Training Title 48
Name: Sarah Higgins
Gender: female
Age: 11 years old
T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs
Background: no history of treatment, developmental milestones met on time, vaccinations up to
date. Sleeps 9-10hrs/night, meals are difficult as she has hard time sitting for meals, she does get
proper nutrition per PCP. she has a younger brother. lives with her parents in Washington,
D.C. No hx of head trauma.
Symptom Media. (Producer). (2017). Training title 48 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-48

NRNP 6635 Case History Report – Week 10: Neurocognitive and Neurodevelopmental Disorders
Training Title 48: Sarah Higgins
1. Introduction
Patient: Sarah Higgins, 11‑year‑old female.

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

Clinical Focus: Neurocognitive and neurodevelopmental disorders in children.

Importance: Highlights how subtle developmental challenges, behavioral difficulties, and family dynamics can influence functioning and require early intervention.

2. Demographics and Background
Age: 11 years old.

Gender: Female.

Vitals: T 97.4, P 58, R 14, BP 98/62 (all within normal pediatric ranges).

Height/Weight: 4’5”, 65 lbs (BMI appropriate for age).

Family: Lives with parents in Washington, D.C.; has a younger brother.

Medical History: No head trauma, vaccinations up to date.

Developmental History: Milestones met on time.

Lifestyle: Sleeps 9–10 hours nightly.

Nutrition: Difficulty sitting for meals, but PCP confirms adequate nutrition.

3. Psychosocial Stressors
Family Dynamics: Younger sibling may influence attention and parental focus.

School Demands: At age 11, increasing academic and social expectations.

Behavioral Concerns: Difficulty sitting for meals may reflect attention or regulation issues.

Social Development: Peer relationships critical at this stage; possible challenges not yet documented.

4. Clinical Presentation (Neurodevelopmental Features)
Reported Symptoms:

Difficulty sitting for meals.

Otherwise normal sleep and nutrition.

Behavioral Indicators:

Possible hyperactivity or attention difficulties.

No history of trauma or medical illness.

Risk Factors:

Family stressors.

School performance demands.

Subtle behavioral regulation issues.

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

Behavior: Cooperative but restless at meals.

Speech: Normal rate/volume.

Mood: Neutral.

Affect: Appropriate.

Thought Process: Logical, coherent.

Thought Content: No delusions or hallucinations.

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

Insight/Judgment: Limited due to age.

6. Differential Diagnosis
Attention‑Deficit/Hyperactivity Disorder (ADHD): Difficulty sitting still, possible hyperactivity.

Autism Spectrum Disorder (ASD): If social or communication deficits present.

Oppositional Defiant Disorder (ODD): If defiance or refusal behaviors emerge.

Learning Disorders: If academic difficulties noted.

Normal Developmental Variation: Some restlessness may be age‑appropriate.

7. Diagnostic Considerations (DSM‑5)
ADHD Criteria:

Inattention and/or hyperactivity‑impulsivity.

Symptoms present in ≥2 settings (home, school).

Impairment in functioning.

ASD Criteria:

Deficits in social communication.

Restricted, repetitive behaviors.

ODD Criteria:

Angry/irritable mood, argumentative/defiant behavior.

Sarah’s Case:

Limited data, but difficulty sitting for meals suggests possible ADHD features.

8. Assessment Tools
Conners Rating Scale: ADHD symptoms.

Vanderbilt Assessment Scale: ADHD and comorbidities.

ADOS‑2 (Autism Diagnostic Observation Schedule): ASD evaluation.

CBCL (Child Behavior Checklist): Broad behavioral screening.

Neuropsychological Testing: Cognitive and learning assessment.

9. Treatment Plan
Pharmacological:

Stimulants (methylphenidate, amphetamines) for ADHD.

Non‑stimulants (atomoxetine, guanfacine) if stimulants not tolerated.

Psychotherapy:

Behavioral therapy.

Parent training.

Social skills training if ASD suspected.

Lifestyle Interventions:

Structured routine.

Positive reinforcement.

Nutrition counseling.

Supportive Measures:

School accommodations (IEP/504 plan).

Family support services.

Community resources.

10. Monitoring and Follow‑Up
Regular pediatric and psychiatric visits.

Teacher and parent feedback.

Medication monitoring.

Developmental progress tracking.

11. Challenges
Diagnostic Ambiguity: Symptoms subtle.

Family Stress: Younger sibling, parental expectations.

School Demands: Increasing academic pressure.

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: Monitor for self‑harm or aggression.

Cultural Sensitivity: Address family background, school environment.

13. Case Summary
Sarah Higgins: 11‑year‑old female with normal development but difficulty sitting for meals.

Likely Diagnosis: Possible ADHD or normal variation.

Treatment: Behavioral interventions, possible pharmacotherapy, school support.

Outcome Goal: Improve functioning, support development, prevent academic/social impairment.

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

What is Sarah’s age? a) 9 b) 10 c) 11 d) 12

Where does Sarah live? a) New York b) Washington, D.C. c) Boston d) Chicago

How many siblings does Sarah have? a) None b) One younger brother c) Two sisters d) Three siblings

What developmental history is reported? a) Delayed milestones b) Met milestones on time c) Head trauma d) Learning disability

How many hours does Sarah sleep nightly? a) 5–6 b) 7–8 c) 9–10 d) 11–12

What difficulty does Sarah have at meals? a) Poor appetite b) Hard time sitting still c) Vomiting d) Food refusal

Which disorder involves inattention and hyperactivity? a) ADHD b) ASD c) ODD d) Depression

Which tool assesses ADHD symptoms? a) Conners Rating Scale b) ADOS‑2 c) CBCL d) PHQ‑9

Which tool evaluates autism? a) ADOS‑2 b) Conners c) Vanderbilt d) AIMS

Which therapy is first‑line for ADHD? a) Behavioral therapy b) Psychoanalysis c) ECT d) Dialysis

Which medication is commonly used for ADHD? a) Methylphenidate b) Clozapine c) Lithium d) Haloperidol

Which school support may be needed? a) IEP/504 plan b) Detention c) Expulsion d) None

What family stressor is present? a) Younger sibling b) Divorce c) Abuse d) Financial debt

What is Sarah’s weight? a) 55 lbs b) 60 lbs c) 65 lbs d) 70 lbs

What is the primary outcome goal? a) Improve functioning and support development b) Relocate family c) Avoid medical care d) Focus only on nutrition