You are working in a community health center as an np.

Case Study
You are working in a community health center as an NP. Although you see children for mental health you will also see children for some basic “bridge” care until primary care providers have openings. If the medical issue is complex then the clinic coordinator will escalate the referral for quicker appointment scheduling.
Presentation: Makala, who is 7, has come to the clinic with a suspected ear infection and as a referral for her daughter’s behaviors. Makala’s mother says that her daughter has been rocking rhythmically and clutching her ear at the same time. There has been some moisture on her pillow in the morning and Makala is reluctant to let her mother investigate what is wrong.
Makala is attempting to rock while she is seated on her mother’s knee and uses the same repetitive vocalization “Don’t wanna go to the shops” over and over again.
She has a history of speech delay but can now complete many full sentences. She has also had some behavior and attention issues in school. She disrupts the teacher often and then gets up from her seat during focus time to go to play centers. She is not easily redirected and becomes argumentative.
She feels hot to touch and will not let healthcare practitioners approach her with any equipment. Her vocalization becomes louder and more insistent when you attempt the examination.
Recognizing possible autism as well as some ADHD diagnosis criteria, discuss the next steps in the answers to the questions.
Write a 2-3 page paper answering the following questions. Be sure to include a minimum of 2 scholarly articles to support your discussion.
1 Discuss autism and ADHD diagnostic criteria.
2. How should you approach examining Makala as a child, and strive to gain her trust?
3. You suspect that autism may be a possibility. What should you do to ensure that your suspicions are correct and how should you go about referring Makala to the local autism team?
4. Makala is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?

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