Primary Care of the Psychiatric Mental Health Client II

Pediatric Case Study Video Transcript

Madeline is a 10-year-old girl of African American descent who was brought into the clinic by her parents, who report that she is constantly washing her hands at home and at her grandmother’s house. She spends about two hours at night preparing for bed and must complete specific routines every evening before going to sleep. Madeline brushes her teeth at least 10 times daily and her belongings all must be in the same place every night. She gets up from bed and repeatedly checks her belongings before she can lie down.

She lives with her parents and two older siblings in a two-family house where her grandmother lives upstairs. Her teacher is very worried about her because she does not complete her school assignments and continually rewrites her schoolwork even when it appears perfect to her teacher. Madeline’s routines and insistence on perfection are interfering greatly with normal functioning. She’s late for school and cannot complete tasks and has no friends. She had a couple neighborhood friends until about a year ago. Her parents noticed these routines about two years ago, but they have become much worse over the last six months.

Madeline is a well-developed child of average height and weight, with hands that are red, chapped, and rough. She used to play soccer but can no longer stay out in the field for more than three minutes at a time. Madeline appears very anxious and asks to go to the bathroom frequently, where she then washes her hands. Six months ago, Madeline’s father lost his job in the hotel industry and her mother had to increase her hours at work as a certified nursing assistant.

Madeleine has been spending increased time with her grandmother, who mother describes as a “germophobe.” Madeleine is afraid her mother will bring Covid-19 home and her grandmother will get sick. She screams and cries to stop mother from leaving to go to work. Madeleine says she can’t “get these thoughts out of her head.”

Madeline's parents are concerned about “drugging” her and are specifically concerned about side effects of any kind of medications.