For this Assignment you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder. To Prepare: 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.

A Comprehensive Assessment of Sarah

Subjective:

CC: “My daughter forgets and losses things easily.”

HPI: Sarah Higgins is a 9-year-old African American female who comes to the office accompanied by her mother for psychiatric evaluation and treatment. The mother says that Higgins has been having attention problems and poor memory since kindergarten. She does not remember school assignments. She has bad sitting behaviors in school and at home.

She squirms in sits and fidgets. For instance, she hardly sits when eating. She cannot organize her work. She avoids hard tasks and hardly finishes her homework or chores. She cannot wait her turn in a group. Recently, there has been a complaint that she intimidates others during plays. She also reports feelings of anxiety when she is wrong. She gets restless and frustrated when she is wrong. Her anxiety is often triggered by being wrong.

Past Psychiatric History:

• General Statement: No history of psychiatric conditions.
• Caregivers (if applicable): Not applicable.
• Hospitalizations: No hospitalizations.
• Medication trials: No medical trials.
• Psychotherapy or Previous Psychiatric Diagnosis: No psychiatric diagnosis or treatment.

Substance Current Use and History: No drug, tobacco, or alcohol use.

Family Psychiatric/Substance Use History: No family history of mental problems or substance abuse.

Psychosocial History: 

She was born and raised by both parents in Washington, D.C. She is the only child and is in grade four. She loves art and visiting museums. She also likes video games. She denies a history of violence or trauma. She denies legal issues.

Medical History: No major medical issues. Vaccinations are up-to-date.

• Current Medications: No medications.
• Allergies:No allergies.
• Reproductive Hx:No Menstrual cycle. Not sexually active.

ROS:

• GENERAL: Positive for weight loss.
• HEENT: Noncontributory.
• SKIN: No rash.
• CARDIOVASCULAR: No chest problems.
• RESPIRATORY: No cough or difficulty breathing.
• GASTROINTESTINAL: No nausea, abdominal pain, or diarrhea.
• GENITOURINARY: No UTI or urinary problems.
• NEUROLOGICAL: No change in bowel movements, dizziness, or headache.
• MUSCULOSKELETAL: Denies muscle and joint swelling, stiffness, or pain.
• HEMATOLOGIC: No bleeding.
• LYMPHATICS: No swelling of glands.
• ENDOCRINOLOGIC: No endocrinologic problems.

Objective:

Physical exam:

Vital Signs: Ht. 4’5, Wt. 63lbs, R 14, P 62, T 97, BP 95/60

• HEENT: No scars on her head. Vision intact. Hearing intact. Normal nasal mucosa. No sore throat.
• Skin: No rash
• Cardiovascular: No murmurs. Regular heart rate and rhythm.
• Respiratory: Chest clear. Lungs clear. No wheezes.
• Neurological: Cranial nerves II- XII intact.

Diagnostic results:

1. Functional Magnetic Resonance Imaging (fMRI): fMRI is more accurate and valid in diagnosing people with ADHD and autism (Sen et al., 2018). The test shows that the patient has lower connectivity between the posterior and precuneus cingulate cortex and anterior cingular cortex, indicating the presence of ADHD (Sen et al., 2018).
2. Behavior Assessment System for Children (BASC-3)– The tool was used to assess the patient’s behavior because it is valid in diagnosing AHDH (Tan et al., 2021).

Assessment:

Mental Status Examination: She is not well-nourished. She appears her age. She has poor attention but is oriented. She was cooperative during the interview. Speech is slow and polite. She reports a happy mood and positive affect. Thought content and process are intact. She has memory problems. She denies delusions, illusions, or hallucinations. She also denies suicidal thoughts