Posted: September 6th, 2023

You are working in a community health center as a NP

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 2 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?

Introduction
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders that affect children’s behavior and development. The symptoms of both disorders often overlap, making it difficult to diagnose accurately. This paper will discuss the diagnostic criteria for autism and ADHD, how to approach examining Ellie and gaining her trust, ensuring that suspicions of autism are correct and referring Ellie to the local autism team, and how to differentiate between autism and ADHD based on diagnostic criteria.

Discuss autism and ADHD diagnostic criteria
Autism Spectrum Disorder (ASD) is a developmental disorder characterized by persistent deficits in social communication and interaction, as well as restricted and repetitive behaviors and interests. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a child must meet the following criteria for a diagnosis of ASD:
Persistent deficits in social communication and social interaction across multiple contexts.
Restricted, repetitive patterns of behavior, interests, or activities.
Symptoms must be present in the early developmental period.
Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning.
ADHD is a neurodevelopmental disorder that affects attention, impulsivity, and hyperactivity. The DSM-5 outlines the following diagnostic criteria for ADHD:

Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Several inattentive or hyperactive-impulsive symptoms that were present before age 12 years.
Symptoms present in two or more settings.
Clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
The symptoms are not better explained by another mental disorder.
How should you approach examining Ellie as a child and strive to gain her trust?
As a healthcare practitioner, approaching and examining a child like Ellie requires a patient-centered approach. It is essential to gain her trust by establishing a positive rapport with her and her mother. The following are strategies that can be used to gain Ellie’s trust:
Establish a positive rapport by introducing oneself and explaining the examination process to Ellie and her mother.
Use a calm, non-threatening approach to reduce anxiety and fear.
Engage Ellie in non-threatening conversation about her interests and favorite things.
Use child-friendly language to explain the examination and answer any questions.
Use play-based approaches to distract and comfort Ellie during the examination.
Allow Ellie to take breaks as needed to reduce stress and anxiety.
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?
To ensure that suspicions of autism are correct, a comprehensive assessment is required. This may include developmental and behavioral assessments, as well as medical assessments to rule out any other possible causes of Ellie’s symptoms. Once a diagnosis of autism is confirmed, referring Ellie to the local autism team can provide her with the necessary support and interventions. This can include access to specialized services, such as speech therapy, occupational therapy, and behavioral therapy. Referrals to the autism team can be made by the healthcare practitioner or through the community health center’s care coordination team.

Ellie is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?
Distinguishing between autism and ADHD can be challenging as both disorders can present with similar symptoms. However, some key differences can help differentiate between the two. The following table summarizes the diagnostic criteria for autism and ADHD and highlights the differences:

Diagnostic Criteria Autism ADHD
Persistent deficits in social communication and social interaction Yes No
Restricted, repetitive patterns of behavior, interests, or activities Yes

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