NRNP 6635 Week 10 Assignment Neurodevelopmental Disorders
The human brain only constitutes approximately 2% of an individual’s total body weight, a percentage that pales in comparison to the brain’s level of importance in human development (Koch, 2016). Although externally protected by layers of membranes as well as the skull, the brain is not very resistant to damage. Damage to the brain may compromise its functionality, which may, in turn, lead to neurodevelopmental disorders in childhood and adolescence or neurocognitive disorders for any number of reasons across the lifespan.
This week, you practice assessing and diagnosing neurocognitive and neurodevelopmental disorders across the lifespan.
Reference: Koch, C. (2016, January 1). Does brain size matter? Scientific American. https://www.scientificamerican.com/article/does-brain-size-matter1/
Learning Objectives Students will:
- Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
- Formulate differential diagnoses using DSM-5 criteria for patients with neurocognitive and neurodevelopmental disorders across the lifespan
- American Psychiatric Association. (2013). Neurocognitive disorders. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 591–644). Author.
- American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01
- Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
- Chapter 21, Neurocognitive Disorders
- Chapter 31, Child Psychiatry
- Document: Comprehensive Psychiatric Evaluation Template
- Document: Comprehensive Psychiatric Evaluation Exemplar
Assignment: Assessing And Diagnosing Patients With Neurocognitive And Neurodevelopmental Disorders
Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2013). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities.
Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such as brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.
For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.
- Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.
- Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
- By Day 1 of this week, select a specific video case study to use for this
Assignment from the Video Case Selections choices in the Learning Resources.
View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
- Identify at least three possible differential diagnoses for the patient.
By Day 7 Of Week 10
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
- Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
- Objective: What observations did you make during the psychiatric assessment?
- Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
- Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Week 10: Neurocognitive and Neurodevelopmental Disorders Sample Paper
Neurodevelopmental disorders are conditions that lead to impaired growth and development of the brain or central nervous system in general. Neurodevelopmental disorders commonly impact an individual’s emotions, learning ability, self-control and memory. These conditions are commonly evident during an individual’s growth and development (Stein et al., 2020). Some of the commonly observed neurodevelopment disorders include attention-deficit hyperactivity disorder (ADHD), autism, learning disabilities, cerebral palsy, conduct disorder etc. In this paper, I shall analyse a psychiatric case, come up with the most likely diagnoses and recommend adequate treatment and management.
Sarah Higgins is a nine-year old female who presented with difficulty in maintaining concentration while at school. Sarah had difficulty remembering the assignments she was given at school. The patient also had difficulty in sitting still for long durations of time and she was constantly fidgeting. She also had difficulty in retaining concentration and had an impaired memory, constantly misplacing her items and forgetting where she placed them.
History of Presenting Illness.
Her mother, who is the informant in this case, says that Sarah’s forgetfulness has been going on for a while to the point where Sarah’s teachers have to leave her a list of the assignments handed out each day. The mother also points out Sarah’s inability to sit still saying that the interview was the longest duration she had ever managed to sit still. Sarah’s mother also points out some dangerous behaviours that Sarah had portrayed when she was younger; jumping into a pool before she could learn how to swim and sticking out her hands into the animal cages every time they went to the zoo.
Past Psychiatric History: Sarah has no previous psychiatric history and is currently not being treated for any psychiatric illness. She has no known history of alcohol, tobacco or drug and substance use.
Development History: She achieved her developmental milestones at the appropriate time and her vaccinations are up to date. She sleeps for the recommended hours each day. She, however, has difficulty sitting down for meals and does not get the recommended nutrition as per the preventive control plan.
Family History: There are no known chronic or psychiatric illnesses among her family members.
Allergies: She has no known drug and food allergies.
ROS: No significant findings were observed on her review of systems.
On examination, Sarah was found to weigh 63 pounds with a height of 4’5. Her temperature was 97.4 with her pulse rate recorded at 62 beats per minute. Her respiratory rate reading was 14 breaths per minute with a blood pressure reading of 95/60. Sarah reports that she sleeps for approximately nine hours each night.
Mental Status Examination.
Sarah is polite and well-behaved for her age. She is willing and co-operative with the interviewer and they easily establish a good rapport with the interviewer. This is shown by the fact that Sarah gives permission for the interviewer to proceed and readily and willingly answers the questions that she is asked.
Sarah is easily distracted and easily loses concentration during the interview. This is observed when she is asked a question by the interviewer on two occasions and she seems distracted. On one occasion, her mother tells her to answer the question that she is asked. On another instance, the interviewer is forced to repeat his question since Sarah was distracted and did not hear the question that she was asked. It is evident that Sarah has a reduced attention span.
From the interview, Sarah answers most of the questions that she is asked with one-word answers. At the start of the interview, her mother urges her to use full words when answering the questions that she is asked. She also seems quite indecisive as she answers the questions asked and is a bit hesitant in responding to some of the issues posed by the interviewer. Sarah also has an impaired memory and is easily distracted.
One of the key diagnostic features in neurodevelopment disorders is a physical examination. It is critical to assess all the systems including the cardiovascular system, respiratory system, gastrointestinal system, genitourinary system and the central nervous system (Myers et al., 2017). This assessment helps in ruling out any underlying medical conditions that may be resulting in the neurodevelopmental disorder observed. Physical exam findings reveal that the patient is not in any obvious respiratory distress and does not show any signs of anemia, clubbing, jaundice, dehydration, cyanosis or oedema.
Clinical observations are another critical component of formulating a diagnosis. Assessing the patient’s level of attention, behaviour, concentration, ability to maintain eye contact and interaction with other individuals is key in coming up with a diagnosis. Other important aspects such as the patient’s speech, articulation, mood and other higher functions are important in diagnosis formulation.
