Case 1a Young Girl With Difficulties In Schoolbackgroundin Psychopha ✓ Solved

Case #1 A young girl with difficulties in school BACKGROUND In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office 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 differential 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 office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHDâ€. Your diagnosis will either confirm or refute that diagnosis. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential 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: ) . This scale was filled 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 difficulty 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 first 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 difficulty with sleep during the pre-school years.

They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV. SUBJECTIVE You observe Katie in the office 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 “OKâ€- her favorite subjects are “art†and “recess.†She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lostâ€. 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 fine. 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 offers no other concerns at this time. Katie’s parents appear somewhat anxious about their daughter’s problems.

You notice the mother is fidgeting 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. Affect 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 specific 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 315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics 314.00 Attention Deficit Hyperactivity Disorder, predominantly 299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder 315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation inattentive presentation Student Name MBA 530 Adaptive Leadership Toolkit Template Replace the bracketed text with the relevant information. Recommended Leadership Competencies (Milestone One) [Insert text.] Leadership Competencies Most Critical to Success [Insert text.] Applying Leadership Competencies to Improve Organizational Performance Desired Future State Where would you like to be? [Add to Milestone One material] Current State Where are you now? [Add to Milestone One material] Identified Gap Difference between desired state and current state [Insert text.] Action Plan Steps to close gap [Insert text.] Attach to this document an executive summary report of two to three pages, (follow the APA sub-headings), for submission to the vice president; the summary report shall contain the following: · A thesis statement summarizing the focus of the paper · An introduction to the adaptive leadership toolkit that provides an overview of its structure and a brief description of each section · An explanation of the rationale used to select the leadership behaviors identified in the toolkit and how they directly relate to the employee engagement survey results · Recommendations on next steps required to roll out the adaptive leadership toolkit to all people leaders in the organization MBA530 Adaptive Leadership Toolkit Executive Summary Report Thesis Statement A thesis statement contains an overview of the general topic and points of the paper, generally in one to two sentences.

Introduction Describe the Adaptive Leadership Toolkit, providing an overview of features and benefits, or what is in it, and include a brief description of each element. Add some research in this section from the course resources. Explanation of the rationale Explain why you selected the leadership behaviors identified in the toolkit? How do the behaviors connect to the employee engagement survey results? Why are these behaviors important to the organization’s success?

Add some research in this section from the course resources. Recommendations What are the next steps you recommend to roll out the adaptive leadership toolkit to all leaders in the organization? Overview In Milestone One, you assessed feedback from the employee engagement survey results, comparing and contrasting the results with the Leadership Circle profile. In the Module Two assignment, you completed your individual Leadership Circle profile and developed the personal development plan in your role as the director in the organization, which you reviewed with your manager, the vice president of leadership and learning. The vice president was impressed with the thoroughness of your assessment and sees value in developing your approach into an adaptive leadership toolkit for use by all people leaders in the organization.

The vice president has asked you to develop an adaptive leadership toolkit that will be used as a reference document for leadership improvement by the entire organization. The VP will then share the toolkit you’ve developed with the chief human resources officer (CHRO). Assignment Details: · Adaptive Leadership Toolkit Template · Access the Adaptive Leadership Toolkit Template . You will note the similarity of the toolkit template to the GROW model template. · Leadership Competencies · Refer to your Milestone One submission and populate the leadership toolkit template with your recommendations. Then populate the template with the leadership competencies you deem most critical for success. · Desired Future State, Current State, Identified Gap, Action Plan · Populate the remaining columns in the template: desired future state, current state, identified gap, and action plan.

As you do so, consider behaviors that need to be addressed for improvement in underperforming areas as identified in the employee engagement survey results. · Desired Future State: Define the future positive rating needed for each survey question identified in your previous assessment. Also provide a two- to three-sentence summary paragraph defining what success in this competency area would look like. · Current State: Define the current positive rating achieved for each survey question identified in your previous assessment. Also provide a two- to three-sentence summary paragraph defining how you would define organizational leaders’ current behavior that resulted in a lower-than-acceptable rating. · Identified Gap: Identify one to two probable reasons that leadership behaviors need to be addressed to improve overall organizational performance. · Action Plan: Identify one to two actions that will be initiated to close the gap between the current state and the desired future state.

Use the SMART process when describing each action. **Guidelines for Submission** To complete this milestone, you must submit the following: · A complete and formatted adaptive leadership toolkit , using the template provided, that is ready to be rolled out to the entire organization · An executive summary report, constructed as a Word document of 2 to 3 pages , for submission to the vice president; the summary report shall contain the following: · A thesis statement summarizing the focus of the paper · An introduction to the adaptive leadership toolkit that provides an overview of its structure and a brief description of each section · An explanation of the rationale used to select the leadership behaviors identified in the toolkit and how they directly relate to the employee engagement survey results · Recommendations on next steps required to roll out the adaptive leadership toolkit to all people leaders in the organization

Paper for above instructions

Case Study Analysis of Katie: A Young Girl with Difficulties in School

Introduction

Katie, an 8-year-old girl, is experiencing significant challenges in her academic and social life. Following a preliminary evaluation and medication loss of efficacy, it is crucial to further assess Katie to explore a potential diagnosis and treatment options. Utilizing the DSM-5 criteria, we will analyze her symptoms and discuss differential diagnoses, assessment tools, and recommended interventions based on current best practices in child psychiatry.

