnosis of ADHD as outlined in the DSM-V among children and adolescents requires a history of hyperactivity, behavioral problems, poor academic performance, distractibility, and inattention (Wolraich et al., 2019). The patient is also required to present with no less than 6 symptoms of hyperactivity or inattention or both leading to functional impairment just like for the patient in the provided case study. Consequently, the patient must start presenting with these symptoms before the age of 12 years, and the patient in the provided case study reported a set of symptoms immediately after joining kindergarten (Bélanger et al., 2018). From the mental status examination results, and provided patient history, in addition to the completed ADHD parent-teacher questionnaire, the patient qualifies for ADHD as the primary diagnosis.
Separation Anxiety Disorder (SAD): According to the DSM-V this disorder is assigned to patients who normally display anxiety or excessive fear when separated from an individual that they were strongly attached to like a family member (Becker et al., 2018). The patient was being raised by two mothers, who ended up separating leaving the patient to stay with one. Patients diagnosed with this disorder will also present with symptoms such as persistent worry about the unexpected event, nightmares about the separation, afraid of being left alone, and unusual distress (Sadaqa Basyouni, 2018). The patient in the provided case study is negative for most of these symptoms which disqualifies this diagnosis.
Unspecified Neurodevelopmental Disorder: According to the DSM-V, UNDD is usually diagnosed in patients who present with symptoms of a certain neurodevelopmental disorder but do not meet the criteria for any of them (Rivollier et al., 2019). It is one of the most common differential diagnoses for ADHD. The patient in the provided case study displayed ADHD symptoms, based on the complete ADHD questionnaire by both her mother and teacher. However, her mother was not sure whether the patient has this disorder, given that she was also separated from her other mother, which might contribute to her symptom and suggestion of another mental problem. This disorder will however be considered only if the patient fails to meet the diagnosis of ADHD.

Reflections: Based on the information provided, the PMHNP was very professional with the use of respectful language and maturing a healthy therapeutic relationship with the patient. The information gathered is quite adequate to support the diagnosis of ADHD. Since the patient’s mother was ready to seek medical attention based on the previously completed ADHD questionnaire, the PMHNP would have thus focused on discussing the available treatment options for the patient (Halperin & Marks, 2019). The patient’s mother has a legal obligation in making decisions concerning her child’s health. As such, the clinician must educate the patient’s mother on the advantages and disadvantages of each treatment option, and convince her of the most effective approach based on clinical judgment (Wolraich et al., 2019). Respecting the patient’s autonomy is crucial to promote positive treatment outcomes.

References

Becker, S. P., Schindler, D. N., Holdaway, A. S., Tamm, L., Epstein, J. N., & Luebbe, A. M. (2018). The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD. Journal of Psychopathology and Behavioral Assessment, 41(1), 93–106. https://doi.org/10.1007/s10862-018-9702-6

Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1—Etiology, diagnosis, and comorbidity. Paediatrics & Child Health, 23(7), 447–453. https://doi.org/10.1093/pch/pxy109

Halperin, J. M., & Marks, D. J. (2019). Practitioner Review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 60(9), 930–943. https://doi.org/10.1111/jcpp.13014

Rivollier, F., Krebs, M.-O., & Kebir, O. (2019). Perinatal Exposure to Environmental Endocrine Disruptors in the Emergence of Neurodevelopmental Psychiatric Diseases: A Systematic Review. International Journal of Environmental Research and Public Health, 16(8), 1318. https://doi.org/10.3390/ijerph16081318

Sadaqa Basyouni, S. (2018). Separation Anxiety and its Relation to Parental Attachment Styles among Children. American Journal of Educational Research, 6(7), 967–976. https://doi.org/10.12691/education-6-7-12

Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., Ihyembe, D., & Hagan, J. F. (2019). ADHD Diagnosis and Treatment Guidelines: A Historical Perspective. Pediatrics, 144(4), e20191682. https://doi.org/10.1542/peds.2019-1682

Subjective:

Chief Complaint: “When teachers tell me assignments in school, I don’t very well remember what they said your assignments are. Sometimes, they have to write her down a list. Sometimes I lose the list. Actually, Every day.”

