Brooke Harbor Health System
PMHNP Clinical Learning Environment
Condition Guide
Attention, social communication, learning, and adaptive functioning are understood across development. Establish onset, collateral history, and impairment across settings before naming a disorder, and look for the co-occurring conditions that are the rule rather than the exception.
Clinical application
Apply these prompts within the simulated clinical context. They support—but do not replace—clinical judgment, supervision, consultation, current guidance, local policy, law, or emergency procedures.
Diagnostic Features
DSM-5-TR diagnosis requires onset in the developmental period, impairment, and exclusions, not symptom counts alone.
Six or more inattentive and/or hyperactive-impulsive symptoms (five or more at age 17 and older) for at least 6 months; several symptoms present before age 12 and in two or more settings; symptoms interfere with functioning and are not better explained by another disorder. Specify combined, predominantly inattentive, or predominantly hyperactive-impulsive presentation.
Persistent deficits in social-emotional reciprocity, nonverbal communication, and relationships, plus at least two restricted or repetitive patterns (stereotyped movement or speech, insistence on sameness, intense interests, sensory hyper- or hyporeactivity). Symptoms begin early but may not be apparent until demands exceed capacity. Specify support level, intellectual and language impairment, and associated conditions.
Deficits in intellectual functioning confirmed by clinical assessment and individualized standardized testing, with deficits in conceptual, social, and practical adaptive functioning, beginning in the developmental period. Severity is defined by adaptive functioning, not IQ score alone.
Persistent difficulty with reading, written expression, or mathematics despite targeted intervention, with skills substantially below age expectations on standardized achievement measures, beginning during school-age years and not better explained by intellectual disability, sensory deficits, or inadequate instruction.
Language disorder, speech sound disorder, childhood-onset fluency disorder, and social (pragmatic) communication disorder. Social (pragmatic) communication disorder is distinguished from autism by the absence of restricted, repetitive patterns.
Developmental coordination disorder and stereotypic movement disorder. Tic disorders are covered in the Obsessive-Compulsive, Tourette's, and Tic Disorders guide.
Open the OCD & Tic Disorders guide →Rating Scales & Screening
Screening supports case finding and follow-up; diagnosis requires a comprehensive evaluation.
Adult ADHD self-report screener (6-item screener and 18-item symptom checklist). Source: Harvard Medical School / World Health Organization. The 6-item screener is free with attribution; the full checklist has separate clinical, academic, and commercial permission terms through NYU.
6-item screener: Official source ↗
18-item symptom checklist: Official access terms ↗
Parent and teacher ratings of ADHD symptoms, impairment, and common co-occurring conditions for school-age children. Source: American Academy of Pediatrics / NICHQ. The first edition (2002) is free to download; newer editions are purchased through AAP.
Official source ↗Two-stage autism screening for toddlers 16–30 months, with follow-up interview. Source: mchatscreen.com. Free downloads are subject to the authors' guidelines; reposting, software distribution, and some other uses require permission or licensing.
Official source & access terms ↗Brief adult autism screening questionnaire used to guide referral for specialist assessment. Source: Autism Research Centre, University of Cambridge. Free for non-profit use, including research and education; for-profit healthcare, commercial, and IT uses may require fees and a licence agreement.
Official source & access terms ↗Assessment & Differential
Milestones, school records and report cards, prior evaluations, teacher and caregiver input; for adults, childhood history from a parent, sibling, or old records when possible.
Hearing and vision, sleep disorders including sleep apnea, seizures, thyroid disease, lead exposure, medications, substance use, and genetic or syndromic causes; refer for genetic evaluation when intellectual disability or autism is diagnosed.
Anxiety, depression, trauma, bipolar disorder, sleep deprivation, substance use, learning or language disorders, intellectual disability, and an unstable or unsafe environment can resemble or accompany ADHD. ADHD and autism can be diagnosed together. Oppositional defiant disorder, conduct disorder, and disruptive mood dysregulation disorder often co-occur with ADHD; see the Child & Adolescent Psychiatry specialty area.
Child & Adolescent Psychiatry specialty area →Assess in the person's preferred language with a qualified interpreter; learning two languages is not a language disorder. Girls, women, and adults may camouflage autistic traits or present with predominantly inattentive ADHD, delaying diagnosis.
Treatment
Ages 4–5: parent training in behavior management first, with methylphenidate considered if improvement is insufficient and impairment persists. Ages 6–11: FDA-approved medication with parent training and/or behavioral classroom interventions. Adolescents: medication with the adolescent's assent, plus behavioral and skills-based interventions. Coordinate school supports.
Stimulants (methylphenidate and amphetamine formulations) are first-line pharmacotherapy; nonstimulants are options when stimulants are unsuitable or not tolerated. CBT for adult ADHD and organizational skills coaching help with function. Before prescribing, review cardiac history and family history of sudden death, blood pressure and heart rate, substance use, and diversion risk, and check the prescription monitoring program. Stimulant labeling carries a boxed warning for misuse, abuse, addiction, and diversion.
No medication treats the core features. Offer developmental and behavioral supports, speech-language and occupational therapy, and caregiver-mediated interventions, and treat co-occurring conditions. Risperidone and aripiprazole are FDA-approved for irritability associated with autism in youth; monitor metabolic and movement effects.
Educational supports, accommodations, and adaptive-skills training. Psychiatric care focuses on co-occurring conditions. A change in behavior may signal pain, illness, or a medication effect, so avoid diagnostic overshadowing and minimize polypharmacy.
Monitoring & Coordination
Appetite, weight, and growth in youth; blood pressure and heart rate; sleep, mood, tics, and misuse or diversion. With antipsychotics, monitor metabolic labs and involuntary movements (AIMS).
Individualized Education Programs (IDEA), Section 504 plans, college disability services, and workplace accommodations under the ADA.
Pediatric-to-adult care transfer, supported decision-making or guardianship when needed, vocational and day supports, and state developmental disability services.
Caregiver stress, respite, sibling needs, and safety planning such as wandering and water safety for some autistic children.
Clinical Sources
These sources support clinical reasoning but do not replace a complete assessment, current prescribing information, local policy, consultation, or individualized shared decision-making.
Diagnosis, evaluation, and treatment of ADHD in children and adolescents.
Open source ↗Developmental surveillance, evaluation, supports, and coordinated care for children with autism.
Open source ↗Evidence-based conclusions about ADHD across the lifespan.
Open source ↗Assessment, treatment, monitoring, and support for children, young people, and adults with ADHD.
Open source ↗Recognition, diagnosis, assessment, and management of autism in adults.
Open source ↗Current FDA labeling for medication-specific dosing, contraindications, warnings, and monitoring.
Open source ↗