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PS10.1,PS11.1 | Developmental Psychiatry — Assignment
CLINICAL SCENARIO
A clinical vignette-based assignment requiring students to differentiate between ADHD, Autism Spectrum Disorder, and Intellectual Disability Disorder in a school-age child, articulate the diagnostic reasoning using DSM-5 criteria, and construct a realistic multidisciplinary management and referral plan. This assignment develops the clinical reasoning skills central to PS10.1 and PS11.1 at the 'Knowledge with How-to' (KH) level, preparing students for integrated patient care in developmental psychiatry.
Instructions
Read the following vignette carefully, then complete each section below. Base your responses on DSM-5 diagnostic criteria and evidence-based management guidelines (Ahuja's Textbook of Postgraduate Psychiatry and Kaplan & Sadock's Synopsis of Psychiatry are recommended references). Cite specific criteria where relevant. Your total response should be 600-900 words.
VIGNETTE:
Rahul is a 9-year-old boy brought to the outpatient psychiatry department by his mother. His class teacher has written a referral letter stating: "Rahul is unable to sit still, frequently disrupts the class, does not complete written work, and cannot follow multi-step instructions. He has been like this since preschool." His mother adds that at home Rahul rarely finishes a meal without leaving the table, loses his school bag repeatedly, and cannot wait his turn during family games. She also mentions that Rahul does not seem interested in making friends, prefers to play alone with his toy trains (arranging them in very specific patterns), and becomes extremely upset if the trains are moved or the arrangement changed. He uses language to communicate his basic needs but rarely initiates conversation. His IQ on assessment is reported at 62, with significant deficits in adaptive functioning (self-care requires prompting, cannot manage money, limited social skills).
Length: 600-900 words
What to Submit
Section 1: Differential Diagnosis — Distinguish the Three Neurodevelopmental Disorders
Using DSM-5 criteria, identify which features in Rahul's vignette support (and which argue against) each of the following three diagnoses: (a) ADHD, (b) Autism Spectrum Disorder, and (c) Intellectual Disability Disorder. Present this as a systematic analysis. Note any DSM-5 rule regarding co-diagnosis that is relevant to Rahul's presentation.
Section 2: Final Diagnostic Formulation
State the most likely DSM-5 diagnosis (or diagnoses) for Rahul, with all applicable specifiers (for ASD: intellectual impairment status, language impairment status; for IDD: severity level). Justify your choices with reference to specific DSM-5 criteria met in the vignette. Address whether ADHD can be co-diagnosed with ASD under DSM-5.
Section 3: Multidisciplinary Management Plan
Outline a realistic, stepwise management plan for Rahul covering: (a) psychoeducation for the family, (b) non-pharmacological interventions (specify type and rationale), (c) pharmacological considerations if any (with first-line agent and evidence base), and (d) school-based accommodations. Indicate who in the multidisciplinary team would lead each component.
Section 4: Referral and Follow-Up
Describe the referrals you would make (to which specialists and for what purpose) and your follow-up plan. Include one key outcome you would monitor at the 3-month review to assess whether the management plan is effective.
Grading Rubric — Developmental Psychiatry Assignment Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Diagnostic accuracy and DSM-5 application: Correct identification of diagnostic features for ADHD, ASD, and IDD with accurate reference to DSM-5 criteria (e.g., onset age, duration, setting requirements for ADHD; two-domain model for ASD; three-criterion triad for IDD) and correct application of DSM-5 co-diagnosis rule. | 10 pts | All three diagnoses accurately analysed using correct DSM-5 criteria; co-diagnosis rule correctly stated; specifiers (ASD severity, IDD severity, intellectual/language impairment) all correctly applied. |
| Clinical reasoning and differential justification: Systematic comparison of features for and against each diagnosis; clear identification of which features overlap across conditions and which are discriminating; justified final formulation. | 10 pts | Thorough differential reasoning with explicit discussion of overlapping and discriminating features; final formulation clearly justified with vignette evidence. |
| Multidisciplinary management plan: Comprehensive plan covering psychoeducation, non-pharmacological interventions (with correct evidence-based choices — behavioural therapy, ABA/ESDM for ASD, parent training for ADHD, life-skills for IDD), pharmacological considerations (methylphenidate for ADHD; no curative drug for ASD/IDD; drugs only for comorbidities in IDD), and school accommodations. Team roles identified. | 10 pts | All four components covered with evidence-based, condition-specific interventions; correct pharmacological reasoning (methylphenidate as first-line for ADHD; no curative drug for ASD/IDD); multidisciplinary team roles correctly identified. |
| Referral, follow-up, and outcome monitoring: Appropriate referrals (e.g., special educator, occupational therapist, speech-language therapist, paediatrician for medication monitoring, social welfare) with stated purpose; follow-up interval; specific, measurable outcome indicator chosen. | 10 pts | Appropriate referrals to relevant specialists with clear stated purpose; realistic follow-up plan; specific measurable outcome (e.g., ADHD rating scale score, adaptive functioning reassessment) identified. |
| Clarity, structure, and academic writing: Assignment follows the four-section structure; responses are appropriately focused; medical terminology used correctly; within word guidance; references to Ahuja or Kaplan & Sadock included where relevant. | 10 pts | Clear, well-structured response following all four sections; accurate medical terminology; within word count; at least one literature reference incorporated. |
PEER REVIEW
As a peer reviewer, read your classmate's response against the rubric above. For each criterion: (1) note one specific strength, (2) identify one specific area for improvement, and (3) assign a score. Your feedback should be specific and evidence-based — reference particular sentences or points in the response. Avoid vague praise ('good job') — explain why a response demonstrates understanding or where a DSM-5 criterion has been misapplied. Your review should be at least 200 words total across all criteria.