History of Presenting Illness: S.H an 11-year-old female Caucasian from Washington presents for a psychiatric evaluation due to difficulty in concentration. She is currently not on any medication. She is accompanied by her mum as she is a minor. They present filled forms on Attention deficit. The patient reports not remembering the assignments she is given at school. She also reports that when the assignments are written on a list she loses the list or forgets where she put the assignment. This problem started when she began school and is not improving or worsening. She also reports finding it difficult to sit still on her chair at school. She fidgets and gets out of the chair. She reports finding it difficult to sit still to read as she only sits still for an average of five minutes. She reports having difficulty remembering what she has read or what she was taught. She reports losing a lot of her personal belongings and making mistakes in classwork. These mistakes frustrate her as she tries to do her best. She reports remembering things that make her feel good. Her mum reports that she loves art but keeps jumping from one artwork to another and faces difficulties when she is in groups. She can however play video games for a long time. The mother reports that she liked engaging in risky behavior from her childhood. She gets adequate sleep of 9-10 hours. She does not feed well due to her inability to sit still for a significant duration of time. There is no reported history of head trauma. Developmental milestones were timely achieved and the vaccination schedule was up to the minute.

Past Psychiatric History: The patient has never been enrolled in treatment before, and no previous hospitalizations or psychiatric diagnoses reported.

Substance Current Use and History: There is no history of substance abuse reported. There is no history of maternal substance abuse during pregnancy.

Family History: There is no family history of mental illness reported.

Social History: The patient lives with both parents in Washington D.C. She has a younger brother. She goes to school. She loves art, playing with her dog, and playing video games.

Medical History: There is no history of head injury, convulsions, or any other illnesses.

Current Medications: S.H is not on any medication.
Allergies: There are no reported drug or food allergies.
Reproductive History: No menstrual history was reported.

ROS:

GENERAL: There is no fever, fatigue, or chills reported.

HEENT: no history of head trauma, no headache, no visual problems, no pain in the eye, no tearing, no blurring of vision, no excessive sensitivity to light, no reported ear discharge, no difficulty hearing, no reported history of sneezing or nasal stuffiness, no sore throat or voice changes.
Skin: no itchiness of the skin or rash eruptions on the skin, no skin pigmentation changes, no striae.
Cardiovascular: No chest pain, no awareness of heartbeat, no dyspnea on exertion, no paroxysmal nocturnal dyspnea, no body edema.
Respiratory: no cough, no chest pains, no breathing difficulties.
Gastrointestinal: no vomiting, no regurgitation of food after eating, no loose stools, no blood in stool, intact appetite.
Genitourinary: no increased frequency or urgency for urination, no per vaginal discharge, no anogenital warts.
Neurological: no headaches, no dizziness, no diplopia, no changes in the normal gait and posture, and no muscle weaknesses.
Musculoskeletal: no joint swellings, no joint pains, no stiffness of joints, and no obvious muscle wasting reported.
Hematologic: no bleeding tendencies such as bleeding gums or hemorrhage in the skin, no pallor, and no recurrent infections.
Lymphatics: no lymph node enlargement, no history of splenomegaly or splenectomy, and no one-sided leg swelling.
Endocrinologic: no awareness of heartbeat, no oversensitivity to heat or cold, no increased frequency of urination or thirst, normal appetite, no darkening of the skin.

Objective:

Physical exam: vital signs: Temperature- 97.4 F, Pulse rate- 58, Respiratory rate 14, Blood Pressure 98/62mmHg Height 4’5 Weight 65lbs.

Diagnostic results: Liver function tests, thyroid function tests, renal function tests, complete blood count and imaging studies are all normal.

Assessment:

Mental Status Examination: S.H is 11 years old female Caucasian minor of medium build and looks her age. She is well kempt and neat. She is initially pleasant in manner but becomes easily distractible. She is fairly calm at the start of the assessment but becomes fidgety and restless within a short time. She has difficulty maintaining eye contact and maintaining social engagement. She displays agitation as she is unable to sit still, and keeps fidgeting, picking her cloth. Her speech rate, rhythm, and volume are fairly normal. Objectively, her mood is appropriate with an anxious affect. She exudes anxiety. Her thought process is coherent, and logical, with a goal-directed stream of thought but she loses interest fast. She is easily distracted. She has no perception anomalies. In cognition, she is alert and oriented. She has difficulties with short-term memory, poor attention, and concentration. Her judgment is intact but only has a grade two insight as she has a slight awareness of being sick and needing help.

