Week 3: Autism Spectrum Disorder, ADHD, ODD, and ICD

“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 does not care about me. She only cares about my little brother and that man that keeps coming around. I don’t care anything 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 describes neurodevelopmental disorders such as autism spectrum disorder and ADHD and disruptive, impulse-control, and conduct disorders, such as oppositional defiant disorder and conduct disorder. These disorders are examined together with a particular emphasis on comparing and contrasting presenting features. Diagnosis of these various conditions can rarely be made in a single office setting and often require a comprehensive approach involving multiple stakeholders, including the child, as well as his or her parents, teachers, and other significant figures in the child’s life 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 by working with your group to develop a Parent Guide. You also examine a case to determine a differential diagnosis and treatment plan that incorporates both psychotherapy and psychopharmacology.

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Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014).
Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)

Sadock, 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”
  • “Intellectual Disabilities”
  • “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-…

Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Irritability in autism	Attention-deficit/hyperactivity disorder
aripiprazole risperidone	armodafinil amphetamine (d) amphetamine (d,l) atomoxetine bupropion chlorpromazine (hyperactivity) clonidine guanfacine haloperidol (hyperactivity) lisdexamfetamine methylphenidate (d) methylphenidate (d,l) modafinil reboxetine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Required Media

Laureate Education (Producer). (2017b).
A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author.

Optional Resources

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.). Hoboken, NJ: Wiley Blackwell.

• Chapter 51, “Autism Spectrum Disorder” (pp. 665–682)

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Assignment 1: Practicum: Decision Tree

For 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: This Assignment is the first of three assignments that are based on interactive client case studies. 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.

Learning Objectives

Students will:

• Evaluate clients for treatment of mental health disorders
• Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

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.

At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis
  • Which Decision did you select?
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • 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 Psychotherapy
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • 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 Psychopharmacology
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • 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.