Training Title 55
Name: Matilda Johnson
Gender: female
Age: 8 years old
T-98.0 P 70 R 24 B/P 110/68
Ht 45 inches Wt 57lbs
Vaccinations are up to date, on target with developmental milestones. Appetite, she is a picky
eater per mom. NKDA
Symptom Media. (Producer). (2017). Training title 55 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-55

1. Introduction
Patient: Matilda Johnson, 8‑year‑old female.

Context: Case study from Symptom Media video (2017).

Clinical Focus: Anxiety disorders, PTSD, and OCD in children.

Importance: Pediatric anxiety disorders are common but often under‑recognized. Early intervention is critical to prevent long‑term impairment in social, academic, and emotional functioning.

2. Demographics and Background
Age: 8 years old.

Gender: Female.

Vitals: T 98.0, P 70, R 24, BP 110/68 (normal).

Height/Weight: 45 inches, 57 lbs (BMI appropriate for age).

Development: Vaccinations up to date, on target with developmental milestones.

Family: Lives with parents, picky eater per mother.

Medical History: No known drug allergies (NKDA).

Psychiatric History: No prior psychiatric treatment reported.

Lifestyle: Normal sleep and appetite patterns, though selective eating noted.

3. Psychosocial Stressors
Family Dynamics: Parental expectations, possible stress at home.

School Stress: Academic demands, peer relationships, bullying risk.

Developmental Stage: Transition from early childhood to middle childhood, increased awareness of social evaluation.

Environmental Stressors: Possible exposure to trauma, family conflict, or community stress.

4. Clinical Presentation (Anxiety/PTSD/OCD Features)
Possible Symptoms (from case context):

Excessive worry about school, family, or safety.

Restlessness, irritability.

Somatic complaints (stomachaches, headaches).

Sleep disturbance (difficulty falling asleep, nightmares).

Avoidance of feared situations.

Ritualistic behaviors (checking, handwashing) if OCD present.

Hyperarousal or intrusive memories if PTSD present.

Risk Factors:

Family history of anxiety.

Developmental vulnerability.

Environmental stressors.

Lack of coping skills.

5. Mental Status Examination (MSE)
Appearance: Age‑appropriate grooming, normal growth.

Behavior: Cooperative but anxious demeanor.

Speech: Normal rate/volume, may be hesitant.

Mood: Reports worry, fear.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Preoccupation with fears or rituals.

Cognition: Alert, oriented ×3, age‑appropriate.

Insight/Judgment: Limited due to age, relies on parental support.

6. Differential Diagnosis
Generalized Anxiety Disorder (GAD): Excessive worry for ≥6 months, difficult to control.

Separation Anxiety Disorder: Fear of being away from parents.

Social Anxiety Disorder: Fear of social situations, performance anxiety.

Obsessive‑Compulsive Disorder (OCD): Presence of obsessions and/or compulsions.

Post‑Traumatic Stress Disorder (PTSD): Trauma exposure with intrusive symptoms, avoidance, hyperarousal.

Adjustment Disorder with Anxiety: Symptoms linked to identifiable stressor.

Medical Causes: Thyroid dysfunction, asthma, GI issues.

7. Diagnostic Considerations (DSM‑5)
GAD Criteria: Persistent worry ≥6 months, associated with restlessness, fatigue, irritability, muscle tension, sleep disturbance.

Separation Anxiety Disorder: Developmentally inappropriate fear of separation, lasting ≥4 weeks in children.

Social Anxiety Disorder: Marked fear of social situations, avoidance, impairment.

OCD: Obsessions (intrusive thoughts) and/or compulsions (repetitive behaviors) causing distress.

PTSD in Children: Trauma exposure, intrusive memories, avoidance, negative mood, hyperarousal.

Matilda’s Case:

Symptoms may align with GAD or separation anxiety.

OCD or PTSD must be ruled out based on specific symptom patterns.

8. Assessment Tools
SCARED (Screen for Child Anxiety Related Emotional Disorders): Assesses anxiety symptoms.

CY‑BOCS (Children’s Yale‑Brown Obsessive Compulsive Scale): Measures OCD severity.

UCLA PTSD Reaction Index: Screens for PTSD in children.

PHQ‑9 Modified for Adolescents: Screens for depression.

Collateral Information: Parent and teacher reports essential.

9. Treatment Plan
Pharmacological:

SSRIs (fluoxetine, sertraline) → first‑line for pediatric anxiety/OCD.

Careful monitoring for side effects (GI upset, suicidality risk).

Avoid benzodiazepines in children.

Psychotherapy:

Cognitive Behavioral Therapy (CBT) → gold standard for pediatric anxiety and OCD.

Exposure and Response Prevention (ERP) for OCD.

Trauma‑focused CBT for PTSD.

Family therapy to involve parents.

Lifestyle Interventions:

Structured routine.

Sleep hygiene.

Nutrition counseling for picky eating.

Relaxation techniques (deep breathing, mindfulness).

Supportive Measures:

School counseling.

Peer support groups.

Coordination with pediatrician for medical issues.

10. Monitoring and Follow‑Up
Weekly therapy sessions initially.

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with school and family.

11. Challenges
Medication Adherence: Parents must supervise.

Family Stress: Parental anxiety may influence child.

School Stress: Academic and peer pressures.

Developmental Limitations: Limited insight, reliance on adults.

Stigma: Mental health stigma in children.

12. Ethical and Cultural Considerations
Confidentiality: Respect child’s privacy, involve parents appropriately.

Consent: Parental consent required, child assent important.

Safety: Suicide/self‑harm risk management.

Cultural Sensitivity: Address family dynamics, school environment.

13. Case Summary
Matilda Johnson: 8‑year‑old female presenting with anxiety symptoms, picky eating, and somatic complaints.

Likely Diagnosis: Generalized Anxiety Disorder or Separation Anxiety Disorder.

Treatment: Combination of CBT, possible SSRI, lifestyle interventions, family involvement.

Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of relapse.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Matilda’s age? a) 6 b) 8 c) 10 d) 12

Where does Matilda live? a) Buffalo, NY b) Orlando, FL c) Memphis, TN d) Locust Grove, OK

What is her weight? a) 45 lbs b) 57 lbs c) 65 lbs d) 70 lbs

What family history is relevant? a) Mother with generalized anxiety and benzodiazepine misuse b) Father with diabetes c) Sister with depression d) None reported

Which diagnosis involves excessive worry ≥6 months? a) GAD b) Separation Anxiety Disorder c) OCD d) PTSD

Which diagnosis involves fear of separation lasting ≥4 weeks in children? a) Separation Anxiety Disorder b) GAD c) OCD d) Adjustment Disorder

Which tool screens for child anxiety? a) SCARED b) CY‑BOCS c) PHQ‑9 d) CAPS‑5

Which tool measures OCD severity in children? a) CY‑BOCS b) SCARED c) PHQ‑9 d) HAM‑A

Which therapy is gold standard for pediatric anxiety? a) CBT b) DBT c) IPT d) Psychoanalysis

Which therapy is used for OCD? a) ERP b) CBT only c) DBT d) IPT

Which therapy is used for PTSD in children? a) Trauma‑focused CBT b) Psychoanalysis c) DBT d) IPT

Which medication class is first‑line for pediatric anxiety/OCD? a) SSRIs b) Benzodiazepines c) TCAs d) MAOIs