Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical–thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical–thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Expert Answer and Explanation

Subjective:

CC (Chief Complaint):
Sarah’s mother reports persistent inattentiveness, distractibility, forgetfulness, and fidgeting behavior. Teachers and caregivers express concern over Sarah’s ability to focus, remain seated, follow instructions, and complete assignments accurately.

HPI (History of Present Illness):
Sarah Higgins is a well-behaved and helpful young child who was brought in for an evaluation of attention-related issues.  Since kindergarten, Sarah has battled inattention, distractibility, and forgetfulness, according to accounts from her mother and teacher.  She frequently misplaces valuables like her personal possessions or geography book.  Teachers have noticed that she frequently gets up from her seat and struggles to remember assignments unless they are in writing.  She still has a tendency to lose the list.  Her academic performance as well as her interactions with professors and peers have been affected by these symptoms, which have persisted throughout her academic career.

Past Psychiatric History:

• General Statement: No prior psychiatric diagnoses or treatments.
• Caregivers: Lives with her mother; parents are separated, but working toward reunification.
• Hospitalizations:
• Medication Trials:
• Psychotherapy or Previous Psychiatric Diagnosis:

Substance Use History:
Sarah denies any use of tobacco, alcohol, or illicit drugs. As a minor under the care of her mother, there is no indication of exposure or experimentation.

Family Psychiatric/Substance Use History:
No known psychiatric disorders were reported in immediate family. Her father had a history of alcohol misuse but achieved sobriety through Alcoholics Anonymous. No psychiatric diagnoses in either parent were disclosed.

Psychosocial History:
Sarah is a school-age child who resides with her mother at the moment.  Despite their separation, the parents are making an effort to get back together.  She has never experienced trauma or abuse.  Although the separation might be a contributing factor to her emotional stress, the family relationship seems supportive.  Sarah sometimes fantasizes about going home to play with her dog, Conley, because she loves spending time with him.  She feels depressed about being apart from her mother as well.  Her academic struggles have caused her to display dissatisfaction and low self-esteem, especially when she tries hard yet consistently makes mistakes.

Medical History:
No chronic medical conditions reported. Immunizations are assumed up to date. No known history of neurological conditions, developmental delays, or head injuries.

• Current Medications:
• Allergies: No known drug or food allergies.
• Reproductive Hx: Not applicable (minor prepubescent patient).

Review of Systems (ROS):

• GENERAL: Denies fever, chills; mother notes distractibility and occasional fatigue.
• HEENT: Denies headaches or visual problems.
• SKIN: No rashes or changes noted.
• CARDIOVASCULAR: No chest pain or palpitations.
• RESPIRATORY: No shortness of breath or cough.
• GASTROINTESTINAL: No nausea, vomiting, or constipation.
• GENITOURINARY: Not applicable.
• NEUROLOGICAL: Denies seizures or weakness.
• MUSCULOSKELETAL: No joint pain or stiffness.
• HEMATOLOGIC: No bleeding or bruising.
• LYMPHATICS: No lymphadenopathy.
• ENDOCRINOLOGIC: No polyuria, polydipsia, or temperature intolerance.

Objective:

Physical Exam:

Sarah appears to be a healthy child who shows no symptoms of physical neglect or malnourishment.  She is dressed suitably for the situation and her age, showing that her caregivers are paying enough attention to her appearance and personal cleanliness.  There were no obvious anomalies or gross motor deficiencies observed during the examination, and her physical development seems to be in line with her chronological age.

Throughout the assessment, she made good eye contact and behaved cooperatively, indicating that she was at ease and interested in the examiner.  No tremors, abnormal motor movements, gait abnormalities, or symptoms of physical distress were present.  The results of the physical examination are often unimpressive and lend credence to the idea that behavioral and cognitive problems should be the main focus of future psychiatric evaluation.

Diagnostic Results:
ADHD rating scales completed by two teachers and mother indicate consistent symptoms of inattention, distractibility, and impulsivity across different settings. These assessments support a diagnosis of ADHD, Combined Presentation.

