| Course | NUR-7641 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Child and Adolescent Populations, Part B |
|---|---|
| Module | Module 2 |
| Paper type | Case analysis: childhood anxiety |
| Length | About 1,095 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7641 Module 2
Nineteen Missed Days and a Normal Stomach: Screening, Diagnosing and Treating Separation and Generalized Anxiety in a 10-Year-Old
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7641: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Child and Adolescent Populations, Part B
Mentor Name
Month Day, Year
Nineteen Missed Days and a Normal Stomach: Screening, Diagnosing and Treating Separation and Generalized Anxiety in a 10-Year-Old
Stomachaches That Start on Sunday Night
Aaliyah, an invented patient, is 10 and in fifth grade in Camden. Since October she has missed 19 school days because of stomachaches and nausea that begin on Sunday evening and fade by midmorning if she stays home. Her pediatrician found normal growth, normal blood counts and celiac screen and no sign of constipation or reflux, and referred her for a psychiatric assessment. Her mother, a home health aide who works early shifts, says Aaliyah follows her from room to room, cannot sleep unless her mother is in the house and calls her at work several times a day to ask if she is safe.
Aaliyah also worries about many ordinary things: whether she will get a math answer wrong, whether a storm will break the windows, whether her grandmother will get sick. Her teacher describes a quiet, careful student who erases her work until the paper tears and freezes when called on. Two close friends remain, though sleepovers at their houses ended in the fall.
Screening and the Interview
Aaliyah and her mother each filled in the SCARED, a screen for anxiety disorders in children. Birmaher et al. (1997) built the 38-item SCARED from an 85-item pool tested with 341 outpatient children and adolescents and 300 parents, and found five factors: panic and somatic symptoms, general anxiety, separation anxiety, social phobia and school phobia. Both the child and parent forms showed good internal consistency and told anxious children apart from those with other disorders, although parents and children agreed only moderately. Aaliyah's mother rated her 41 and Aaliyah rated herself 36, both well above the usual cutoff of 25, with the highest subscale scores for separation and generalized worry.
The interview confirmed what the scores suggested. Her fear that something will happen to her mother has lasted far longer than four weeks and keeps her from school and sleepovers, which meets the criteria for separation anxiety disorder. Her worry about many topics, with poor sleep and a tense stomach more days than not since last spring, meets the criteria for generalized anxiety disorder. She has no panic attacks, no compulsions and no low mood beyond frustration at missing school.
Ruling Out Other Causes
Her normal workup makes a medical cause of the stomachaches unlikely, but the paper does not dismiss them: anxiety produces real physical symptoms through muscle tension and the body's stress response, and telling her the pain is imaginary would damage trust. Thyroid tests were normal. She takes no medicines that cause restlessness, drinks no caffeine and has not been bullied, according to both her and her teacher. Her mother's long work hours and a frightening car accident the family had last summer are noted as stressors that may have made her fears worse.
Therapy Alone: The Coping Cat Trial
Kendall (1994) randomly assigned 47 children aged 9 to 13 with anxiety disorders to a 16-session cognitive behavioral program or a waiting list. The program taught children to notice their body's anxiety signals, recognize anxious thoughts, plan coping steps and reward themselves, and the second half of the sessions practiced facing feared situations. Many treated children no longer met criteria for an anxiety disorder after treatment and at one-year follow-up, with improvement seen in reports from children, parents and teachers. This trial is one reason CBT is offered first for many anxious children.
Adding Medicine: The CAMS Trial
Walkup et al. (2008) tested CBT, sertraline, the two combined and a placebo in 488 young people between 7 and 17 years old who had separation, generalized or social anxiety disorder. After 12 weeks, 81 percent of those on combined treatment were rated much or very much better, against 60 percent on CBT alone, 55 percent on sertraline alone and 24 percent on placebo. Suicidal and homicidal thoughts were no more frequent with sertraline than with placebo, and no child attempted suicide, although sertraline caused more insomnia, tiredness and restlessness than CBT.
| Treatment in CAMS | Much or very much improved |
|---|---|
| CBT plus sertraline | 81 percent |
| CBT alone | 60 percent |
| Sertraline alone | 55 percent |
| Placebo | 24 percent |
Deciding With the Family
The options were explained to Aaliyah and her mother using these numbers. Because she has missed so much school and has two disorders, the family chose combined treatment rather than waiting to see whether CBT alone would be enough. Sertraline starts at a low dose and rises every two weeks as tolerated toward a moderate dose. The boxed warning about suicidal thoughts with antidepressants in young people is explained in plain terms, and her mother is told which changes to call about: new agitation, talk of death or self-harm, or sudden changes in sleep or behavior. Aaliyah is seen weekly in the first month.
