Physical Exams and Diagnostic Tests
Physical Exams and Diagnostic Tests
TO REPLY WITH A COMMENT TO EACH POST WITH TWO REFERENCE PER POST APA WITH CITATION ABOVE 2013. THE SECOND POST WILL BE GIVING TOMORROW.
Post 1
Questions
How does not seeing your dad make you feel? It is well understood that familial structure and exposure to marital discord are key risk factors in children with disruptive behavioral disorders (DBDs).
Do you believe your behavior is “ok” and acceptable? Many children may have little insight into their behavior, the consequences, and how their behavior affects those around them. Evaluating their perspective is valuable in that the feedback can be included in their treatment plan and goals.
What in your daily life upsets you the most? Workups of children with ADHD incorporates assessment for comorbid anxiety, depression, and developmental and learning disorders (Hamed, Kauer, & Stevens, 2015). Evaluating daily anxiety causing factors such as school work, home environments, trauma, etc. can give the practitioner insight into clear diagnosis, treatment, and services appropriate for the client.
Feedback
The most important people in the client’s life that could provide valuable feedback are her mother, grandmother, and teacher because they have the most contact with the client. The grandmother is important to interview as she may have different experiences with the client while in her care. The grandmother can also be asked about the mother’s behaviors and temperament during her childhood and adolescent years, especially considering the mother is exhibiting obvious symptoms of ADHD in her adult life. Studies have shown a mean heritability rate of 75% in family studies of behavioral disorders (Wilens & Spencer, 2010). The client’s teacher can provide a overview on any specific triggers preceding her tantrums and outbursts in class, and relationships with peers. The mother should be asked about the severity of the client’s behavior and tantrums at home, relationship with sister, and level of disobedience as these assessments may indicate progression into more severe behavioral disorders suggesting prompt attention (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015).
Physical Exams and Diagnostic Tests
When diagnosing ADHD and other DBDs, a thorough physical evaluations is needed to rule out medical causes. A structural MRI could document diffuse abnormalities in children with ADHD. A study found, individuals with ADHD may have smaller total cerebrum, cerebellum, and four cerebral lobes that do not change over time; in adults, imaging studies have shown smaller anterior cingulate cortex, thought to be the region that regulates ability to focus on tasks and choose between options, and smaller dorsolateral prefrontal cortex, which controls memory and ability to process new information (Wilens & Spencer, 2010). EEG should also be considered as one study found EEG’s show more Beta activity than Theta/Alpha activity in children medication responders compared to non-medication responders, strongly suggesting a biological correlation to the behaviors in ADHD (Hamed et al., 2015). Blood chemistry, thyroid levels, and ferritin levels have also been linked to the diagnosis of ADHD.
Differential Diagnoses
ADHD (most likely): Based on criteria outlined in the DSM-5, symptoms of inattention, hyperactivity, and impulsivity should be observed in at least different setting and present for 6 months or longer; symptoms must result in impairment of social, academic, or other functioning; and symptoms must not be better explained or attributed to other physical or mental health condition, or social situation (Brown, Samuel, & Patel, 2018).
Oppositional Defiance Disorder (ODD): Defined as a longstanding pattern of hostile, defiant, or disobedient behavior. Children with ODD experience more school failures, suspensions, and expulsions; home relationships are often disrupted; and they are less successful at per relationships (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015). Characterized by temper tantrums, arguing with parents and other adults, defiance, refusal to comply with directives, deliberately annoying others, and being spiteful and vindictive.
Conduct Disorder: A disruptive behavioral disorder with higher incidence in adolescence years, that includes some antisocial behaviors such as lying or stealing. Severity of symptoms often rise with age and can co-occur with substance abuse disorders. Adolescents with the disorder demonstrate more school failure, drug abuse, and arrests than adolescents without the disorder. It has been suggested that children with ADHD can progress to conduct disorder without proper treatment and intervention (Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders, 2015).