Assessment Tools

Several validated assessment tools can be utilized to evaluate attention disorders and accompanying behavioral concerns. The Child Behavior Checklist (CBCL) can provide a comprehensive view of Katie's behavior patterns reported by her parents and identify potential psychosocial stressors in her life (Achenbach & Rescorla, 2001). Additionally, the Conners’ Teacher Rating Scale (CTRS) offers insight into Katie’s behavior in an academic setting from her teacher's perspective, focusing on attention, hyperactivity, and aggression symptoms characteristic in ADHD cases (Conners, 2008). Another relevant tool could be the Behavior Assessment System for Children (BASC), which offers ratings from both parents and teachers, providing a holistic viewpoint regarding her social and academic challenges (Reynolds & Kamphaus, 2004).

Symptoms Analyzed with DSM-5 Criteria

The DSM-5 outlines specific criteria for diagnosing Attention Deficit Hyperactivity Disorder (ADHD). In Katie’s case, we see a majority of the following symptoms:
1. Inattention: Katie shows short attention span during tasks, readily admits to her mind wandering during class, and demonstrates difficulty in interacting with peers. These behaviors resonate with the DSM-5 criteria for inattention (American Psychiatric Association, 2013).
2. Easily Distracted: Her teacher’s report indicates that she is easily distracted and makes careless mistakes, affirming the inattentiveness highlighted in the DSM-5.
3. Challenges with Academic Performance: Katie’s struggles with spelling, reading, and arithmetic could indicate co-occurring learning disability alongside ADHD, aligning with criteria for specific learning disorders (American Psychiatric Association, 2013).
4. Social Withdrawal: Although not a defining criterion for ADHD, her preference for solitary play during recess may indicate possible social anxiety, relevant for considering a differential diagnosis.
Given that the current medication does not alleviate her symptoms, it's important to consider other potential diagnoses:
1. Autism Spectrum Disorder (ASD): Katie's difficulty interacting with peers and showing preference for solitary activities might reflect mild autistic traits (DSM-5, 299.00).
2. Specific Learning Disorder: The impairments in reading and arithmetic warrant consideration of specific learning difficulties based on DSM-5 criteria (315.0 and 315.1).
3. Social Anxiety Disorder: Her possible anxiety during social situations could also be reflective of emotional disturbances (300.23).

Parental and Teacher Evaluations

Parental and teacher assessments are paramount in evaluating Katie. Parents report her as quiet and reserved at home, while her teacher comments on her significant distractibility and inattentiveness during class. The parents' anxiety may also impact how they interpret Katie’s behaviors. Their concern about her academic struggles can feed into their perception of Katie's learning and social difficulties.

Differential Diagnosis

Based on the assessment data, various differential diagnoses could be proposed:
- ADHD, Predominantly Inattentive Presentation (314.00): Given her observable inattentiveness, distractibility, and academic challenges, ADHD remains a strong contender.
- Autism Spectrum Disorder (299.00): Given her preferences for solitary play and difficulty in peer interactions, assessing for ASD would be prudent despite normal developmental milestones during early childhood.
- Specific Learning Disorder (315.0 and 315.1): Identifying issues specifically related to reading and math may mean concurrent specific learning disorders.

Recommended Interventions

An effective plan of intervention requires a multifaceted approach focusing on psychoeducation, behavioral strategies, and possibly medication. Initial steps could include:
1. Psychoeducation: Educating Katie's parents about ADHD and how it manifests. This knowledge can help them establish supportive routines and strategies at home.
2. Behavioral Interventions: Implement strategies such as structured routines and breaking down tasks into manageable steps to improve attention spans and learning at home. Consider also Positive Behavioral Interventions and Supports (PBIS) as part of the school environment (Sugai & Simonsen, 2012).
3. Cognitive-Behavioral Therapy (CBT): Engaging Katie in CBT can address both her attentional challenges and potential social anxiety. Research supports CBT's effectiveness in improving emotional regulation and academic performance (Ginsburg & Silverman, 2000).
4. Comprehensive Evaluation for Learning Disabilities: An educational assessment could clarify if Katie is experiencing specific learning disabilities, paving the way for tailored interventions at school.

Conclusion

Katie's challenges are multifaceted and require careful assessment to ensure appropriate diagnosis and intervention. While ADHD is a primary consideration, it is essential to examine other potential diagnoses that may be impacting her social and academic functioning. Utilizing structured assessments, gaining insights from teachers and parents, and offering comprehensive interventions will facilitate Katie's development. As stakeholders in her clinical care, our actions can ultimately guide Katie towards improved outcomes and a more fulfilling school experience.

References

1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth, & Families.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
3. Conners, C. K. (2008). Conners 3rd edition (Conners 3). Multi-Health Systems.
4. Ginsburg, G. S., & Silverman, W. K. (2000). Early intervention for anxiety disorders in youth: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 68(6), 988-996.
5. Reynolds, C. R., & Kamphaus, R. W. (2004). BASC-2 Behavioral Assessment System for Children-Second Edition. Pearson.
6. Sugai, G., & Simonsen, B. (2012). Response to intervention in primary schools: A research-based model. Preventing School Failure: Alternative Education for Children and Youth, 56(2), 60-66.
7. DuPaul, G. J., & Stoner, G. (2014). ADHD in the schools: Assessment and intervention strategies (3rd ed.). Routledge.
8. Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
9. American Academy of Pediatrics. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20193438.
10. Faraone, S. V., & Biederman, J. (1998). Sustained attention deficit hyperactivity disorder (ADHD) and the association with reading disability: a review of the evidence. Journal of Learning Disabilities, 31(4), 315-323.