| Course | NU677 PMHNP Diagnosis and Management Across the Lifespan III |
|---|---|
| Unit | Unit 2 |
| Paper type | Pediatric assessment write-up |
| Length | About 790 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU677 Unit 2
An Hour of Toy-Horse Stories at Home, Not a Word at School: A Pediatric Assessment Write-Up Weaving Three Sources Into a Diagnosis of Selective Mutism
[Student Name]
Purdue University Global
NU677: PMHNP Diagnosis and Management Across the Lifespan III
Unit 2 Pediatric Assessment Write-Up
[Instructor Name]
[Date]
The child and family are composite; details are bracketed.
Reason for Referral
[Rosa], [six], was referred by her pediatrician after her first-grade teacher raised concern that she has not spoken at school since starting in [September]. She participates by pointing, nodding and drawing, and she has one friend with whom she whispers on the playground.
Sources
1. Parent interview: her mother, [Ms. P.], in person, [60] minutes.
2. Teacher report: a structured questionnaire and a [15]-minute phone call with her teacher, [Mr. D.].
3. Child observation and interview: [45] minutes in the clinic playroom, first with her mother present, then with the clinician alone for [ten] minutes.
What the Parent Reports
At home [Rosa] is talkative, bossy with her younger brother and tells long stories with her toy horses. She speaks freely with her parents, brother and grandmother. She stops talking when visitors arrive, at the pediatrician's office and in stores, where she hides behind her mother. She was a shy toddler and cried at daycare drop-off for months. Speech and language milestones were on time; a hearing screen at [four] was normal. Her mother was also shy as a child. Spanish and English are both spoken at home, and [Rosa] is fluent in both.
What the Teacher Reports
She follows instructions, completes her work and reads at grade level by pointing to words. She does not speak to adults or in class, even when asked directly, and freezes with a blank face when called on. She has not spoken in a group activity. She is not disruptive. The teacher initially wondered about a language delay but notes that her written work and comprehension are strong.
What Was Observed
With her mother present, [Rosa] whispered to her mother and nodded or shook her head to the clinician's questions. She played with the horses in the playroom and, after about [20] minutes, narrated quietly to her mother while the clinician was turned away. When the clinician spoke to her directly, she stopped and looked down. Alone with the clinician she did not speak but drew a picture of her horses and pointed to answer questions. Her play was imaginative and age-appropriate; eye contact was brief but present when not asked to speak.
Integrating the Sources
All three sources agree that she can speak fluently and wants to communicate, and all three show that speaking stops wherever she feels watched by people outside her family. The parent establishes normal language at home in two languages. The teacher establishes the consistent absence of speech at school over five months. The observation shows the switch happening in real time as the audience changes.
Differential Diagnosis
1. Selective mutism. Consistent failure to speak in specific social situations where speaking is expected, despite speaking in others, lasting more than one month and not limited to the first month of school, interfering with school, and not explained by a language problem or another disorder. She meets these criteria. Selective mutism is now classed among the anxiety disorders and is closely linked to social anxiety (Muris & Ollendick, 2015).
2. Language disorder or bilingual adjustment. Unlikely: she is fluent in both languages at home and understands instruction fully.
3. Autism spectrum disorder. Unlikely: her play is imaginative, her social interest is clear, and her speech at home is reciprocal.
4. Hearing impairment. Excluded by the normal screen and her response to quiet speech.
5. Social anxiety disorder. Likely comorbid, given her behavior with visitors and in stores.
Selective mutism is less rare than once thought; in a school-based sample of kindergarten to second-grade children, its prevalence was [0.71] percent, and although affected children improved over six months, they remained impaired compared with peers (Bergman et al., 2002).
Plan
1. Diagnosis: selective mutism with probable social anxiety, explained to her mother as an anxiety problem about speaking in front of others, not defiance.
2. Treatment: a behavioral program based on graded exposure to speaking, starting with whispering to her mother at school and gradually adding her teacher. In a randomized pilot trial, integrated behavior therapy for selective mutism improved speaking behavior at school compared with a waitlist, with gains maintained at three months (Bergman et al., 2013).
3. School: meet with her teacher to remove pressure to speak on demand and to plan small steps, such as her mother visiting the classroom after school.
4. Reassess in [twelve] weeks; consider medication only if she does not respond to behavioral treatment.
References
Bergman, R. L., Gonzalez, A., Piacentini, J., & Keller, M. L. (2013). Integrated Behavior Therapy for Selective Mutism: A randomized controlled pilot study. Behaviour Research and Therapy, 51(10), 680-689. https://doi.org/10.1016/j.brat.2013.07.003
Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 938-946. https://doi.org/10.1097/00004583-200208000-00012
Muris, P., & Ollendick, T. H. (2015). Children who are anxious in silence: A review on selective mutism, the new anxiety disorder in DSM-5. Clinical Child and Family Psychology Review, 18(2), 151-169. https://doi.org/10.1007/s10567-015-0181-y
The Purdue Global NU677 Unit 2 instructions
Unit 2 asks for a pediatric psychiatric assessment that draws on several informants, typically a parent, a teacher and the child. Expect to describe the reason for referral, what each source reports, what you observed, how the sources fit together, a differential diagnosis and a plan. Write-ups usually run two to four pages. Graders look for integration: a single account built from all sources, with any disagreements explained, rather than three separate summaries. Developmental history, language background and hearing must be addressed in young children. The plan should reach into school as well as home, since that is where many childhood problems are most visible and where they must be treated.