Primary Diagnosis: DSM-V 314.01 (F90.2) Combined presentation of Attention Deficit and Hyperactivity Disorder: S.H meets the criteria of both Inattention and hyperactivity according to the DSM-V criteria. She makes classwork mistakes as a result of not paying attention to the details, she daydreams constantly even in situations where there are no distractions, reluctant in school work but she can sit long hours for video games, and she keeps losing her personal belongings like books and her bracelet, is easily distractible and immensely forgetful. She shows hyperactivity by being fidgety, getting off her chair when she is not supposed to, she can’t concentrating on one artwork at a time and having difficulties waiting for her turn. These symptoms must occur before age 12 (American Psychiatric Association, 2013). For this patient, these symptoms started when she began school. According to Cabral et al., (2020) ADHD interferes with the social and academic development of patients. As discussed, S.H is unable to do her class work in the right manner as per the rubrics. The symptomatology of ADHD in this patient is also displayed both at home and school.

Differential Diagnoses: 299.00 (F84.0) Autism Spectrum Disorder, 300.02 (F41.1) Generalized Anxiety disorder, and 312.34 (F63.81) Intermittent Explosive Disorder.

299.00 (F84.0) autism spectrum disorder: Children with ASD tend to display inattention and social difficulties just like those with ADHD (American Psychiatric Association, 2013). Both ASD and ADHD may be manifested in poor academic and social performance. Inattention in ASD is due to an inherent lack of interest in something while in ADHD is due to distraction from external stimuli (Rommelse et al., 2018). This rules out ASD as S.H have an interest in things like art and class work but is just distracted.

300.02 (F41.1) Generalized Anxiety disorder: Anxiety state disorder is a plausible differential as it is also marked by inattention and hyperactivity. There is restlessness and difficulty in concentration characterized by daydreaming (Ströhle et al., 2018). These symptoms are both present in S.H who keeps on daydreaming and is unable to concentrate on a single task for long. However, anxiety states are generally marked with worry and ruminations which are absent in this patient.

312.34 (F63.81) Intermittent Explosive Disorder: Both ADHD and Intermittent Explosive Disorder manifest through heightened impulsivity and hyperactivity (Radwan & Coccaro, 2020). Although these disorders may coexist in a single patient, they are demarcated by the fact that IED patients exhibit severe aggression and temper outbursts. This rules out IED as S.H does not exhibit aggression.

Reflections:

A detailed history and quality in-hospital and out-of-hospital evaluation are critical in the diagnosis of ADHD. The patient must be monitored in more than one environment (Wolraich et al., 2019). It is plausible that the care provider gives questionnaires to be filled out at home and school. This patient presents with the classical features of ADHD consisting of inattention and hyperactivity. According to Grimm et al., (2020) the heritability of ADHD stands at 77-88%. This is a high value. If I were to redo this case, I would look for any family history of ADHD in first-degree relatives. The diagnosis of a child to be having a mental disorder of any kind is a distressing experience for parents, especially first-time parents. Such situations require adequate counseling to help them know that they can be helped to shape the child’s future into a desirable one.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th edition). Reference Reviews, 28(3). https://doi.org/10.1108/rr-10-2013-0256

Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational Pediatrics, 9(S1), S104–S113. https://doi.org/10.21037/tp.2019.09.08

Grimm, O., Kranz, T. M., & Reif, A. (2020). Genetics of ADHD: What Should the Clinician Know? Current Psychiatry Reports, 22(4). https://doi.org/10.1007/s11920-020-1141-x

Radwan, K., & Coccaro, E. F. (2020). Comorbidity of disruptive behavior disorders and intermittent explosive disorder. Child and Adolescent Psychiatry and Mental Health, 14(1). https://doi.org/10.1186/s13034-020-00330-w

Rommelse, N., Visser, J., & Hartman, C. (2018). Differentiating between ADHD and ASD in childhood: some directions for practitioners. European Child & Adolescent Psychiatry, 27(6), 679–681. https://doi.org/10.1007/s00787-018-1165-5

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Aerzteblatt Online, 115(37). https://doi.org/10.3238/arztebl.2018.0611