NRNP-6645-13/NRNP-6645S-13-Psychotherapy Mult Modalities
NRNP-6645-13/NRNP-6645S-13-Psychotherapy Mult Modalities
The Gestalt Therapist working with a patient notices that every time a sensitive issue come up the patient will change the topic and tell a joke. The therapist recognizes this interruption as which of the following?
A patient whose husband had recently died suddenly expresses remorse regarding an argument they had shortly before his death. The Gestalt Therapist would likely use which of the following techniques to complete unfinished business?
C. Empty-chair dialogue
D. Language of responsibility
In child psychotherapy consideration of systems that promote a child’s ongoing development include which of the following?
Which of the following is a philosophical approach to psychotherapy which deals with universal themes of life?
A. Gestalt Therapy
C. Existential psychotherapy
D. Person-Centered Psychotherapy
The patient in Dialectical Behavior Therapy (DBT) expresses frustration that the skills taught don’t work, the process is taking too long, and is struggling to complete homework. The advanced practice psychiatric nurse using a DBT model would do which of the following?
A. Validate the patient ‘s frustration while encouraging and reinforcing use of skills.
B. Analyze the behaviors and consequences of the behaviors with the patient.
C. Focus on behavioral control and management with emotions as a contextual element.
D. All of the above
Which of the following is not consistent with Eye Movement Desensitization and Reprocessing (EMDR) literature in treating PTSD?
A. Treatment effects are long lasting.
B. EMDR involves extended exposure
C. EMDR treatment for trauma is less time intensive.
D. The aim is to reduce the subject distress and strengthen adaptive beliefs related to the traumatic event.
In working with an older adult female patient, the advanced practice psychiatric nurse notices that the patient starts bringing her baked goods, and says “You remind me so much of my daughter, you are so easy to talk to.” The advanced practice psychiatric nurse recognizes this as
D. Time for termination
The situation in which increasing amounts of a substance is needed to achieve the same desired effect is known as which of the following?
Which of the following therapeutic approaches would be a better choice for an older adult who presents with chronic depression, mild cognitive impairment expressing concerns about a negative life event and perceives himself as helpless?
A. Interpersonal Psychotherapy (IPT)
B. Cognitive Behavioral Therapy (CBT)
C. Cognitive Behavioral Therapy for Mild Dementia (CBT-MD)
D. Reminiscence Therapy (RT)
Stigma of mental illness in the elderly:
A. Has contributed to psychiatric symptoms being expressed with physical symptoms.
B. Is much more severe in baby boomers than in other elderly cohorts.
C. Is much less an issue in baby boomers than in other elderly cohorts
D. Leads to more discussion of emotions in primary care settings.
The person-centered therapist who is genuine and authentic during the therapy session is exhibiting which psychological condition?
B. Actualizing tendency
C. Belief of human nature
D. Accurate empathic understanding
Which of the following is not consistent with a family-centered approach in child therapy?
A. In family-centered treatment, the family is the focus of treatment.
B. Family- centered treatment is appropriate to improve family interactions.
C. Family-centered treatment is appropriate to keep families engaged in services
D. Family-centered treatment is appropriate to increase family knowledge about mental health.
Which of the following does the advanced practice psychiatric nurse need to consider when treating older adults with Substance Use Disorders?
A. Co-existing medical or psychiatric disorder
B. Age-related physiological and psychological changes
C. Collaboration with primary care providers
D. All of the above
Which of the following is true about the therapeutic alliance when working with children?
A. The therapeutic alliance is a core factor that creates change in therapy.
B. The therapeutic alliance/bond with the child is all that is really needed.
C. The advanced practice psychiatric nurse must develop a strong therapeutic alliance with the child’s parents prior to attempting to engage the child in therapy.
D. As the therapy is really about the child, parents/family, the advanced practice psychiatric nurse focuses on facilitating healthy family interactions.
The underlying assumptions of Trauma Resiliency Model therapy include which of the following?
A. Human response to threat are subcortical in nature.
B. Response to trauma is likely transient and should go away with or without treatment.
C. The mind has no bias; thus, we make sense of the world in a symmetrical manner.
D. Current psychiatric concepts adequately account for the impact of multiple or long-term
The advanced practice psychiatric nurse realizes a basic assumption of Dialectical Behavior Therapy (DBT) is that therapists treating the difficult patient need support. This support includes which of the following?
