Provided education to client and family regarding symptoms and neurobiology of illness.

Chief Complaint: “I just moved to this area, and we need a good pediatrician for her down syndrome management, and I wanted her to get her yearly physical”.
History of present illness: the patient is 5 years old female with dx of down syndrome presenting with her mother for transfer of care and had concerns about recent changes in her daughter’s behavior. Her mother thinks she is anxious. The mother reported worrying about her daughter’s adjustment to the new preschool. As she noticed, she started biting her nails, she withdrawn, and her teacher reported that she saw her twisting hair. That is so different from her behavior at her old school, where she never raised her hand or talked. Her mother thinks she is anxious. She reports the anxiety did not affect her sleep. She goes to bed at 8 pm and wakes up at 630am. She sleeps through the night but seems a bit more restless lately, flipping around in her bed and messing with the pillow and blankets. However, her mother reported she noted She now falls asleep in the car on her way home from school, which She never did on her way home from her previous school, and That drive was even longer. She noticed an increase in the loudness of her snoring and Episodes in which she stops breathing during sleep. She is not specific on when she started seeing the increase in snoring and what aggravated it. The mother also reported that the patient’s eating had changed drastically in the past few months. Previously she would eat whatever we put in front of her, but now she only wants to eat carbs. She will eat two servings of mac and cheese, then cry for more an hour later because she is full. The mother reported she has noted her daughter had gained over the last 6-12 months.
Please do the differential diagnosis and the plan For each differential diagnosis provide rationality with DM5 I included an example below
Differential Diagnosis:
Adjustment disorder
Anxiety Disorder, Unspecified
Obstructive sleep apnea
Treatment Plan/Recommendation SHOULD FOLLOW EVIDENCED-BASED PRACTICE GUIDELINES.
Provided education to client and family regarding symptoms and neurobiology of illness.
1. Recommended psychotherapy for ongoing adjustment disorder. Rationale backed with citation
2. The client was educated to see PCP for sleep apnea Rationale backed with citation
3. The client to follow up 3-4 weeks and call provider with questions or concerns Rationale backed with citation
4. Also include referrals for PCP, speech therapy, special education, blood work.( TSH, FT4, polysomnography/sleep study ). Rationale backed with citation
Example
Diagnosis and Differentials
309.81(F43.10) posttraumatic stress disorder
Rationale: The client with a previous diagnosis of PTSD and inpatient hospitalizations in the past. She endorses symptoms (ITEMIZED DSM-5 SYMPTOMS HERE AS INDICATED IN YOUR HPI) of irritability, nightmares, flashback, hypervigilance, anger, anxiety, and fear after a recent encounter with the alleged man that raped her. She is reliving the traumatic experience with new-onset insomnia and nightmares. These symptoms are consistent with the diagnosis of PTSD and have been ongoing for greater than one month (INDICATE HERE HOW LONG/TIMING IS ESSENTIAL) According to APA, 2021, a client with the above symptoms presenting for more than 1 month met the criteria for the diagnosis of PTSD.