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: Makala, who is 7, has come to the clinic with a suspected ear infection and as a referral for her daughter’s behaviors. Makala’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 Makala is reluctant to let her mother investigate what is wrong.
Makala 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 the examination.
Recognizing possible autism as well as some ADHD diagnosis criteria, discuss the next steps in the answers to the questions.
Instructions
Write a 4 page paper answering the following questions. Be sure to include a minimum of 2 scholarly articles to support your discussion.
1. Discuss autism and ADHD diagnostic criteria.
2. How should you approach examining Makala 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 Makala to the local autism team?
4. Makala is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?
All work should be original and submitted as a Word document unless otherwise indicated in the assignment instructions. ALL assignments need to be APA 7 format and accompanied title page in APA 7th edition format in order that the work would be properly identified for the student, the course, and the assignment. Work submitted without a title page will receive a grade of 0.
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Sample—–
about the most effective methods to assess and manage co-occurring autism and ADHD. Autism
is defined by difficulties in social communication and repetitive behaviors, while ADHD is
defined by inappropriate symptoms of inattention and hyperactivity-impulsivity. (Hatch et al.,
2023). While symptom profiles are separate in theory, research consistently shows that they
often co-occur, a fact now acknowledged in the Diagnostic and Statistical Manual-5th Edition
(DSM-5), which no longer forbids a comorbid diagnosis. (APA, 2022). Educators and healthcare
professionals must acknowledge that autism and ADHD often occur together. This recognition
requires a shift from previous guidelines that treated autism and ADHD as separate conditions, to
incorporating approaches that address their co-occurrence. (Hours et al., 2022).
The components of autism spectrum disorder and ADHD have numerous commonalities. Many
children showing indicators of autism spectrum disorder may initially receive a misdiagnosis of
ADHD before being correctly identified by a pediatrician or child development expert. (Hatch et
al., 2023). Many children with autism exhibit signs of ADHD, such as inattention, social
awkwardness, selective attention, and impulsivity. They may exhibit impatience or struggle with
communication. Individuals with ADHD and ASD may have challenges in academic and
interpersonal areas, but some may excel intellectually despite struggles in personal relationships.
(Zablotsky et al., 2020).
Autism spectrum disorder is often present in children with attention-deficit/hyperactivity
disorder, but there is a significant gap in treatment needs for this subpopulation. According to a
2014 National Survey on the Diagnosis and Treatment of ADHD and Tourette Syndrome, around
1 in 8 children with ADHD had previously been diagnosed with ASD. Dual diagnosis led to a
combination of hyperactive/impulsive and inattentive ADHD subtype, increased treatment needs,
and other co-occurring disorders. Atypical performance monitoring and attentional resource
allocation are linked to both ASD and ADHD. Distinctive processing characteristics are unique
to each condition, with ADHD showing a preference for novelty, maybe due to heightened
perceptual capacity and visual stimulus retention. ASD is associated with abnormal feedback
processing, whereas ADHD may include unusual monitoring of conflict and rewarding feedback.
Reduced inhibitory control has been associated with ADHD, although this relationship has not
been particularly studied in young people with ASD. (Lau-Zhu et al., 2019).
To assess Makala, the practitioner must first gain her trust. This should be done with the
practitioner establishing rapport by engaging with her, exposing her to various items and
activities, and observing her preferences. The practitioner should use both direct and indirect
reinforcers, including social activities and tangible items. Family members can be valuable
resources for finding preferred items and activities. Most autistic children have something that
they are completely obsessed with. Find out what that is and utilize that in the interaction.
(Taylor et Fisher, 2010). As important as it is to know what Makala likes and enjoys, it is equally
important to know what she doesn’t like or what upsets her. It is imperative to pay attention to how she feels, how she interacts with you and give her the space she needs while giving her the
attention she needs. This will help her feel safe and gain her trust.
Makala is required to undergo a comprehensive evaluation to determine if she may have autism.
This assessment will include a review of her medical history, interviews with her parents and
teachers, and a range of examinations including cognitive, communication, and social skills
assessments. The goal is to determine if she has autism and the type of autism spectrum disorder
she may have. (CDC, 2022).
Makala would need to be referred to an appropriate center to ensure that she gets the correct
diagnosis. In the Dallas area, there are many, many centers to choose from. The UT
Southwestern and Children’s Center for Autism Care is the one that jumps out to me. The Center
for Autism Care is a joint effort between UT Southwestern and Children’s Medical Center, where
health experts from both institutions work together to assess and manage autism and other
developmental problems. They utilize advanced methods and work closely with prominent
scientists in the field. For the evaluation to take place there, a referral form would be filled out
with all the relevant information relating to Makala’s diagnosis. Beginning services at UTSW
would be beneficial for Makala because they are able to transition her from pediatric autism care
to adult autism care seamlessly within the organization. (UTSW, n.d.).
Children with ADHD often exhibit early social development skills like playing well, using hand
gestures, responding to names, and imaginative play. ADHD does not impact humor, empathy,
or facial expressions, which can accurately represent their emotional condition. Despite struggles
with adherence to rules, they comprehend them and exhibit social engagement, which, when
absent, are essential indicators of autism. (Leonard, 2024).
ADHD and autism often coexist due to shared genetic and neurological factors. Research on the
correlation between ADHD and autism is still in its early stages. Prior to the 2013 revision of the
DSM-5, ADHD and autism were considered mutually exclusive diagnoses. Both conditions
share characteristics and symptoms, but each disorder is a distinct neurological disorder similar
to the other. (Ma et al., 2021).