Subjective
- CC (chief complaint): The patient cannot sit still and suffers from inattention and high distractibility in almost any class. Also noted are excessive motor activity, impulsive behavior, minor problems in social communication, and forgetfulness (the patient often loses things).
- HPI: At a very early age, the patient was hyperactive and wall-jumping, and she even jumped into the pool before she could swim. Her parents could not take Sarah to the zoo, as she stuck her hand into the grate, where animals could bite her. When the patient went to school, she had trouble remembering what the teacher said: they had to make a list for her so that she could complete the assignments. Since Sarah often lost (forgotten) her worksheets, the list was transferred to the patient’s mother’s phone. In the lessons, the girl often fidgets in place, cannot sit for a long time, and often gets up from her chair. When the patient reads, she also cannot concentrate for a long time and rarely remembers the content of what she read; and does not remember at all what the teacher read or said.
Past Psychiatric History
- General Statement: no history of treatment.
- Caregivers (if applicable): no.
- Hospitalizations: unknown.
- Medication trials: no.
- Psychotherapy or Previous Psychiatric Diagnosis: no.
- Substance Current Use and History: unknown.
- Family Psychiatric/Substance Use History: unknown.
- Psychosocial History: unknown.
- Medical History:
- Current Medications: no
- Allergies: unknown
- Reproductive Hx: no
ROS:
- GENERAL: the general condition of the body is normal; there are problems with eating, and the patient receives proper nutrition according to PCP.
- HEENT: no problems found.
- SKIN: fine.
- CARDIOVASCULAR: unknown.
- RESPIRATORY: unknown.
- GASTROINTESTINAL: unknown.
- GENITOURINARY: unknown.
- NEUROLOGICAL: there is a diet from the PCP.
- MUSCULOSKELETAL: unknown.
- HEMATOLOGIC: unknown.
- LYMPHATICS: unknown.
- ENDOCRINOLOGIC: unknown.
Objective
- Physical exam: (if applicable) was not carried out
- Diagnostic results: Attention deficit hyperactivity disorder (ADHD); is expressed primarily in restlessness and inattention of the child. Any task tires very quickly, literally a couple of minutes after the start. It is almost impossible for the patient to focus on learning a new subject, but she shows some attention to the things that interest her (video games, art). The patient forgets the information others tell her, may forget/lose objects, or not hear the request addressed.
Assessment
- Mental Status Examination: The patient does not pose a threat to herself or others. The girl’s mother specified that with age, she became more diligent and stopped performing life-threatening actions (jumping into the pool or sticking her hands into the cages of animals in the zoo). More often, Sarah is distracted by things that interest her (a picture in the office) or dreams of good things (playing with a pet). However, periodically the patient is visited by disturbing thoughts (a quarrel with classmates or the absence of a mother).
Differential Diagnoses
Hyperactivity
The child always forgets about her homework or the assignments the teacher gives her, daydreams during classes, and is hectic at dinner. The patient also does not know how to wait and is mainly in a fasting movement, which are the main symptoms of hyperactivity (Diagnostic and statistical manual, 2022). Hyperactivity is usually part of ADHD, so it makes sense to diagnose mixed ADHD, including inattention and distractibility and impulsive and hyperactive behavior.
Auditory Perception Disorder (APD)
Although they are two physiological disorders with similar symptoms, ADHD and APD are very different. Children with ADHD have trouble concentrating, and children with APD have difficulty processing the information they hear (Riegner, 2021). Hearing loss affects language skills, and children with ADHD have impaired executive function and memory and find it challenging to manage their emotions. The general symptoms also found in the patient are that she does not listen when spoken to, as if she is falling out of the conversation. The patient is also found to be forgetful, easily distracted, and poor at following requests (Diagnostic and statistical manual, 2022). The diagnosis could be APD because Sarah has poor listening comprehension and is often overwhelmed. However, the child also exhibits impatience, daydreaming, and restlessness, which, together with past symptoms, make it possible to diagnose ADHD.
Bipolar Disorder (BD)
Bipolar disorder is best known for the mood swings it causes. In different phases of BD, there is increased excitability, anxiety, talkativeness, distractibility, fussiness or depressed mood, tearfulness, suicidal thoughts, and more (Diagnostic and statistical manual, 2022). One of the most significant differences is that bipolar disorder primarily affects mood, while ADHD primarily affects behavior and attention (Ditrich et al., 2021). In addition, people with bipolar disorder experience various mania or hypomania and depression episodes. On the other hand, patients with ADHD experience chronic symptoms, including Sarah, who did not show the typical phase shifts of BD.
Reflections
If I were to conduct the session again, I would like to study the family not only from the perspective of the parents themselves but also from the perspective of the child with ADHD. When communicating with the mother, I could find heredity, which can cause a genetic predisposition to ADHD. In addition, the family environment would help identify possible causes of the disorder. Perhaps the child has experienced or is in a stressful situation. It would also allow us to learn how parents cope with the symptoms of the child’s illness: an adequate response will allow more confident treatment.
As a rule, hyperactivity represents ethical conflicts between benefit/non-harm and justice for practitioners. During the session, it became known that the teacher generally contributes to the child’s support by writing down assignments for her and passing them to the child’s mother. However, the patient’s hyperactive behavior (for example, restlessness) can cause problems in the educational process for the patient and other children. Teachers may advise medical practitioners that a child will not be allowed back to school if the child is not on medication or that a diagnosis is required before special educational facilities are provided.
In addition to psychological assistance and drug treatment, the role of parents is essential. It will be adequate to offer parents help in cleaning things or preparing for school and praise them for their diligence and overcoming difficulties. It is necessary to emphasize every achievement, no matter how small, and give the child confidence in their abilities (Treatment of ADHD, 2022). A daily routine compiled together will help the child gain peace and spirit; she needs to understand her duties and their sequence. When treating ADHD, Sarah has no visible socioeconomic or cultural risks of worsening the condition: the main thing, in this case, is the support of the environment.
References
Diagnostic and statistical manual of mental disorders: Dsm-5-Tr (5th ed.). (2022). American Psychiatric Association.
Ditrich, I., Philipsen, A., & Matthies, S. (2021). Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited – A review-update on common grounds and subtle distinctions. Borderline Personality Disorder and Emotion Dysregulation, 8(1). Web.
Riegner, T. L. (Ed.). (2021). Auditory processing disorder (for parents). KidsHealth. Web.
Treatment of ADHD. Centers for Disease Control and Prevention. (2022). Web.