A. The support is provided through case management
B. The support is designed to focus on clinical issues of the patient
C. The DBT therapist in solo practice does not need a consultation group for support.
D. The support includes a consultation group to treat the therapist by using the same skills the patient is asked to use.
The advanced practice psychiatric nurse realizes which of the following with respect to individuals with personality disorders of traits?
A. Often these individuals will see their problems as independent of their own behaviors.
B. These individuals will often describe themselves as a victim.
C. These individuals often present for treatment at the request of a significant other or other external pressure.
D. All the above.
Addiction is now recognized as which of the following?
A. A preventable personality disorder
B. A family disorder due to poor parenting
C. A volitional behavior that can be managed independently’
D. A primary disease of the brain’s neurocircuitry.
Which of the following are psychotherapeutic techniques used in person centered psychotherapy?
A. A highly structured approach is used.
B. Process interventions are widely used.
C. Directive, interpretive techniques are used.
D. A nondirective-facilitative counseling approach is used.
When referring a patient to a 12-step group the advanced practice psychiatric nurse realizes which of the following supports successful patient engagement in 12-step group participation?
A. Provide an overview of the 12-step approach, explain the concept of powerlessness and spirituality within the 12-step tradition.
B. Use MI to contract for attendance at several different groups to find the right “fit” and encourage attendance.
C. Encourage patient to not worry about going to the groups because due to high attrition rates, most groups have many new patients at each session.
D. A and B only
The advanced practice psychiatric nurse notices in working with a patient with a dissociative disorder that the person appears to be doing worse after significant gains are made. The advanced practice psychiatric nurse explains the reason for this is likely which of the following?
A. This indicates the change(s) really did not take
B. The patient is unconsciously sabotaging the therapy.
C. This indicates process is trying to force a change too fast.
D. As positive changes occur they may be followed by a temporary increase in sadness, anger, or anxiety because even positive change may be experienced as a loss.
Which of the following medications may be recommended for patients with insomnia due to PTSD?
A. Any antidepressant can offer as first-line treatment in adults for PTSD.
B. Non-benzodiazepines such as trazodone (Desyrel)
C. Prazosin (Minipress) may be helpful if nightmares are present.
D. B and C
Which of the following is not true about self-regulation as it applies to therapy with children?
A. Self-regulation is a developmental milestone of childhood in which the child controls behavior in the service of socially desirable conduct.
B. Self-regulation is a pivotal developmental process of integrating emotion, memory and behavior.
C. Self-regulation mechanisms from a neuroscience perspective are basic mechanisms predominantly located in the globus pallidus.
D. Self-regulation issues are often seen in various child psychopathology.
Stress inoculation therapy (SIT) can be helpful for patients with phobic avoidance due to trauma. The advanced practice psychiatric nurse using SIT would do which of the following?
A. Artistic endeavors such as sculpting, drawing painting.
B. Movement therapies such as dance.
C. Tapping on acupressure points
D. Cognitive skills such as thought stopping and guided self-dialogue.
The advanced practice psychiatric nurse using Dialectical Behavior Therapy with a patient with borderline personality disorder uses persuasive dialogue to do which of the following?
A. Invite the patient to new ways of viewing a situation
B. Guiding patient to develop more skills to achieve a greater quality of life.
C. Engage the patient in change talk
D. A and B
Which of the following is not consistent with the Dialectical Behavior Therapy approach to boundary maintenance?
A. Clarify explicitly the boundaries of the therapeutic relationship.
B. The therapist will maintain confidentiality within the limits of the law and ethical practice.
C. Explain a professional relationship is based on mutual respect and the desire to help the patient.
D. Maintain a rigid distant relationship with the patient to avoid any mixed messages to the patient.
One of the problems when meeting with children individually is that it can create secrets. Which of the following responses would the advanced practice psychiatric nurse do to address this concern?
A. Do nothing, maintaining the child’s privacy protects the therapeutic relationship.
B. Decide what the parents need to know and give them a summary of the individual session in with the child in the room.
C. Decide what the parents need to know and give them a summary privately to avoid any awkwardness for the child.
D. Discuss with the child what he or she wants to share with the parents and facilitate the process as needed.
Sleep disturbances are common for those who have experienced trauma. Which of the following would not be recommended when teaching patients about good sleep hygiene?
A. Regular daily exercise
B. Avoid napping during the day.
C. Maintain a quiet cool bedroom
D. Put bedroom TV on a timer so it will automatically go off after you are asleep.
Which best describes gerotranscendence?
