Differential Diagnosis for Ellies Symptoms- Ear Infection and Rhythmic Rocking.

Differential Diagnosis for Ellies Symptoms- Ear Infection and Rhythmic Rocking.

Autism disorder is a neurodevelopment disorder characterized by impaired communication and social interaction. It is often associated with repetitive behaviors. On the other hand, ADHD is a mental disorder commonly observed in pediatrics and adolescents (Bougeard et al., 2021). It is characterized by inattention, hyperactivity, and impulsivity. Ellie, a six-year-old girl described in the case scenario, appears to have features overlapping between ADHD and autism. This paper aims to discuss the diagnostic criteria for ADHD and autism, the examination approach for a child, the way to confirm the diagnosis of autism, and the differences between autism and ADHD based on the diagnostic criteria.

Diagnostic Criteria for Autism and ADHD

Dsm-5 has five criteria for the diagnosis of autistic spectrum disorder, including criteria A to E. Criteria A emphasizes that there must be deficits in social interaction and communication characterized by deficits in social approach, non-verbal communication, and difficulties maintaining social relationships. Criteria B includes behaviors manifested by at least two symptoms, including motor stereotypes, difficulty transitioning to new routines, preoccupation with unusual behaviors and objects, and decreased or increased response to environmental stimuli. Criteria C insists that the symptoms must be present in early childhood. Criteria D states that the symptoms must have a significant clinical impact on social and occupational functioning (Carter, 2022). Lastly, criteria E outlines that the observed features must not be explained by intellectual disorder and global development disorder.

Similarly, ADHD also has five diagnostic criteria A to E. The A criterion states that there must be persistent hyperactivity or inattention that impairs the development or functioning of an individual characterized by at least six symptoms of either inattention or hyperactivity that have lasted for at least six months. The symptoms of inattention are failure to be attentive to details, difficulties maintaining attention in activities, difficulty listening actively, difficulty following instructions, failure to be organized, getting distracted easily, forgetfulness, being avoidant, and losing things that are important for activities. On the other hand, the symptoms of hyperactivity include fidgeting, running/climbing in inappropriate situations, inability to participate in leisure activities, difficulty staying still/calm, excessive talkativeness, failure to observe taking, and always bothering others. Criterion B states the symptoms of hyperactivity and/or inattentiveness must have been present before the age of 12 years. Criteria C emphasizes the symptoms being present in two or more settings such as work, school, or home. Criterion D states that there must be evidence that the social, occupational, or academic function is impaired (American Psychiatric Association et al., 2023). Lastly is criterion E, which states the symptoms should be solely observed in cases of schizophrenia or psychotic disorder.

Ellies presented with symptoms of autism, including repetitively rocking her head and a history of speech delay. In addendum, she also presented with features of ADHD, which included being disruptive during classes, argumentative, not easily redirected, and inattentive. However, further information and evaluation may help ascertain whether Ellie meets the diagnostic criteria for ADHD and/or Autism spectrum disorder.

Approach to Examining Ellie to Gain Her Trust

There is a need for the children to build trust in caregivers for efficient service provision. According to Stein Duker et al. (2019), there are several approaches proposed to help win children’s trust. To begin with, the environment should be child-friendly to make the child comfortable. For instance, the room should have toys and colourful decorations. This has been shown to ease anxiety. The other approaches include playing with the child while communicating with them, introducing self to the child, using language that is age-appropriate for the child, offering the child choice when possible, using the examination equipment as the toys, and applying other distraction techniques such as storytelling to divert the child’s attention. Specifically for Ellie, it would be important to use distraction techniques such as toys, play, and involving her mother during examination time.

How to Confirm the Diagnosis of Autism and Referring to Autism Centre

Unfortunately, there is no specific test for confirming the diagnosis of autism. However, taking histories and performing patient assessments play a big role in confirming the diagnosis. First and foremost, the first thing to do would be to interview the mother based on the DSM-5 criteria to find out whether Ellie meets the diagnostic criteria for autism spectrum disorder and whether the symptoms are not a result of other mental or physical illnesses. Secondly, it would also be crucial to use autism screening tools such as the Ages and Stages Questionnaire to have an understanding of Ellie’s development. Thirdly, it would also be prudent to assess Ellie’s interaction and behaviours during the interview to ascertain if, indeed, she has the symptoms of autistic spectrum disorder (Brian, Zwaigenbaum & Ip, 2019). Lastly, collaboration with a child psychiatrist who can further evaluate the child and confirm the diagnosis of autistic spectrum disorder would be necessary.

