NRNP – 6665 Week 8: Neurodevelopmental Disorders Example
Subjective:
CC (chief complaint): “My boss has accelerated job deadlines, which puts a lot of pressure on me, and makes me feel like I can’t concentrate.” The patient reports
HPI:
Mr. Harold Brown, a 60-year-old male patient, comes to the psychiatric clinic for an evaluation after his boss recommends that he visit a psychiatrist. He reports having difficulties focusing at work. He recently reported making silly mistakes while working on his architectural projects. For example, he was tasked to build air ducts, but he did so through a solid wall, a firewall, and a supporting wall, and he claims not even to realize what he was doing. Another time, he was tasked with drawing window openings, and he drew them much too small. He claims that the difficulty with concentration began when they were forced to work under ridiculously tight deadlines. He did not have similar difficulties before when he was relaxed and on a flexible schedule.
He reports having had similar difficulties in school. During exams, when people would cram in the library, he would have trouble maintaining sustained concentration while reading. He would be easily distracted by what was going on outside the windows, such as the snow. If anyone whispered next to him, he would go to another side of the library, reporting being easily distracted by the whispers. At work, the patient and all the other architects and engineers get daily lectures from the chief of the department on the mission of the day. He admits having difficulty concentrating during the lectures since he continues thinking about his dog, lunch, and other things.
He also reports failing to finish his duties. Recently, when designing the gutters for a penthouse, his attention was instantly attracted to the Italian tile floor slanted the wrong way, and he abandoned the gutter task to examine how to rectify the misaligned floor tiles. He also claims to have trouble arranging duties and activities at school and home. “At home, I lose my shoes, socks, phone, and jacket, and I can’t locate them,” he says. One of his employees suggested that he maintain a calendar and mark key dates and events on it, but he seldom looks at it and considers it a waste of time. He also describes being hyperactive and being a bit uncomfortable on a chair. His recent trouble concentrating and low productivity at work led his employer to schedule a psychiatric assessment for him.
Past Psychiatric History:
- General Statement: despite glaring difficulties with concentration which began while in school, this is the first time the patient is seeking a psychiatric assessment
- Caregivers (if applicable): None
- Hospitalizations: No history of previous hospitalization due to medical or surgical illnesses
- Medication trials: No previous medication trials
- Psychotherapy or Previous Psychiatric Diagnosis: No previous psychotherapy. There have been no past psychiatric diagnoses; nonetheless, he states that his mother felt he had a problem and often threatened to send him for psychiatric examination, which never occurred.
Substance Current Use and History: He takes a little coffee now and again to help him focus. On weekends, he enjoys one scotch drink with a cigar.
Family Psychiatric/Substance Use History: He dates casually, never married, no children. He has one younger brother. No substance use disorders in the family.
Psychosocial History: He was raised by his mother. He has one younger sibling (brother). He now lives alone, dates casually and has never married, and has no children. He is an engineer with a bachelor’s degree. He works as an engineer for a prominent architectural engineering firm. He has never had a legal problem.
Medical History:
He has a history of hypertension, angina, hypertriglyceridemia, and benign prostatic hyperplasia (BPH).
- Current Medications:
- Cozaar 100mg daily for hypertension
- ASA 81mg PO daily and Valsartan 80mg daily for angina
- Fenofibrate 160mg daily for hypertriglyceridemia
- Tamsulosin 0.4mg PO at bedtime for BPH
- Allergies: Dilaudid
- Reproductive Hx: Heterosexual
ROS:
- GENERAL: Reports hotness of body. Denies hills, weight loss, weakness, or fatigue
- HEENT: Head: denies head trauma. Eyes: Denies visual loss, blurred vision, or double vision. Ears: Denies loss of hearing, pain, or discharge. Nose: Denies nasal congestion, loss of smell, runny nose, and sneezing. Throat: Denies sore throat
- SKIN: Denies rashes, or itching
- CARDIOVASCULAR: Denies palpitations, chest pain, orthopnea, paroxysmal nocturnal dyspnea (PND), or lower limb edema
- RESPIRATORY: Denies dyspnea, coughs, or sputum
- GASTROINTESTINAL: Denies nausea and/or vomiting, diarrhea, constipation, abdominal tenderness, or swelling
- GENITOURINARY: Denies dysuria, frequency, hesitancy, color changes, or odor
- NEUROLOGICAL: Denies headache, dizziness, syncope, paralysis, gait disturbances, numbness, or tingling sensations.