Inside the NU677 Unit 2 example
The write-up opens with the referral and lists the three sources with their length and setting. Each source then has its own short section: the mother's account of a talkative child at home and a shy toddler, the teacher's account of a capable pupil who freezes when asked to speak, and the clinician's observation of whispering to her mother and silence when addressed. An integration paragraph, with a highlighted sentence, states what all three sources agree on. Five possible diagnoses are weighed, with the Muris and Ollendick review and the Bergman prevalence study. A four-step plan cites the Bergman trial of integrated behavior therapy and includes her teacher.
NU677 Unit 2 rubric: what earns full points
Pediatric write-ups are usually marked on use of multiple informants, integration, developmental and cultural context, diagnostic reasoning and the plan. The informant row earns full points when each source is described with its limits. Integration is where many write-ups fall short; the best ones name what each source adds and where they agree. Context rewards attention to language background, milestones and hearing. Diagnostic reasoning is judged on criteria applied to the child and alternatives ruled out with evidence. The plan earns credit when it involves both home and school, sets a timeline for review, and holds medication back until behavioral treatment has had a fair trial.
NU677 Unit 2 help: mistakes that cost points
A common error is reading a child's silence at school as defiance or shyness and waiting for it to pass. Another is diagnosing a language disorder without checking how the child speaks at home. Students often forget bilingual context, which can matter for a child learning in a second language. Some write-ups describe each informant but never combine them. Others recommend medication first. And plans that leave the teacher out miss the setting where the problem lives; a teacher who stops calling on the child in front of the class may remove pressure better than any clinic session can. Remember too that the parent's own anxiety, if present, shapes what the child avoids, so a plan that coaches the family at home often matters as much as the sessions in the clinic.
Get an NU677 Unit 2 example written to your instructions
Pediatric cases in NU677 Unit 2 arrive with different informants, so list the reports your case includes, parent, teacher or others, and forward the case alongside the rubric. Within 24-48h a free first write-up follows, joining those sources into a single developmental account, testing rivals with evidence and putting non-drug treatment where the evidence places it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU677 papers and MSN samples
- NU677 Unit 1: Hallucinations Across the Lifespan Post
- NU677 Unit 3: Consent and Assent Analysis
- NU677 Unit 4: Perinatal Risk-benefit Paper
- NU677 Unit 5: Seminar Reflection
- NU677 Unit 6: Deprescribing Review
- NU677 Unit 7: Delirium and Dementia Differential
- NU677 Unit 8: Capacity Assessment
- NU677 Unit 9: Legal Duty Brief
- NU677 Unit 10: Lifespan Case Synthesis
- NU676 Unit 2: SNAPPS Presentation, Bupropion Insomnia
- MN501 Unit 2: Role Analysis Paper
- NU675 Unit 2: Antipsychotic Continuation Decision
- MN502 Unit 2: Philosophy of Nursing Statement
NU677 Unit 2 questions, answered
Which rating scales suit a young child's assessment?
Choose instruments validated for the age and the question, and name what each measures. For selective mutism, parent questionnaires such as the Selective Mutism Questionnaire and teacher versions cover different settings, and broader checklists can screen for co-occurring anxiety. State the informant for each score, since a teacher's rating and a parent's rating of the same child answer different questions.
Does a pediatric write-up need a developmental history?
Yes. Milestones, temperament, onset timing and family history often explain more than current symptoms alone. For a young child, include speech and language milestones, early temperament such as behavioral inhibition, and what changed around onset. Keep it focused on what bears on the diagnosis and the plan rather than a full chronology from birth.
When would medication appear in a pediatric plan like this?
Usually after behavioral treatment has been tried, and only with the reasoning shown. For many childhood anxiety presentations, psychotherapy with family and school involvement comes first. If a prompt calls for a medication discussion, keep regimens bracketed, cite pediatric evidence and leave that call with the prescriber and parents jointly.
Where can I find a free NU677 Unit 2 sample paper?
The full NU677 Unit 2 pediatric assessment write-up is on this page, with three sources, an integration paragraph, a five-item differential and a home-and-school plan, plus three references. A write-up built from your own informants can be requested.
How common is selective mutism in NU677 Unit 2?
In a school-based sample of young children, its prevalence was 0.71 percent, higher than once thought. Affected children improved somewhat over six months but stayed impaired compared with classmates, which supports treating rather than waiting.