Biopsychosocial History, Presenting Problems, and Symptoms
Parents brought their 11-year-old daughter, Callista, to the clinic with the main problem of the inability to meet expectations either at school or at home. The girl lags behind the group in such activities as calculations and reading. She makes careless mistakes and loses her place when she has to read the book. Her teachers use some disciplinary measures in order to reduce distractions (move her desk outside the doorway), compare her achievements with those of her sister, and underline her weaknesses. However, parents do not appreciate such behaviors because it seems that school workers try to shame Callista. They also think that their daughter is in her own world and needs some hints and redirections to complete her tasks. She eats slowly and forgets to do routine tasks.
Callista, in her turn, shares an active imagination, uses different literary and media characters to show her interests, and defines homework and studies as boring activities. She loves her family and believes her family also loves her despite their favoritism of the older sister. During the assessment, she is cooperative but distracted with poor eye contact; fidgeting is also observed. The girl expects her family could do more to understand her needs and interests. She likes to write stories using the imaginative material but hates math.
Differential Diagnoses and Final Diagnosis
Socially inappropriate behaviors, hyperactivity (fidgeting), and lack of energy in doing some work may be the signs of bipolar disorder. According to the American Psychiatric Association (2013), poor concentration on tasks and inattention that last more than four days provoke bipolar complications, and Callista demonstrates some behavioral changes. Poor communication skills, failing grades, and refusal to participate in classroom activities are the symptoms of depression in the patient. However, the child does neither feel hopelessness nor have suicidal thoughts (Mullen, 2018). If a child has some problems in studying a particular subject, specific learning disorder may be diagnosed due to a lack of interest in reading and math or frustration. However, in this case, Callista has additional symptoms and behavioral problems not only at school but at home as well. Therefore, regarding such behaviors as inattentiveness, distraction, poor listening, difficulties staying seated (fidgeting), problems with organization, and troubling memory, Callista has attention-deficit/hyperactivity disorder (ADHD).
Contributing Factors to the Client’s Condition
Family support and behaviors that demonstrate teachers at school are the main contributing factors to Callista’s condition. On the one hand, the client expects that her beloved people understand her behavior and interest. As soon as she feels their support, her behavior could be improved. On the other hand, a school is a place where the girl learns how to behave and cope with difficulties. If her teachers demonstrate negative attitudes to her inabilities, she does not get an example of how to work hard but sees what negative consequences may be expected. Therefore, attention to social factors and the creation of a favorable environment should be paid in the analysis of the patient’s case.
Clinical Treatment
In the majority of cases, children who are diagnosed with ADHD should pass pharmacological and non-pharmacological treatments. Callista is ready to cooperate, and the task of a primary care provider is to identify if ADHD is the only chronic condition. Then, behavioral classroom interventions, parent training in behavior management (PTBM), and combination have to be combined (Shrestha et al., 2020). Peer relationships and interactions may be improved in a group setting through developing friendship relationships and following common tasks and norms. Cognitive training aims at stabilizing working memory and establishing habits that are crucial for everyday activities. Organizational skills training includes 65-minute sessions several times a week for ten weeks to help the child understand and learn the basics of daily planning (Shrestha et al., 2020). Extended-release medications are preferable in Callista’s case because they have to be taken once in the morning compared to other drugs that should be taken every several hours. Concerta or Daytrana are prescribed if no side effects are reported.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Ng, C. W. M., How, C. H., & Ng, Y. P. (2017). Managing depression in primary care. Singapore Medical Journal, 58(8), 459-466. Web.
Mullen, S. (2018). Major depressive disorder in children and adolescents. The Mental Health Clinician, 8(6), 275-283. Web.
Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: A review. Translational Pediatrics, 9(1), 114-124. Web.