Getting Back to School
CBT is delivered in 14 weekly sessions. Aaliyah learns to rate her worry on a thermometer, to notice the thought "something bad will happen to Mom" and to test it against what actually happens. Exposure is planned as a ladder: first, arriving at school with her mother and going to the nurse's office for ten minutes, then to class for the first period, then a full morning, then the full day, with her mother dropping her at the door. Her mother learns to praise brave behavior and to stop answering repeated reassurance calls.
Her school counselor joins the plan with consent. Aaliyah may go to the counselor's office once a day if she feels sick, for no more than ten minutes, before returning to class, and she is not sent home for stomachaches without a fever or vomiting. Her mother agrees to one scheduled phone call at lunch instead of many unplanned ones.
Measuring Progress
The parent and child SCARED are repeated at weeks 6 and 12, and school attendance is counted each week. A fall below the cutoff on both forms and a full week of school would show a strong response. If she has not improved by week 12, the dose and the exposure plan are reviewed before any change of medicine.
Conclusion
Aaliyah's missed school and stomachaches reflect separation and generalized anxiety disorders, confirmed with the SCARED from both her and her mother and with a careful interview. CBT alone helps many anxious children, but the CAMS trial showed that adding sertraline produced the highest response rate. A graded return to school, planned with her counselor and backed by measured follow-up, turns that evidence into a plan for her.
References
Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545-553. https://doi.org/10.1097/00004583-199704000-00018
Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(1), 100-110. https://doi.org/10.1037/0022-006X.62.1.100
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., Ginsburg, G. S., Rynn, M. A., McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753-2766. https://doi.org/10.1056/NEJMoa0804633
NUR 7641 Module 2 instructions, in plain terms
Anxiety in children ranks high among the common mental health concerns that the NUR-7641 catalog description puts at the center of Part B; because TESU keeps the course syllabus private, this module builds its case from that description. Expect an analysis that screens with a validated parent and child tool, separates anxiety disorders from one another and from medical causes, chooses between therapy alone and combined treatment using trial data, explains the antidepressant warning and plans a return to school. Some sections assign social anxiety or selective mutism instead. Confirm whether your directions require a full exposure ladder or only a summary of the therapy plan. Report the screen's scores from each informant.
Inside the NUR 7641 Module 2 example
Aaliyah's Sunday night stomachaches and normal workup open the paper. Her mother's and her own SCARED scores are reported with the scale's development data, and the interview confirms two disorders. Medical causes and stressors are reviewed without dismissing her pain. The Coping Cat trial shows what CBT alone achieves, and the CAMS trial's four arms appear in a table. The family's choice of combined treatment, the sertraline titration and the warning are explained. A graded return to school with her counselor, measures at weeks 6 and 12 and a conclusion finish the case. Margin notes explain why both informants and the warning matter. Her mother's single lunchtime call replaces many unplanned ones.
Where the marks sit in the NUR 7641 Module 2 rubric
Childhood anxiety cases are graded on screening with both parent and child reports, accurate diagnosis of each disorder present, a medical workup for physical complaints, an evidence-based choice between CBT and combined treatment, correct SSRI dosing with the boxed warning explained, and a school plan. Mentors credit trial response rates reported accurately and used in the decision with the family. An exposure ladder with concrete steps shows understanding of how CBT works. Plans that stop reassurance calls and set rules for going home sick show attention to what keeps anxiety going. The two trials and the screening study should appear in APA style. Attendance counted weekly is a strong functional measure.
Common NUR 7641 Module 2 mistakes, and how to avoid them
Students often treat a child's stomachaches as either purely medical or imaginary. Explain how anxiety causes real symptoms. Another gap is using only the parent's rating; report both. Do not start an SSRI without explaining the boxed warning and the follow-up schedule. Write the exposure steps as a ladder with times and places. Give the school counselor a defined role, and limit how long the child may leave class. State when you will review the plan if she does not respond. Your own anxiety case can go to the desk with its directions; the first draft costs nothing. Count missed school days as a measure of progress, and say what result would count as success.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7641 Module 2 questions, answered
Where can I find a free NUR 7641 Module 2 sample paper?
Aaliyah's case, from SCARED scores to a graded return to school, is printed in full on this page.
What is the SCARED questionnaire?
A 38-item parent and child screen for anxiety disorders with five factors: panic and somatic symptoms, general anxiety, separation anxiety, social phobia and school phobia.
What did the CAMS trial show?
After 12 weeks, about 81 percent of children improved with CBT plus sertraline, 60 percent with CBT, 55 percent with sertraline and 24 percent with placebo.
Is CBT alone enough for childhood anxiety?
Often it helps a great deal, as the Coping Cat trial showed, but combined treatment gave the highest response rate in CAMS and suits more severe or impairing cases.
How do you help an anxious child return to school?
With a graded plan agreed with the school: short steps toward a full day, limited visits to the nurse or counselor and fewer reassurance calls.