Developmental assessment is also key. A developmental assessment is carried out to establish the child’s level of functioning and reasoning in comparison to his or her peers. Interest is not only taken in what the child does, but how well they are able to perform a specific given task (Saito et al., 2020). Developmental assessments highlight a child’s motor functioning, speech, language and cognitive capabilities. This is critical in the determination of the presence of any neurodevelopmental disorders.
Assessment of a child’s growth is also critical in the establishment of any neurodevelopmental disorders. Looking at a child’s weight, height and head circumference and comparing to the expected range for that certain age group aids in establishing the presence or absence of most neurodevelopmental disorders. Most conditions associated with learning disabilities and developmental delays are commonly associated with abnormalities in the various growth parameters.
I would order a brain imaging test. Brain imaging is an important diagnostic tool in the establishment of neurodevelopmental disorders. Cranial ultrasounds, computed tomography scanning and magnetic resonance imaging have proven useful in neurodevelopmental disorders. These tests aid in identifying children with the highest risk of developing neurodevelopmental disorders, establishing diagnosis and prognosis of the various conditions and in so doing making it easier to manage neurodevelopmental disorders.
The differential diagnoses in this case include attention deficit hyperactivity disorder, learning disabilities and autism disorder.
The DSM-5 criteria for attention deficit disorder requires that there be five or more symptoms of inattention or hyperactivity that have been persistent for a duration of more than six months that negatively impact the social and academic functioning of the individual (Kemper et al., 2018). Some of the major symptoms observed include aggression, excitability, fidgeting, impulsivity, persistent repetition of words or actions, difficulty focusing, absent-mindedness, reduced attention span, among others.
DSM-5 criteria for learning disabilities requires the establishment of reduced intellectual ability, a significant decline in social and adaptive functioning and most commonly, childhood onset.
The criteria for autism require that there be an impaired social-emotional reciprocity, difficulty in establishing and maintaining relationships, repetitive motor functions, fixated interests among other symptoms (Dekhil et al., 2018).
Based on the evidence gathered from the interview, the most likely diagnosis is therefore ADHD. The patient clearly has a short attention span and is easily distracted, symptoms that according to Kemper et al. (2018), are key in the diagnosis of ADHD in children. The key pertinent positive findings include being too focused on certain tasks. We also learn that Sarah can play video games for extended durations of time.
Other positive pertinent findings include increased energy levels, being spontaneous and being creative and inventive. Pertinent negative findings include self-isolation, increased risk-taking tendencies and behaviours, inability to form and maintain lasting bonds and relationships and self-isolation.
From the interview, I have learnt that children are easily distracted during interviews, and it is almost impossible to engage them for long durations of time without them being distracted. I would employ the use of more stimulating techniques such as drawing or the use of building blocks to retain the child’s attention, reduce the probability of her being distracted while also assessing her level of performance regarding other children within her age bracket.
One of the key legal/ ethical considerations to consider is vulnerability. Vulnerability can be defined as the reduced ability of a human being to anticipate, cope with, resist and overcome the impacts and challenges posed by various situations in life (Haugom, Ruud, & Hynnekleiv, 2019). Taking into consideration that the patient is a nine-year-old child, she is easily predisposed and vulnerable to many challenges posed by her condition.
Other various key legal/ ethical considerations include conflict of interest, exploitation, operational challenges, misconceptions regarding therapeutics among others. Taking into consideration the patient’s age, the parents’ beliefs and socioeconomic status, various treatment and management options may fail to be undertaken in consideration to the various factors identified.
In conclusion, attention deficit hyperactivity disorder is a common chronic condition that commonly presents with difficulty in maintaining attention, hyperactivity and impulsiveness. The condition is commonly diagnosed during the early stages of life. Medication, therapy and collaborative engagement with other health care professionals is critical in the management of this conditions.
- Dekhil, O., Hajjdiab, H., Shalaby, A., Ali, M. T., Ayinde, B., Switala, A., Elshamekh, A., Ghazal, M., Keynton, R., Barnes, G., El-Baz, A. & Hampson, M. (2018). Using resting state functional MRI to build a personalized autism diagnosis system. PLOS ONE, 13(10), e0206351–. doi:10.1371/journal.pone.0206351
- Haugom, E. W., Ruud, T., & Hynnekleiv, T. (2019). Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals. BMC Health Services Research, 19(1), 1-12. https://doi.org/10.1186/s12913-019-4727-4
- Kemper, A. R., Maslow, G. R., Hill, S., Namdari, B., LaPointe, N. M. A., Goode, A. P., & Sanders, G. D. (2018). Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jan. (Comparative Effectiveness Reviews, No. 203.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK487761/
- Myers, L., Anderlid, B. M., Nordgren, A., Willfors, C., Kuja-Halkola, R., Tammimies, K., & Bölte, S. (2017). Minor physical anomalies in neurodevelopmental disorders: a twin study. Child And Adolescent Psychiatry And Mental Health, 11, 57. https://doi.org/10.1186/s13034-017-0195-y
- Saito, M., Hirota, T., Sakamoto, Y., Adachi, M., Takahashi, M., Osato-Kaneda, A., & Nakamura, K. (2020). Prevalence and cumulative incidence of autism spectrum disorders and the patterns of co-occurring neurodevelopmental disorders in a total population sample of 5-year-old children. Molecular Autism, 11, 1-9. https://doi.org/10.1186/s13229-020-00342-5
- Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21. https://doi.org/10.1186/s12916-020-1495-2