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Posted: July 7th, 2022
ADHD diagnostic criteria
You are working in a community health center as a NP. Although you see children for mental health, you will also see children for some basic “bridge” care until primary care providers have openings. If the medical issue is complex then the clinic coordinator will escalate the referral for quicker appointment scheduling.
Presentation Ellie, who is 6-years old, has come to the clinic with a suspected ear infection and as referral for her daughter’s behaviors. Ellie’s mother says that her daughter has been rocking rhythmically and clutching her ear at the same time. There has been some moisture on her pillow in the morning and Ellie is reluctant to let her mother investigate what is wrong.
Ellie is attempting to rock while she is seated on her mother’s knee and uses the same repetitive vocalization, “Don’t wanna go to the shops” over and over again.
She has a history of speech delay but can now complete many full sentences. She has also had some behavior and attention issues in school. She disrupts the teacher often and then gets up from her seat during focus time to go to play centers. She is not easily redirected and becomes argumentative.
She feels hot to touch and will not let healthcare practitioners approach her with any equipment. Her vocalization becomes louder and more insistent when you attempt examination.
Recognizing possible autism as well as some ADHD diagnosis criteria discuss next steps in the answers to the questions.
Write a 3-page paper answering the following questions. Be sure to include a minimum of two scholarly articles to support your discussion.
1. Discuss autism and ADHD diagnostic criteria.
2. How should you approach examining Ellie as a child and strive to gain her trust?
3. You suspect that autism may be a possibility. What should you do to ensure that your suspicions are correct, and how should you go about referring Ellie to the local autism team?
4. Ellie is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?
Autism and ADHD Diagnostic Criteria
Autism and ADHD are two distinct neurodevelopmental disorders with different diagnostic criteria. Autism, also known as autism spectrum disorder (ASD), is characterized by difficulties in social communication and interaction, as well as restricted and repetitive patterns of behavior, interests, or activities (American Psychiatric Association [APA], 2013). On the other hand, ADHD is characterized by inattention, hyperactivity, and impulsivity that interfere with functioning or development (APA, 2013).
The diagnostic criteria for autism includes persistent deficits in social communication and social interaction across multiple contexts, such as difficulties with nonverbal communication, failure to develop age-appropriate peer relationships, and lack of social or emotional reciprocity (APA, 2013). Additionally, individuals with autism may have restricted, repetitive patterns of behavior, interests, or activities, such as excessive adherence to routines or rituals, highly restricted interests, and hyper- or hypo-reactivity to sensory input (APA, 2013).
The diagnostic criteria for ADHD includes six or more symptoms of inattention and/or hyperactivity-impulsivity that have persisted for at least six months and are inconsistent with developmental level, such as careless mistakes, difficulty sustaining attention, excessive talking, and interrupting or intruding on others (APA, 2013). The symptoms must also cause impairment in at least two settings and have an onset before age 12 (APA, 2013).
It is important to note that while these diagnostic criteria distinguish between autism and ADHD, there can be overlap between the two conditions, and it is not uncommon for individuals to be diagnosed with both (Lai et al., 2014).
Examining Ellie and Gaining Her Trust
When examining Ellie, it is important to approach her with sensitivity and empathy, taking into account her potential pain and discomfort from the ear infection. Building trust with Ellie and her mother will be crucial to ensure a successful examination.
First, it may be helpful to explain the examination process to Ellie and her mother in simple and clear language, emphasizing that the healthcare practitioner is there to help her. It may also be helpful to offer a distraction, such as a toy or book, to help Ellie feel more comfortable and relaxed during the examination.
Additionally, it may be beneficial to use a calm and reassuring tone of voice and approach Ellie at her level, maintaining eye contact and respecting her personal space. It may also be helpful to involve Ellie in the examination process as much as possible, allowing her to participate in decisions and choices, such as which ear to examine first.
Overall, the key to gaining Ellie’s trust will be to approach her with empathy, sensitivity, and patience, taking into account her unique needs and behaviors.
Referring Ellie to the Local Autism Team
If there is a suspicion of autism in Ellie, it may be necessary to refer her to a local autism team for further evaluation and diagnosis. This team may include specialists such as a developmental pediatrician, psychologist, speech therapist, and occupational therapist, who can conduct a comprehensive evaluation to determine if Ellie meets the diagnostic criteria for autism.
Before referring Ellie to the local autism team, it may be helpful to discuss the referral process with Ellie’s mother and ensure that she understands the purpose and potential benefits of the evaluation. It may also be helpful to provide resources and support to Ellie’s mother throughout the process, including information on local support groups and interventions for autism.
Differentiating Autism from ADHD Based on Diagnostic Criteria
Differentiating autism from ADHD can be challenging because the two conditions share some overlapping symptoms, such as inattention and hyperactivity. However, there are also some key differences in the diagnostic criteria that can help distinguish between the two conditions.
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