Assessment:

Mental Status Examination (MSE):

• Appearance: Clean, well-groomed
• Behavior: Cooperative, shy but responsive
• Speech: Clear, age-appropriate, delayed response latency
• Mood: “Fine”
• Affect: Constricted but appropriate
• Thought Process: Goal-directed, some tangentiality due to distractibility
• Thought Content: Age-appropriate, denies suicidal or homicidal ideation
• Cognition: Alert and oriented x3
• Insight: Limited due to developmental age
• Judgment: Appropriate for age

Differential Diagnoses:

1. ADHD, Combined Presentation (F90.2)
   • Meets DSM-5-TR criteria with symptoms of inattention (losing items, forgetfulness, daydreaming, poor task completion) and hyperactivity/impulsivity (fidgeting, leaving seat, difficulty sitting still). Symptoms present for more than 6 months and cause impairment in academic functioning (Lukomski et al., 2022).
2. Adjustment Disorder with Mixed Disturbance of Emotions and Conduct (F43.25)
   • Considered due to her reaction to parental separation, which may be exacerbating inattention and emotional sensitivity. However, the persistent nature of her symptoms predates the separation, and the symptom profile is better explained by ADHD (Isakov et al., 2023).
3. Generalized Anxiety Disorder (F41.1)
   • Some overlap such as inattentiveness and physical restlessness can occur, especially in academic settings (Mukhametzyanova et al., 2025). However, Sarah does not report excessive worry or physiological signs of anxiety such as headaches, muscle tension, or insomnia. Anxiety is ruled out as the primary diagnosis.

Critical Thinking Process:

Several possible diagnoses were closely compared using the DSM-5-TR criteria. A combined presentation was chosen Based on symptoms, multi-setting incidence, impact on social and academic functioning.  The persistent and widespread symptom pattern led to the exclusion of adjustment disorder (Dragan et al., 2021).  Though they lacked the required symptom cluster, mood and anxiety disorders were taken into consideration.

Pertinent Positives:

• Difficulty sustaining attention in tasks
• Frequently loses items
• Difficulty organizing tasks
• Easily distracted and forgetful
• Fidgeting and inability to remain seated
• Symptoms present in both school and home environments

Pertinent Negatives:

• No hallucinations or delusions
• No suicidal or homicidal ideation
• No evidence of trauma or abuse

Reflection Notes:

In order to evaluate Sarah’s internal experience more thoroughly, more focus may be made on speaking with her directly if the session were to be repeated.  Occasionally, she showed passive engagement and showed deference to her mother.  More honest answers could be obtained by using kid-friendly evaluation instruments or innovative interviewing techniques.  Informed consent and a developmentally appropriate explanation of the session’s goal are crucial from an ethical standpoint.  Parental participation must be considered with confidentiality.

Both Sarah and her mother should get health promotion that emphasizes ADHD as a neurodevelopmental issue rather than a moral failing (Dragan et al., 2021).  Behavioral therapy, school-based assistance, and the possibility of stimulant prescription, pending additional evaluation, should all be included in intervention strategies.  It is necessary to keep an eye on Sarah’s age, parental divorce, and potential emotional foundations. Cultural perceptions of mental health and parental stressors such as single parenting, and socioeconomic concerns should guide family-centered treatment planning.

References

Dragan, M., Grajewski, P., & Shevlin, M. (2021). Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic. European journal of psychotraumatology, 12(1), 1860356. https://doi.org/10.1080/20008198.2020.1860356

Isakov, R. I., Herasymenko, L. O., Kydon, P. V., Fysun, Y. O., Belov, O. O., Pshuk, N. G., & Skrypnikov, A. M. (2023). Predictors of the formation and features of the clinical picture of adjustment disorders. https://repository.pdmu.edu.ua/handle/123456789/20366

Lukomski, M., Caruso, D., Thompson, K., & Di Natale, M. (2022). A program to improve the assessment of a child for attention deficit hyperactivity disorder. Journal of Child and Adolescent Psychiatric Nursing, 35(2), 164-170. https://doi.org/10.1111/jcap.12361

Mukhametzyanova, A. K., Petelin, D. S., & Isaikin, A. I. (2025). The effect of anxiety and depressive disorders on pain intensity, quality of life, and physical activity in patients with chronic non-specific neck and low back pain. Consilium Medicum, 27(02), 112-116. https://doi.org/10.26442/20751753.2025.2.203152

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