A. Erik Erikson’s ninth stage of development
B. Emphasizes ongoing growth over decrements
C. Focuses on the transition to old-old (80 years and older).
D. Focuses on letting go and coming to terms with end of one’s life
Evidence-based therapeutic modalities for treating older adults with anxiety include which of the following:
A. Cognitive Behavioral Therapy, Relaxation training, Biofeedback
B. Dialectical Behavior Therapy, Reminiscence Therapy, Biofeedback
C. Guided Imagery, Music Therapy, Yoga
D. A and C
Which of the following is not consistent with recommendations for teaching Trauma Resiliency Model (TRM) skills?
A. TRM self-care skills can be taught and used in any order.
B. TRM skill may be taught in individual or group settings
C. To teach TRM skills, the therapist should be adept at using the skills themself.
D. Teaching TRM is cost effective as only one teacher is needed individually or with groups.
In working with an older female patient, the advanced practice psychiatric nurse notices the patient seems to respond superficially reminding the advanced practice psychiatric nurse of her own mother and finds herself looking forward to their sessions, which recently have been going longer than scheduled. The advanced practice psychiatric nurse recognizes this as
D. A sign of a close therapeutic relationship
The advanced practice psychiatric nurse using supportive psychotherapy with a patient with a preoccupied attachment style would use which of the following interventions?
A. Active interventions to facilitate emotional expression and connection.
B. Supportive interventions to help the patient contain overwhelming emotions.
C. Any interventions on the psychodynamic continuum with not customizations.
D. None of the above. Attachment style has no bearing on psychodynamic therapy.
The advanced practice psychiatric nurse using Dialectical Behavior Therapy with a patient diagnosed with a personality disorder explains that for success in treatment, the patient must attend the individual and group skills sessions consistently. It is explained to the patient that if four sessions are missed consecutively the treatment will end. Which of the following is true about this rule?
A. This is a guideline, not a requirement.
B. It gives the patient control over his or her commitment to treatment
C. This is one of the optional rules for Dialectical Behavior Therapy and may be done at the therapist’s discretion.
D. This is a therapeutic strategy to exert control over the patient and therapy process.
Dysregulation of this area of the brain is associated with memory problems and this person may be unable to integrate memories into the present and personal memory into identity, and thought to underlie symptoms of flashbacks, nightmares, avoidances and dissociation.
A. Locus coeruleus
Which of the following is not consistent with a humanistic-existential approach?
A. Awareness allows one freedom to make choices.
B. Authenticity allows a person to be fully response for choices.
C. Given the appropriate conditions a person will automatically grow in positive ways.
D. Part of aliveness is living with feelings of dread, guilt, and anxiety.
Emotion-Focused therapy integrates which of the following?
A. Person-centered therapy and Gestalt therapy
B. Gestalt therapy and Neuroscience research of emotions.
C. Neuroscience research of emotions and Person-centered therapy.
D. Person-centered therapy, Gestalt therapy and Neuroscience research of emotions.
Which of the following is consistent with the psychotherapeutic approach used by existential psychotherapists?
A. The existential approach has a specific set of techniques used.
B. The existential relies on the patient to drive the therapeutic direction.
C. The existential therapist presents broad existential themes but avoids in-depth questioning.
D. The existential psychotherapist is free to draw on techniques from other psychotherapeutic models .
Which of the following is not consistent with a family-centered approach in working with children/adolescents?
A. The family is the focus of the treatment
B. Family treatment is appropriate to improve family interactions.
C. Family treatment is appropriate to keep families engaged in services.
D. Family treatment is appropriate to increase family knowledge about mental health.
The advanced practice psychiatric nurse is working with a patient who states she believes her boss hates her. After some discussion, it is clear the patient has strong negative feelings towards her boss. The advanced practice psychiatric nurse working within a Gestalt framework, recognizes this as an interruption consistent with which of the following?
The patient demonstrates the ability to regulate his emotions in such a way he can think through them. The advanced practice psychiatric nurse using a Dialectical Behavior Therapy approach recognizes this ability is consistent with which stage of treatment?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
A specific type of CBT therapies aimed to reduce distress as a person experiences sensation with danger is known as which of the following?
