1. Assgn 2 – WK4 (C)
Practicum: Decision TreeFor this Assignment, you examine the
client case study in this week’s Learning Resources. Consider how you might assess and
treat pediatric clients presenting with symptoms noted in the case.Note: For these
assignments, you will be required to make decisions about how to assess and treat clients.
Each of your decisions will have a consequence. Some consequences will be insignificant,
and others may be life altering. You are not expected to make the “right” decision every
time; in fact, some scenarios may not have a “right” decision. You are, however, expected to
learn from each decision you make and demonstrate the ability to weigh risks versus
benefits to prescribe appropriate treatments for clients. The
Assignment:Examine Case 1. You will be asked to make three decisions concerning the
diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as
mental factors that might impact the client’s diagnosis and treatment. (N: B. A CASE STUDY
WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)At each Decision Point,
stop to complete the following: · Decision #1: Differential Diagnosiso Which
Decision did you select?o Why did you select this Decision? Support your response with
evidence and references to the Learning Resources.o What were you hoping to achieve by
making this Decision? Support your response with evidence and references to the Learning
Resources.o Explain any difference between what you expected to achieve with Decision #1
and the results of the Decision. Why were they different? · Decision #2:
Treatment Plan for Psychotherapyo Why did you select this Decision? Support your
response with evidence and references to the Learning Resources.o What were you hoping
to achieve by making this Decision? Support your response with evidence and references to
the Learning Resources.o Explain any difference between what you expected to achieve
with Decision #2 and the results of the Decision. Why were they different? ·
Decision #3: Treatment Plan for Psychopharmacologyo Why did you select this Decision?
Support your response with evidence and references to the Learning Resources.o What
were you hoping to achieve by making this Decision? Support your response with evidence
and references to the Learning Resources.o Explain any difference between what you
expected to achieve with Decision #3 and the results of the decision. Why were they
different?· Also include how ethical considerations might impact your treatment plan and
communication with clients and their families.Note: Support your rationale with a minimum
of three academic resources. While you may use the course text to support your rationale, it
will not count toward the resource requirement. Case #1A

2. young girl with difficulties in
school BACKGROUNDIn 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 ADHD”. 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 ScaleThe parents give the PMHNP a copy of a form titled “Conner’s
Teacher Rating Scale-Revised” (Available at:
http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf). 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. SUBJECTIVEYou 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 “OK”- her favorite subjects are “art” and “recess.” She states that
she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”.
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

3. EXAMThe 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 OneBASED 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 Disorder315.0 Specific Learning Disorder with
Impairment in Reading and 315.1 Impairment in Mathematics314.00 Attention Deficit
Hyperactivity Disorder, predominantly inattentive presentationANSWER CHOOSEN:
Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation 314.00
Attention Deficit Hyperactivity Disorder, predominantly inattentive
presentation RESULTS OF DECISION POINT ONE· Client returns to
clinic in four weeks· You selected Attention deficit hyperactivity disorder, predominantly
inattentive presentation. Based on this choice, outline the remainder of the diagnostic
evaluation that you will conduct on this child and their parents. Be sure to include
standardized assessment instruments that you would
administer · Decision Point Two· BASED ON THE ABOVE
INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE
FOR YOUR DECISION. · Wellbutrin 75 mg orally daily· · Strattera 25 mg orally daily· ·
Adderall XR 10 mg orally dailyANSWER CHOOSEN: Adderall XR 10 mg orally
daily RESULTS OF DECISION POINT TWO· Client returns to clinic in
four weeks· Katie’s parents seem absolutely delighted upon their return stating that Katie
is paying more attention in school, but note that there is still room for improvement,
particularly in the afternoon· They report that Katie’s teacher has reported that Katie is
able to maintain her attention throughout the morning classes but come afternoon, she
“daydreams.”· Katie’s parents are also concerned about her decrease in appetite since
starting the medication. Decision Point ThreeBASED ON THE
ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE
RATIONALE FOR YOUR DECISION. Katie’s parents that weight loss is common with
stimulant medications used to treat ADHD medication with family thearpy a small dose
of immediate release Adderall in the early afternoonANSWER CHOOSEN: Add a small dose
of immediate release Adderall in the early
afternoon Guidance to StudentWhereas weight loss is common with
stimulant medication, this option does not address Katie’s parents’ concerns about the
return of symptoms in the afternoon.Augmentation with family therapy is also a good idea
as it can help Katie with her symptoms and further help her parents to understand the
unique challenges that Katie experiences, as well as ways that they can help her with
symptoms, however, this option does not address the return of inattentive symptoms in the

4. afternoon.Adding a small dose of immediate relate Adderall in the afternoon can help Katie
to maintain attention throughout the afternoon and into the early evening when she must
do homework. This would be the best option. Learning
ResourcesRequired ReadingsSadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s
synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA:
Wolters Kluwer.Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–
150)Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)American Psychiatric
Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.“Neurodevelopmental Disorders”o “Intellectual Disabilities”o
“Communication Disorders”“Disruptive, Impulse-Control, and Conduct Disorders”Volkmar,
F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice
parameter for the assessment and treatment of children and adolescents with autism
spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry,
53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-
8/pdf Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th
ed.). New York, NY: Cambridge University Press. Required
MediaLaureate Education (Producer). (2017b). A young girl with difficulties in school
[Multimedia file]. Baltimore, MD: Author. (SEE THE ATTACHED CASE STUDY SAMPLE WITH
ANSWER) Optional ResourcesThapar, A., Pine, D. S., Leckman, J. F.,
Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th
ed.). Hoboken, NJ: Wiley Blackwell. Chapter 51, “Autism Spectrum Disorder” (pp. 665–
682)