You are a psychiatric/mental health nurse practitioner employed in a local community health center. Today you are seeing Melinda, a 4-year-old female who presents with her biological, single father. Melinda was referred by her pediatrician. The reason for the referral is a possible autism spectrum disorder. She has limited verbal skills with sensory issues. NSG590 Melinda, a 4-year-old female
1. What will be your initial approach to an evidence-based assessment of this child and her family?
The initial approach to an evidence-based assessment of this child is conducting a comprehensive interview with the Parent. The interview will involve open-ended questions, questionnaires, and checklists. The next thing would be to perform a structured observation of the child on areas such as eye contact, vocalizations, use of gestures. Other areas to observe include use of toys, pretend play, repetitive patterns, social interaction, and response to sounds, lights, textures, or other stimuli. The other aproach is to use assessment Tools.
2. What are the parameters to consider for the ultimate diagnosis, based on the assessment findings and evaluation?
It should be based on lack of ocial-emotional reciprocity, nonverbal communication, and problems maintaining relationships. It could also be based on repetitive motor movements, rigid adherence to routines, and focus disproportionate to age.
3. What would be your approach to treatment, integrating both psychotherapy and psychopharmacologic approaches?
Treatment could include psychotherapy such as speech and language therapy, occupational therapy, parent-child interaction therapy, and social skills training. Also, medications that are effective include Risperidone, Aripiprazole, Methylphenidate, Alpha-2 adrenergic agonists, Selective serotonin reuptake inhibitors (SSRIs), and Melatonin.
4. What types of support and long-term care and follow-up might be needed for this child and her family?
Melinda requires support such as Early Childhood Intervention Programs, Individualized Education Plan (IEP), structured classrooms with trained staff, peer group, ongoing social skills groups.