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ADHD case study
Case study:
You are working in a community health center as a NP. Although you see children for mental health, you will also see children for some basic “bridge” care until primary care providers have openings. If the medical issue is complex then the clinic coordinator will escalate the referral for quicker appointment scheduling.
Presentation Ellie, who is 6-years old, has come to the clinic with a suspected ear infection and as referral for her daughter's behaviors. Ellie’s mother says that her daughter has been rocking rhythmically and clutching her ear at the same time. There has been some moisture on her pillow in the morning and Ellie is reluctant to let her mother investigate what is wrong.
Ellie is attempting to rock while she is seated on her mother’s knee and uses the same repetitive vocalization, “Don’t wanna go to the shops” over and over again.
She has a history of speech delay but can now complete many full sentences. She has also had some behavior and attention issues in school. She disrupts the teacher often and then gets up from her seat during focus time to go to play centers. She is not easily redirected and becomes argumentative.
She feels hot to touch and will not let healthcare practitioners approach her with any equipment. Her vocalization becomes louder and more insistent when you attempt examination.
Recognizing possible autism as well as some ADHD diagnosis criteria discuss next steps in the answers to the questions.
Discuss in 2-3 pages answering the following questions. Be sure to include a minimum of two scholarly articles to support your discussion.
Discuss autism and ADHD diagnostic criteria. How should you approach examining Ellie as a child, and strive to gain her trust? You suspect that autism may be a possibility. What should you do to ensure that your suspicions are correct and how should you go about referring Ellie to the local autism team? Ellie is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?
Full Answer Section
Restricted, repetitive patterns of behavior, interests, or activities: Insistence on sameness, repetitive movements, or a strong preoccupation with specific topics.
Symptoms present from early childhood.
Attention-Deficit/Hyperactivity Disorder (ADHD):
Patterns of inattention:
Difficulty sustaining attention, easily distracted, and forgetful.
Hyperactivity and impulsivity: Excessive fidgeting, restlessness, talking excessively, or interrupting others.
Symptoms present in multiple settings.
Approaching Ellie for Examination
Given Ellie's reluctance to be examined, it is essential to approach her with patience, understanding, and respect. Here are some strategies:
Establish Rapport: Build a rapport with Ellie by engaging in age-appropriate activities or conversations.
Observe Behavior: Observe Ellie's behavior in various settings to gain a better understanding of her symptoms.
Involve Parents: Collaborate with Ellie's parents to gather information about her developmental history and current behaviors.
Use Distractions: Employ techniques like playing a game or singing a song to distract Ellie during the examination.
Suspected Autism: Next Steps
To confirm the suspicion of autism, refer Ellie to a multidisciplinary team that specializes in autism evaluation. The team may include a developmental pediatrician, psychologist, speech-language pathologist, and occupational therapist.
Differentiating Autism from ADHD
While autism and ADHD can share some symptoms, there are key differences:
Social Communication: Autism is characterized by persistent deficits in social communication and interaction, whereas ADHD primarily affects attention and impulsivity.
Repetitive Behaviors: Individuals with autism often exhibit restricted, repetitive patterns of behavior, interests, or activities, which are less common in ADHD.
Early Onset: Autism is typically diagnosed early in childhood, while ADHD may not be diagnosed until later.
Conclusion
Ellie's presentation suggests a possible diagnosis of autism, with overlapping symptoms of ADHD. A comprehensive evaluation by a multidisciplinary team is necessary to confirm the diagnosis and develop an appropriate treatment plan. By understanding the diagnostic criteria for both conditions and using a patient-centered approach, healthcare providers can effectively assess and support children like Ellie.
Sample Answer
Understanding Autism and ADHD Diagnostic Criteria
Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are both neurodevelopmental disorders that can present with similar symptoms, making differentiation challenging.
Autism Spectrum Disorder (ASD):
Persistent deficits in social communication and interaction: Difficulties in initiating and maintaining relationships, understanding social cues, and engaging in reciprocal conversations.