Sam is a 6 and 1/2 year old male Grade 1 student who lives in Tyler with his parents. He is the onl

Sam is a 6 and 1/2 year old male Grade 1 student who lives in Tyler with his parents. He is the only child of two parents, both of whom have completed bachelors degrees. There is an extended family history of mental health concerns as well as excellent academic achievement.  Sam is an intelligent and caring young boy who presents with significant potential to excel academically-just like his parents. In his spare time, Sam enjoys spending time with his friends, and participating in physical activities such as swimming, running and biking. He also enjoys participating in social events, and is often invited to play dates and birthday parties. He is very popular with the other children in his class. It is noteworthy that, during the interview, he did not know his address or home phone number, could not print his surname, and recognized only a few pre-primer words.  While Sam interacts well with peers his own age, his parents note that he can be easily led and influenced by others. They also report that Sam gets upset when he does not receive recognition or feels that he has been ignored. His teacher notes that he sometimes acts ‘socially immature’, and that he often demonstrates attention-seeking behaviors. Sam describes difficulties with focusing, and sitting still in class. He recognizes that he is able to ‘hyper focus’ on some activities of interest; however, he often has difficulty sustaining his attention at school. His parents and teacher indicate that Sam is restless, and often requires reminders to help him stay on task. He is described as “constantly running around” and presenting with difficulties listening and following instructions. Sam’s teacher indicates that he often blurts out answers and interrupts other students in the classroom. Sam recognizes this tendency in himself, but says that he “can’t help it” in spite of his best intentions.  Sam has challenges falling asleep, and sometimes finds that he wakes up in the middle of the night.  When he wakes up he finds that he has difficulty getting back to sleep – sometimes staying awake for as long as an hour and a half before he drifts off to sleep again  His mother reports difficulties at home with following routines and remembering instructions. His parents describe emotional reactivity as well as confrontational behaviors demonstrated both at home and at school. His teacher notes that Sam is very defiant towards listening to instructions, but generallyinteracts well with his peers. He is easily frustrated and emotionally impulsive – Sam has had several incidents of hitting, crying outbursts, and inappropriate behavior. Behavioral concerns with aggression, lying, arguments, and disruptive behavior were noted in pre-school program at age 4, as well. The school counselor and Sam’s teacher have requested that Jonathan be evaluated. Sam and his mom and dad are in your office today.  How will you address Sam’s concerns?  What are 4 differential diagnoses you will consider for Sam? What are the pertinent positives and pertinent negatives for each of your choices?  (ie. Pertinent positive=why you think it COULD be that diagnosis.  Pertinent negatives= what factors make you rule it out).  Use DSM-5 criteria as rationales for your responses. What is your working diagnosis and why?What is your plan for assessing Sam?  Outline the process for assessing a pediatric patient with these symptoms.  What collateral resources will you utilize to get additional information and why? What Laboratory/Diagnostic/Evaluation tests will you utilize in Sam’s assessment?  What is/are your rationales for ordering these?  Provide a BIRP NOTE FOR YOUR ENCOUNTER WITH SAM BELOW.  desired outcomes. In the PLAN, please include pharmacological & non-pharmacological interventions, behavioral interventions, educational interventions, teaching with parents, and plan for follow up.      Health Science Science Nursing PSYCHOLOGY 4353 Share QuestionEmailCopy link Comments (0)

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