- MUSCULOSKELETAL: Denies joint pains, swelling, stiffness, or limb deformity
- HEMATOLOGIC: Denies bleeding diathesis, easy bruising, anemia, or jaundice
- LYMPHATICS: Denies lymphadenopathies
- ENDOCRINOLOGIC: Denies polyuria, polydipsia, polyphagia, heat or cold intolerance, or excessive sweating
Objective:
Physical exam:
He is in a general fair condition but febrile, with no obvious respiratory distress. He does not have any pallor, jaundice, cyanosis, lymphadenopathy, or edema. His vital signs are as follows:
T- 98.8 F
P- 74 beats/minute
RR 18 breaths/minute
BP 134/70 mm Hg
Ht 5’10
Wt 170lbs
Neurologic: GCS 15/15. Oriented to time, person and place. He has intact memory. Sensory and motor systems are intact
Cardiovascular: S1 and S2 sounds were heard, with no additional sounds. Apex heard at the 5th intercostal space, mid-clavicular line.
Respiratory: Lungs are bilaterally clear to auscultation
Diagnostic results:
Montreal Cognitive Assessment (MOCA): 28/30 difficulty with attention and delayed recall
Adult ADHD Self-Report Scale for DSM-5 (ASRS): 21/24
Assessment:
Mental Status Examination:
A 60-year-old male patient looking his age walks into the clinic. He is well-groomed, has a slim physique, and is quite uncomfortable remaining seated on the chair as he continues to stand and gaze out the window. He makes no eye contact with the examiner, does not listen when spoken to directly, and continues to blurt out answers even before the questions are completed. His speech is fast-paced, loud, and hyper-talkative, and he loses the spontaneity of the conversation by jumping from one topic to the next. When asked about his mood, he says, “I’m sad because I can’t concentrate.” His affect is sad, which is appropriate considering his sad mood. His thought content is preoccupied with feeding his dog and deciding what to eat for lunch, whereas his thought process is positive for a flight of ideas, jumping from one topic to the next. He has no abnormalities in his perception. His memory is intact, and he is oriented to time, person, and place. His abstract, judgment, and insight are all intact, and he admits to having a problem that requires assistance.
Differential Diagnoses:
Primary Diagnosis: Adult ADHD
Adult ADHD is diagnosed using the DSM-5 criteria, which include inattention and hyperactivity-impulsivity as critical features. To establish the diagnosis in persons 17 years and older, at least five symptoms of inattention or at least five symptoms of hyperactivity-impulsivity must be present in criteria A and B, respectively (APA, 2022; Salvi et al., 2019). In several ways, the 60-year-old patient displays inattention or trouble focusing.
He makes careless mistakes at work, such as drawing window openings much smaller, he fails to complete his tasks, such as jumping to examine how to fix the Italian tiled floor before finishing the gutters, he does not maintain sustained attention during lectures at work, and while in school could not sustain concentration in the library; he reports that he could easily be distracted by extraneous stimuli, such as whispers or snow outside the windows, and finally, he has trouble arranging his belongings and often misplaces his shoes, phones, and socks at home. Furthermore, he has hyperactivity-he reports that he is quite uncomfortable on the chair and always wants to move about freely.
In criterion B, the symptoms of inattentiveness or hyperactive-impulsivity must have been apparent before the age of 12. The patient had inattentive symptoms while in school, but the age at which they began is unknown. Furthermore, the symptoms must have shown in more than two places (criterion C), as Harold did at school, home, and work., and they must cause considerable social, occupational, and academic dysfunction, as evidenced in the patient who had problems at school and now at work.
On MSE, he feels uneasy sitting in the chair and prefers to stand and look out the window. When talked to directly, he does not listen and blurts out replies even before the inquiry is finished. Furthermore, he is hyper-talkative and babbles, is preoccupied with thoughts of feeding his dog and determining what to eat for lunch, and displays a flight of ideas. His symptoms of inattention-hyperactivity, suggestive MSE findings, MOCA of 28/30 30 with problems in attention and delayed memory, and ASRS5 of 21/24, which suggests a likely ADHD, all support the diagnosis of ADHD.
Autism spectrum disorder: Individuals suffering from ADHD or autism spectrum disorder may demonstrate inattention, social dysfunction, and difficult-to-control behaviors (Antshel & Russo, 2019; Hayes et al., 2018). However, social dysfunction in autism spectrum disorder is caused by difficulties in social communication and social interaction, as indicated by a lack of social-emotional reciprocity and deficits in nonverbal communication behaviors that are not present in the patient, ruling out the diagnosis.
Alzheimer’s: Individuals suffering from Alzheimer’s disease have cognitive deficits in areas such as complex attention, executive function, and social cognition (Knopman et al., 2021). Harold Brown’s inattention is caused by ADHD rather than cognitive impairment, ruling out Alzheimer’s disease.
