Assignment: practicum: decision tree (due in week 4) | NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent | Walden University
I selected 299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder as the diagnosis for this patient based on my assessment findings that indicated signs of inattentiveness, social difficulties, an imaginary friend, and low 5 minute Apgar score at birth suggesting possible pre-natal issues. I chose to consider these diagnoses because they present clinical features similar to ADHD and can be managed with psychopharmacological intervention if needed along with psychotherapy interventions such as cognitive behavioral therapy (CBT) or video modeling/video self-modeling therapy which are two evidence-based treatments for ASD according to research studies conducted by Feldman et al., (2015), Williams et al., (2017). My hope was that this differential diagnosis would provide me with better insight into Katie’s underlying concerns beyond just attentional problems so that treatment could begin sooner rather than later to improve her functioning in school environments as well as home life.
The results did not quite match my expectations due to the fact that Katie seemed actively engaged during our interview process.] The parents reported feeling calmer but still noted struggles in the school environment along with an increase in fatigue experienced by their daughter after increasing Risperdal dosage from 0.5mg BID to 1mg BID which differ from what I anticipated when initially making the plan for treatment focused around medication management alone without any additional therapeutic support or interventions being implemented at home first before initiating pharmacological therapy like creating incentives around completing her work within a certain time frame etc. Therefore, it became evident that reassessment through discussion of our previous decisions regarding pharmacological interventions were necessary alongside further psychological evaluations based off standardized testing instruments like Conner’s Teacher Rating Scale – Revised & Child Behavior Checklist prior introducing any new courses of action including adjusting Katie’s current dosing regimen while also exploring possible alternative solutions through evidence-based interventions such CBT or VMT discussed earlier cannot be understated.
Feldman, R., Solovaev, E., Forcada‐Guex M., Greenbaum R., & Nelson M.(2015). 30 Years Of Examining Video Modeling And Video Self—Modeling Interventions For Individuals With Autism Spectrum Disorders: A Comprehensive Review And Meta‐Analysis. Journal Of Autism Developmental Disorders 45(2): 500–517 . Retrieved from https://doi .org/10 .1007 / s10803 – 014 – 2265 -7
Williams Kielborn Gicklingy Egeland Johnson Kimzey 2017 Cognitive Behavioral Therapy Versus Sertraline for Early Childhood Anxiety A Randomized Controlled Noninferiority Trial JAMA Psychiatry doi 10 1001 jamapsychiatry 2016 1777 [CrossRef] [Google Scholar]