Differentiating between ADHD and Autism based on Diagnostic Criteria

Even though there may be an overlap between ADHD and Autism spectrum disorder, it is very important to review the criteria for specific disorders to avoid misdiagnosis. Based on the DSM-5, ADHD and autism have very different diagnostic criteria. As described above, autism is characterized by impaired social interaction and communication and abnormal and repetitive behaviours (Carter, 2022). Furthermore, the symptoms must have been present in early childhood, but the exact age is not specified. On the other hand, ADHD is characterized by two key issues, including inattention and/or hyperactivity, with at least six symptoms (Ma et al., 2021). Symptoms of inattention and hyperactivity must have been there for at least six months. The criteria emphasize the presence of symptoms in two distinct settings, such as school and home, for a diagnosis to be made.

Conclusion

In summary, from the case scenario, Ellie had features overlapping autism spectrum disorder and ADHD. Autism is majorly characterized by abnormal social interaction and communication and abnormal repetitive behaviours. On the other hand, ADHD is characterized by symptoms of inattention and hyperactivity that must have been present for at least six months. The DSM-5 has criteria for diagnosing ADHD and autism; therefore, careful consideration must be taken for confirmation of either of the diagnoses.

References

American Psychiatric Association, Guelfi, J.-D., & Crocq, M.-A. (2023). Dsm-5-Tr Manuel Diagnostique Et Statistique Des Troubles Mentaux, Texte Révisé (5th ed.). Elsevier Masson.

Bougeard, C., Picarel-Blanchot, F., Schmid, R., Campbell, R., & Buitelaar, J. (2021). Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: a systematic literature review. Frontiers in psychiatry, 12, 744709. https://doi.org/10.3389/fpsyt.2021.744709

Brian, J. A., Zwaigenbaum, L., & Ip, A. (2019). Standards of diagnostic assessment for autism spectrum disorder. Pediatrics & Child Health, 24(7), 444-451. https://doi.org/10.1093/pch/pxz117

Carter, K. (2022). Psychopathology: Understanding Psychological Disorders. Cambridge University Press. https://books.google.co.ke/books?hl=en&lr=&id=bhOjEAAAQBAJ&oi=fnd&pg=PR16&dq=DSM-5TR+criteria+for+autistic+spectrum+disorder&ots=DIDRgYhsaa&sig=qxUuo-av9WOL5GN5WM5-RW2imy0&redir_esc=y#v=onepage&q=DSM-5TR%20criteria%20for%20autistic%20spectrum%20disorder&f=false

Ma, S. L., Chen, L. H., Lee, C. C., Lai, K. Y., Hung, S. F., Tang, C. P., … & Leung, P. W. (2021). Genetic overlap between attention-deficit/hyperactivity disorder and autism spectrum disorder in SHANK2 gene. Frontiers in neuroscience, 15, 649588. https://doi.org/10.3389/fnins.2021.649588

Stein Duker, L. I., Floríndez, L. I., Como, D. H., Tran, C. F., Henwood, B. F., Polido, J. C., & Cermak, S. A. (2019). Strategies for success: A qualitative study of caregiver and dentist approaches to improving oral care for children with autism. Pediatric dentistry, 41(1), 4E-12E. https://www.ingentaconnect.com/content/aapd/pd/2019/00000041/00000001/

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You are working in a community health center as an 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 a 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 behaviour and attention issues in school. She disrupts the teacher often and then gets up from her seat during focus time to go to play centres. She is not easily redirected and becomes argumentative.

She feels hot to the touch and will not let healthcare practitioners approach her with any equipment. Her vocalization becomes louder and more insistent when you attempt the examination.

Recognizing possible autism as well as some ADHD diagnosis criteria, discuss the next steps in the answers to the questions.

Write a 2-3 page paper answering the following questions. Be sure to include a minimum of two scholarly articles to support your discussion.

Discuss autism and ADHD diagnostic criteria.

How should you approach examining Ellie as a child, and strive to gain her trust?

You suspect that autism may be a possibility. What should you do to ensure that your suspicions are correct, and how should you refer Ellie to the local autism 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?