B. Exposure Therapy
C. Cognitive Rehearsal
D. Guided relaxation and meditation
Which of the following is consistent with using the Help Now! Skills
A. Help Now skills are only to be used during the therapy session.
B. Help Now skills are only to be used when the patient is hyperaroused
C. Help Now skills are only to be used when the patient is hypoaroused.
D. Help Now skills are as a kind of emotional “CPR”
The stabilization skills and concepts that form the foundation of Trauma Resiliency Model stand alone as a model in and of itself called CRM. CRM stands for which of the following?
A. Cognitive Restructuring Model
B. Cognitive Resiliency Model
C. Community Resiliency Model
D. Cognitive Regeneration Model
The primary source for constructive change in a humanistic-existential approach is which of the follow:
A. The patient’s motivation
B. The therapist’s structure
C. The therapist-patient relationship
D. The patient-family relationship
The advanced practice psychiatric nurse working with a child exposed to a traumatic event using trauma-focused cognitive behavioral therapy recognizes E in the acronym PRACTICE represents which therapeutic component of this therapeutic approach?
D. Enhancing safety
In following the rules for the Dialectical Behavior Therapy (DBT) therapist, the therapist would not do which of the following?
A. Recognize the therapist is human and fallible.
B. Make every reasonable effort to provide competent treatment for the patient.
C. Share the rules for the DBT therapist with the patient during orientation to the therapy.
D. The therapist agrees to use consultation and allow the patient to view this directly if desired.
Which of the following activities is not consistent with the first phase of the eight-phase protocol for Eye Movement Desensitization and Reprocessing (EMDR) when working with a patient who has PTSD?
B. Identification of targets.
C. Screening for use of EMDR
D. Screening for affect tolerance and dissociation
The therapeutic frame supports the clinician in which of the following ways? Select all that apply.
A. Maintaining a therapeutic stance of neutrality.
B. Maintaining a therapeutic stance of anonymity.
C. Maintaining a therapeutic stance of non-intrusiveness.
D. A and C
The most effective treatment for SUD with or without co-morbid psychiatric disorders is:
A. Multidimensional addressing medical, psychosocial and mental health issues
B. Trauma-informed care.
C. 12-Step Peer Support Groups
D. Cognitive Behavioral Therapy
Which of the following trends life trends suggests advanced practice psychiatric nurse be prepared to provide mental health and illness treatment in a variety of community and non-traditional settings.
A. More older men than women living alone.
B. Greatest percentage of older adults living in nursing homes.
C. Projected doubling of number of homeless adults between 2010 and 2050.
D. More older adults preferring to leave their homes to seek other living arrangements.
The advanced practice psychiatric nurse working with a patient with a borderline character structure realizes the psychodynamic treatment of choice for those with borderline character structure is which of the following?
A. Expressive psychotherapy
B. Supportive psychotherapy
C. Psychoanalytic psychotherapy
D. A combination of all of the above.
The advanced practice psychiatric nurse working with children/adolescents in psychotherapy is aware of which of the following?
A. The basic structure of psychotherapy with children aligns with principles of psychotherapy for adults.
B. The basic structure of psychotherapy with children for the most part is not aligned with principles of psychotherapy for adults.
C. Engaging with the family precedes engagement with the child or adolescent in the first family meeting.
D. Typically children are exited to engage in psychotherapy to improve the home situation.
Which of the following is true about use of medications and/or psychotherapy in treatment of PTSD?
A. Medications alone can cure PTSD
B. Medication may be a helpful as an adjunctive treatment but is not a first-line treatment
C. Medication directly promotes new learning and processing.
D. Medications assuage the guilt, grief and interpersonal difficulties specifically in patients with PTSD.
Evidence supports use of Dialectical Behavior Therapy patients with which of the following diagnoses?
B. New onset depression
C. Bipolar Affective Disorder
D. Borderline Personality Disorder
Memories of the drug related event may be modified through various therapies including which of the following
C. Pharmacological interventions
D. All of the above
In working with children between the ages of about 7-11 years of age, the advanced practice psychiatric nurse would include activities consistent with which of stage of Piaget’s stages of cognitive development?
C. Formal operational
D. Concrete operational
According to Wheeler et al. (2020) which of the following is NOT supported by current evidence about Mental Health in older adults?
A. At least 20% of older adults have one or more mental health or substance use conditions.
B. Mental illness is a normal part of aging.
C. There is an increasing need for behavioral health and substance abuse specialty services in primary care.
D. Mental health policy and treatment of older adults have lagged resulting in this population being underserved.
In working with an older adult patient in the termination phase the advanced practice psychiatric nurse suggests it may be helpful to teach family members ways to support the patient and prevent relapse. This demonstrates which of the following?
