PMHNP: Autism Spectrum Disorder and Intellectual Disabilities

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1 Describe the clinical situation in detail. (Who was it, when did it happen, what happened, what caused it to happen, where did it happen, how did it happen). What feelings, prejudices, and biases did you experience during your clinical experience?
Clinical Situation
This is a case of B.D., a 10-year-old male child, who was brought for a consultation two months ago at the hospital clinic of the psychiatry department. The mother has a chief complaint of her child’s hyperactive behavior and poor communication skills, resulting in difficulty making and maintaining friends. The condition has been persistent for at least four months now.
The interview proved that it was challenging to have a proper conversation with the child. The child could not correctly answer the questions during the conversation, and there was a back-and-forth conversation. The child could not express his emotions adequately, and his affect was restricted. When asked about his interests, the child mentions some but the other answers are inappropriate. He cannot adequately explain the extent or intensity and the specifics of his interests. Nonverbal communication was also poor as the child could not maintain eye contact and often misunderstood the interviewer’s actions. The child also has a blank or plain facial expression most of the time.
When the interviewer attempted to change the mood from a boring to a humorous situation and vice-versa, the child could not seem to adjust and demonstrated that he could not grasp the ice breaker.
Due to the circumstances, the interviewer found it challenging to obtain reliable information from the child, and the information was relayed mainly by his mother. The child’s expressions and responses puzzled the interviewer. However, the interviewer was professional and immediately coped with the situation.
Feelings, Prejudices, and Biases
Initially, the nurse practitioner was having difficulty grasping the situation because the conversation did not have a proper direction. It leads to frustration on the nurse practitioner’s side. Moreover, the nurse practitioner was also minimally irritated with the patient’s facial expression because it was as if he were mocking the clinician.
According to the criteria from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, as stated by the Center for Disease Control and Prevention (2022), the patient probably has an autism spectrum disorder, and further evaluation is needed to determine if the patient also has an intellectual disability. Thus, on top of the mentioned feelings, the nurse practitioner also felt empathetic toward the patient and the patient’s family, especially the mother, because the clinician already understands the patient’s possible diagnosis and its impact on the patient and his family’s life.
Aside from the feelings mentioned, the nurse practitioner also had some prejudices and biases. The mother mentioned that the condition might be the result of vaccinations received by the child previously; that was why she was reluctant to have the child vaccinated against COVID-19. However, since she weighed the risks versu...