Ava is a seven-year-old girl, the second of two children of a middle-class family living in a suburban area of a northwest city. Ava has one sister that is two years older than she is. Her mother’s pregnancy was normal, with no complications and Ava’s birth was normal. Ava had colic the first three months, cried extensively and was difficult to comfort. After three months, she became passive and cried very little with comfort from her mother. Her growth and development appeared to be normal. She met all the developmental milestones her first three years. She interacted normally with her sister and parents, except that she would become tearful and anxious when her parents would get a babysitter.
At age four, she was in nursery school and appeared to function normally except during the first month when Ava had difficulty when her father would drop her off at school. The nursery school was a small private school with a lot of personal attention given to each child. Although shy, she made friends and liked going to nursery school after she became adjusted to the new setting. Her parents liked the school so much that they decided to keep Ava in kindergarten at this school with her same teachers and friends. However, tuition at the school became a problem after Ava’s mother became sick with lupus and was unable to work.
At age six, Ava’s parents enrolled her in first grade at the public elementary school in their neighborhood. For the last two weeks, she has refused to go to school and has missed six school days. She began routinely brushing her hair before bed and insisted on making sure each side was brushed with an even number of strokes. She also had her mother tuck her in bed on the right side and her father come after on the left side each night. She would become very tearful and upset if the routine was not followed. She is awake almost all night worrying about going to school and asks the same questions over and over about the environment, teachers, and other students. As the start of the school day approaches, she cries and screams that she cannot go, chews holes in her shirt, pulls her hair, digs at her face, punches the wall, throws herself on the floor, as well as experiences headaches, stomachaches, and vomiting. Over the past two weeks, she has become gloomy, has stopped reading for fun, and frequently worries about her mother’s Lupus and that she may die. She asks her every night if she has dreamed about her funeral. In addition, Ava is phobic of dogs, avoids speaking and writing in public, and wets the bed every night.
Her parents immediately made an appointment to see her PCP. Her doctor conducted a thorough physical exam, found no physical abnormalities and then referred her to you, a Family PMHNP.
Family history of mental health includes the following: mother has a history of panic disorder; her father has a history of treatment with medications for ADHD as a child; and she has a cousin diagnosed with Asperger’s syndrome.
For your assignment, write a paper that addresses the following prompts using evidence-based references to support your answers:
Summarize the case.What is your provisional diagnosis, as well as the possible differentials?Justify your answer with DSM-5 criteria (be short, brief and to the point).Is Ava too young to diagnose, or is there a basis for early identification and intervention?What psychiatric scales or assessment tools might you use with this patient? With the parents? List and describe briefly.What would be your treatment plan for medications, if any? If you do choose to offer medication as part of the treatment plan, please address the following medications issues:Target symptomsReceptors affectedPsychiatric and system effectsPossible parental concernsWhat would be your school-based treatment plan, if any?What would be the implications for the families of children and adolescents with these diagnostic pictures?How does the mother’s health play into the picture of Ava’s diagnosis? What type of therapy would you recommend for Ava (and her family) to work through her issues?Identify resources for patients/families with this diagnosis in the form of community groups, web-sites, advocacy, as well as treatment resources available in your service area.What are you worried about (if anything)? Consider this question in terms of treatment, assessment, alliance, compliance, effectiveness, safety, and other factors.
GRADING RUBRIc
Assignment Criteria
Level III
Level II
Level I
Not Present
Criteria 1
Level III Max
Points: 15
Level II Max
Points: 13
Level I Max
Points: 9
Not Present
0 Points
Content of Paper
● Demonstrates a well-articulated
understanding of the subject matter in a clear, complex, and informative
manner
● Develops content and theories are well
● Links content to the paper requirements and practical
experience
● Includes relevant material that fulfills all
objectives of the paper
● Uses scholarly resources that were not provided
in the course materials
● Completes all instruction requirements
● Demonstrates an understanding of
the subject matter
● Explains and applies knowledge
of evidence-based practice, ethics, theory, and/or role
● Uses a variety of scholarly resources from
the course material and some that were not provided in the course materials
● Includes relevant material that
fulfills all objectives of the paper.
● Completes all instruction requirements
● Demonstrates a moderate
understanding of the subject matter
● Summarizes content with minimal
application to evidence-based practice, theory, or role-development
● Presents content but is missing
depth and or development
● Uses only scholarly resources
that were provided in the course materials
Completes most instruction
requirements
● Does not meet the criteria
Criteria 2
Level III Max
Points: 15
Level II Max
Points: 13
Level I Max
Points: 9
Not Present
0 Points
Analysis and Synthesis of Paper Content and
Meaning
● Provides critical analysis in an accurate,
clear, concise, and complete presentation of the required content
● Synthesizes information from scholarly
resources
● Provides new information or insight related
to the context of the assignment with both supportive and alternative
information or viewpoints
● Completes all instruction requirements
● Provides evidence of further synthesis of
course content via scholarly resources
● Synthesizes information to help fulfill
paper requirements
● Supports content with at least one
viewpoint.
● Completes all instruction requirements
● Lacks clarification or new
information
● Supports content with scholarly
reference without adding any new information or insight
● Provides content that may be
confusing or unclear, and the summary may be incomplete
● Completes most instruction requirements
● Does not meet the criteria
Criteria 3
Level III Max
Points: 10
Level II Max
Points: 8
Level I Max
Points: 6
Not Present
0 Points
Application of Knowledge
● Offers a multidisciplinary
approach via scholarly resources
● Applies practice that is
accurate and plausible
● Supports practice with
additional scholarly resources
● Answers all questions posed
within the assignment in a well-developed manner with citations for
validation
● Completes all instruction requirements
● Presents a summary of the
paper’s content, findings, and knowledge gained
● Indicates how the information
will be used within their professional practice
● Completes all instruction requirements
● Lacks objective criteria
● Applies superficial bridge
between the assignment and the broader course content
● Indicates how they will apply
this new knowledge to their clinical practice in a vague manner
● Completes most instruction requirements
● Does not meet the criteria
Criteria 4
Level III Max
Points: 5
Level II Max
Points: 4
Level I Max
Points: 3
Not Present
0 Points
Organization
● Provides well-organized content with a clear
and complex purpose statement and content argument
● Provides concise writing with a logical flow
of ideas
● Provides organized content with
an informative purpose statement and supportive content and summary statement
● Provides argument content with
minimal issues in content flow
● Provides poor organization, and
flow of ideas distract from content
● Provides a purpose statement
● Provides narrative that is
difficult to follow and frequently causes reader to reread work
● Does not meet the criteria
Criteria 5
Level III Max
Points: 5
Level II Max
Points: 4
Level I Max
Points: 3
Not Present
0 Points
College-level academic writing
●
Includes
no more than three grammatical, spelling, or punctuation errors that do not
interfere with the readability
●
Meets
the assignment length requirements
●
Includes
no more than four grammatical, spelling, or punctuation errors that do
not interfere with the readability
●
Meets
the length requirements
●
Includes
five or more grammatical, spelling, and punctuation errors makes
understanding parts of assignment difficult, but does not interfere with
readability
●
Meets
the length requirements
●
Does
not meet the criteria
Maximum
Total Points
50
42
30
0
Minimum
Total Points
43 points minimum
31 points minimum
1 point minimum
0
Updated 2/2/2021