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.
Write a 2-3 page paper 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?
Expert Solution Preview
Introduction:
The case presented involves a 6-year-old girl named Ellie who is suspected of having an ear infection and behavioral issues. The healthcare practitioner suspects that Ellie may have autism and possibly some ADHD diagnosis criteria. In this paper, we will answer questions related to autism and ADHD diagnostic criteria, how to approach examining Ellie as a child and strive to gain her trust, how to ensure our suspicions of autism are correct and how to refer Ellie to the local autism team, and finally, how to differentiate autism from ADHD based on diagnostic criteria.
1. Discuss autism and ADHD diagnostic criteria:
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction across multiple contexts, as well as restricted, repetitive patterns of behaviors, interests, or activities. ADHD, on the other hand, is a disorder characterized by symptoms of inattention, hyperactivity, and impulsivity that interfere with daily functioning. The diagnostic criteria for autism and ADHD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 criteria for autism include deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. The DSM-5 criteria for ADHD include symptoms of inattention and/or hyperactivity-impulsivity that interfere with daily functioning and have been present for at least six months.
2. How should you approach examining Ellie as a child and strive to gain her trust?
To approach examining Ellie, the healthcare practitioner should take a child-friendly approach. It is essential to use non-threatening language, provide clear and concise information, and be patient in answering her questions. The practitioner should also strive to gain Ellie’s trust by establishing a rapport with her and her mother. The healthcare practitioner can use visual aids to explain the procedures and show Ellie what he/she will be doing. Additionally, the healthcare practitioner can offer age-appropriate distractions, such as toys or music, to help Ellie feel more comfortable during the exam.
3. 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?
To ensure that our suspicions of autism are correct, we should refer Ellie to a local autism team for an evaluation. The autism team can conduct a comprehensive evaluation, including developmental, cognitive, and behavioral assessments. During evaluation, her history, current functioning, and symptoms will be observed, and a diagnosis of autism or any other developmental disorder can be made. Referral can be made to the autism team via a phone call, email, or a referral letter.
4. Ellie is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?
Differentiating autism from ADHD requires a comprehensive evaluation, including developmental, cognitive, and behavioral assessments. The key difference between autism and ADHD is the presence of social communication and social interaction deficits, which is a hallmark feature of autism. Individuals with ADHD may have difficulties with social interactions due to hyperactivity, impulsivity, or inattention, but these difficulties are not the primary concern. However, those with ASD typically exhibit deficits in social communication and social interaction, as well as restricted, repetitive behaviors, interests, or activities.