Reflections:
This case has helped me better understand ADHD, especially in adults, and how to utilize the DSM-5 and other assessment instruments, such as the MOCA and the ASRS5 to validate ADHD diagnosis. In terms of ethics, elderly psychiatric patients need to be treated with the greatest justice, taking into consideration their mental health requirements, financial status, and social support. Furthermore, Mr. Harold’s psychiatric treatments must be tailored in such a way that they are beneficial (beneficence), do not cause harm (non-maleficence), and do not violate the patient’s autonomy.
In terms of social determinants of health, the patient, based on his medical history, has little social support since he has never married and has just one brother. As a result, when he is discharged from the mental clinic, the lack of adequate social support may signify a poor prognosis (Wang et al., 2018). He is employed as an engineer at an architectural firm and consequently can afford to access mental care services. In addition to his psychiatric comorbidity, his chronic medical illnesses are expensive in the long term, and he may need health insurance to assist him access and utilizing healthcare services.
References
American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787.x17_neurocognitive_disorders
Antshel, K. M., & Russo, N. (2019). Autism spectrum disorders and ADHD: Overlapping phenomenology, diagnostic issues, and treatment considerations. Current Psychiatry Reports, 21(5), 34. https://doi.org/10.1007/s11920-019-1020-5
Hayes, J., Ford, T., Rafeeque, H., & Russell, G. (2018). Clinical practice guidelines for the diagnosis of autism spectrum disorder in adults and children in the UK: a narrative review. BMC Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1800-1
Knopman, D. S., Amieva, H., Petersen, R. C., Chételat, G., Holtzman, D. M., Hyman, B. T., Nixon, R. A., & Jones, D. T. (2021). Alzheimer disease. Nature Reviews. Disease Primers, 7(1), 33. https://doi.org/10.1038/s41572-021-00269-y
Salvi, V., Migliarese, G., Venturi, V., Rossi, F., Torriero, S., Viganò, V., Cerveri, G., & Mencacci, C. (2019). ADHD in adults: clinical subtypes and associated characteristics. Rivista Di Psichiatria, 54(2), 84–89. https://doi.org/10.1708/3142.31249
Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018). Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1736-5
NRNP – 6665 Week 8: Neurodevelopmental Disorders Instructions
I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She doesn’t care about me. She only cares about my little brother and that man that keeps coming around. I don’t care about her. That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.
—Jacob, age 11
ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS
There are many mental disorders that occur early in the life course. The DSM-5 describes neurodevelopmental disorders such as intellectual disability and delay, autism spectrum disorder, language and speech disorders, ADHD and specific learning disorder (e.g., dyslexia, difficulty mastering mathematical reasoning). Diagnosis of these various conditions can rarely be made in a single office visit and often requires a comprehensive approach involving multiple stakeholders, including the child, his or her parents, teachers, other significant figures in the child’s life, and medical and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.
The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent.
This week, you begin exploring disorders that occur early in the life course and use this knowledge to create a study guide for a neurodevelopmental disorder.
Learning Objectives
Students will:
- Analyze signs and symptoms of neurodevelopmental disorders
- Analyze the pathophysiology of neurodevelopmental disorders
- Analyze diagnosis and treatment methods for neurodevelopmental disorders
- Summarize legal, ethical, and patient education factors related to neurodevelopmental disorders
Learning Resources
Required Readings (click to expand/reduce)
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
- Chapter 51, “Autism Spectrum Disorder”
- Chapter 55, “ADHD and Hyperkinetic Disorder”
Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
- Chapter 13, “Child/Adolescent Neurodevelopmental Disorders”
Required Media (click to expand/reduce)
Medication Review
| Irritability in autism | Attention-deficit/hyperactivity disorder |
| aripiprazole risperidone |
amphetamine IR, XR, and ER dextroamphetamine atomoxetineclonidine hydrocholoride ER Dexmethylphenidate IR and XR guanfacine hydrocholride ER lisdexamfetamine methylphenidate methylphenidate hydrocholoride IR and ER, transdermal |
Assignment: Study Guide Forum
Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.
For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.
Photo Credit: Getty Images/iStockphoto
To Prepare
- Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5.
- Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.
The Assignment
Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.
Areas of importance you should address, but are not limited to, are:
- Signs and symptoms according to the DSM-5
- Differential diagnoses
- Incidence
- Development and course
- Prognosis
- Considerations related to culture, gender, age
- Pharmacological treatments, including any side effects
- Nonpharmacological treatments
- Diagnostics and labs
- Comorbidities
- Legal and ethical considerations
- Pertinent patient education considerations
By Day 7 of Week 8
Submit your Assignment to the forum as an attachment. Although no responses are required, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.
Week 8: Neurodevelopmental Disorders
Week 8: At a Glance
INTRODUCTION
I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She doesn’t care about me. She only cares about my little brother and that man that keeps coming around. I don’t care about her. That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.
—Jacob, age 11
There are many mental disorders that occur early in the life course. The DSM-5-TR described neurodevelopmental disorders such as intellectual disability and delay, autism spectrum disorder, language, speech and communication disorders, ADHD, motor disorders, developmental coordination disorder, stereotypic movement disorder, tic disorder, and specific learning disorders (e.g., dyslexia, difficulty mastering mathematical reasoning) . Diagnosis of these various conditions can rarely be made in a single office visit and often requires a comprehensive approach involving multiple stakeholders, including the child, his or her parents, teachers, other significant figures in the child’s life, and medical and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.
The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent.
This week, you begin exploring disorders that occur early in the life course and use this knowledge to create a study guide for a neurodevelopmental disorder.
LEARNING OBJECTIVES
Students will:
- Analyze signs and symptoms of neurodevelopmental disorders
- Analyze the pathophysiology of neurodevelopmental disorders
- Analyze diagnosis and treatment methods for neurodevelopmental disorders
- Summarize legal, ethical, and patient education factors related to neurodevelopmental disorders
Week 8: Learning Resources
LEARNING RESOURCES
Required Readings
- Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental healthLinks to an external site.. American Psychiatric Association Publishing.
- Chapter 12, “Developmental Milestones”Links to an external site.
- Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry(6th ed.). Wiley Blackwell.
- Chapter 51, “Autism Spectrum Disorder”
- Chapter 55, “ADHD and Hyperkinetic Disorder”
- Utah State University. (n.d.). Creating study guidesLinks to an external site.. https://www.usu.edu/academic-support/test/creating_study_guidesLinks to an external site.
- Walden University. (2020). Success strategies: Self-paced interactive tutorialsLinks to an external site.. https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategiesLinks to an external site.
- Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
- Chapter 13, “Child/Adolescent Neurodevelopmental Disorders”
Required Media
- Dillon, K. (2019, March 23). DSM-5neurodevelopmental disordersLinks to an external site.. [Video]. YouTube. https://www.youtube.com/watch?v=Jx4GuyX5SgcLinks to an external site.
- The National Center for Learning Disabilities. (2013, February 20). What is ADHD?Links to an external site.[Video]. YouTube. https://youtu.be/0Wz7LdLFJVMLinks to an external site.
- (2017, October 17). Autism – causes, symptoms, diagnosis, treatment, pathologyLinks to an external site.[Video]. YouTube. https://youtu.be/x2hWVgZ8J4A
Medication Review
| Irritability in autism | Attention-deficit/hyperactivity disorder |
| aripiprazole risperidone |
amphetamine IR, XR, and ER dextroamphetamine atomoxetineclonidine hydrocholoride ER Dexmethylphenidate IR and XR guanfacine hydrocholride ER lisdexamfetamine methylphenidate methylphenidate hydrocholoride IR and ER, transdermal |
Week 8: Assignment
STUDY GUIDE FORUM
Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.
For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
TO PREPARE
- Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5-TR.
- Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.
THE ASSIGNMENT
Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5-TR but also supported by at least three other scholarly resources.
Areas of importance you should address, but are not limited to, are:
- Signs and symptoms according to the DSM-5-TR
- Differential diagnoses
- Incidence
- Development and course
- Prognosis
- Considerations related to culture, gender, age
- Pharmacological treatments, including any side effects
- Nonpharmacological treatments
- Diagnostics and labs
- Comorbidities
- Legal and ethical considerations
- Pertinent patient education considerations
BY DAY 7 OF WEEK 8
You will need to submit your Assignment to two places: the Week 8 Study Guide discussion forum as an attachment and the Week 8 Assignment submission link. Although no responses are required in the discussion forum, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.
Access the Study Guide Forum (or click the Next button).
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK8Assgn+last name+first initial.
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
NRNP_6665_Week8_Assignment_Rubric
| NRNP_6665_Week8_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeCreate a study guide, in outline form with references, for your assigned disorder. Incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. |
|
30 pts | ||||
| This criterion is linked to a Learning OutcomeContent areas of importance you should address, but are not limited to, are:• Signs and symptoms according to the DSM-5-TR• Differential diagnoses• Incidence• Development and course• Prognosis• Considerations related to culture, gender, age• Pharmacological treatments, including any side effects• Nonpharmacological treatments• Diagnostics and labs• Comorbidities• Legal and ethical considerations• Pertinent patient education considerations |
|
50 pts | ||||
| This criterion is linked to a Learning OutcomeSupport your guide with references to the DSM-5-TR and at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines. Be sure they are current (no more than 5 years old). |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The guide follows correct APA format for parenthetical/narrative in-text citations and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||