A. A major HIPPA violation
B. Lack of confidence in the patient and the therapeutic process of CBT
C. An appropriate strategy to solidify a supportive network for the patient.
D. Resistance to terminating the therapeutic relationship.
Which of the following screening tools is geared toward screening pregnant women for alcohol and drug abuse
Which of the following is not consistent with humanistic-experiential techniques?
A. May include working with dreams or the empty chair.
B. Use of creative arts such as drawing, music and movement.
C. Humanistic-existential therapists interpret for the patient and provide guiding advice.
D. Humanistic-existential therapists use techniques that are reflective and experimental in style.
An advanced practice psychiatric nurse who has been leading groups for patients with comorbid PTSD and Substance abuse starts experiencing disturbing dreams, anxiety, irritability , withdrawal and problems in interpersonal relationships. These symptoms are consistent with the phenomenon of:
C. Secondary traumatization
Which of the following is consistent with Trauma Resiliency Model (TRM) therapy?
A. TRM therapy facilitates patient’s awareness of pleasant, unpleasant, and neutral body sensations.
B. TRM acknowledges negative affect and it’s accompanying unpleasant physical sensations.
C. TRM therapist teaches patient techniques to intentionally modulate negative emotions by shifting away from negative sensations.
D. All of the above
The person-centered therapist is expected to exhibit which of the following characteristics?
B. Unconditional positive regard
C. Accurate empathic understanding
D. All of the above
Which of the following is not consistent with the use of mindfulness in patients requiring stabilization following trauma?
A. Mindfulness underlies all stabilization.
B. Mindfulness is described as having internal and external awareness in abundance.
C. Mindfulness allows patient to become fully aware of their experiences and enables them to react to their experiences.
D. Mindfulness allows patient to become fully aware of their experiences and enables them to respond to their experiences.
Which of the following is not consistent with the Principles of Effective Treatment for Addiction according to the NIH?
A. Treatment needs to be readily accessible.
B. Psychotropic medication should be stopped prior to treatment.
C. Treatment does not need to be voluntary to be effective.
D. Drug use during treatment must be monitored continuously as lapses may occur during treatment.
Critical goals in addiction treatment include improving impulse control, reducing craving, and promoting and adaptive social environment. Evidenced based skills that can best impact these goals include:
A. Life Review Therapy
B. Contingency Management
C. Motivational Interviewing
D. Interpersonal Psychotherapy
E. B and C
Which of the following is not consistent with what is known about relapse?
A. Relapse indicates treatment failure.
B. Relapse is a persistent risk in addiction.
C. Relapse is a characteristic of all chronic medical diseases.
D. Relapse is the return to substance use or addictive behaviors after periods of abstinence.
The patient in Dialectical Behavior Therapy with a history of self-harming through cutting, has shown progress in effectively using skills to manage urges integrating skills to manage emotions and behaviors with increased awareness of self. The advanced practice psychiatric nurse recognizes the patient is ready for which of the following?
A. The patient is ready to focus on self-fulfillment
B. The patient is ready to focus on self-efficacy
C. The patient is ready to begin exposure therapy.
D. The patient is ready to begin termination from therapy.
The advanced practice psychiatric nurse encourages the older adult to recall long forgotten experiences, events which are memorable to the person. This is known as
A. Life Review Therapy (LRT)
B. Reminiscence Therapy (RT)
C. A Mindfulness Strategy
D. Interpersonal Psychotherapy (IPT)
The advanced practice psychiatric nurse working with a patient with borderline personality disorder is aware that which of the following attachment styles has been highly correlated with Borderline personality disorder?
A. Secure attachment style
B. Unresolved attachment style
C. Preoccupied attachment style
D. Disorganized attachment style
A natural process whereby the individual is continually disturbed by the emergence of a need, strives to restore equilibrium by constantly reorganizing and adapting to changing circumstances in recognized by the Gestalt therapist as which of the following?
A. Figure and ground
B. Organismic self-regulation
C. Layers of the personality
D. None of the above
Positive substance use disorder treatment out-comes unique to women can be strengthened by which of the following.
A. Valuing the significance of relationships
B. Recognizing generalized psychobiological attributes and healthcare needs.
C. Minimizing focus on societal roles and gender expectations.
D. All of the above
Dysfunctional processes, developed early in life that people employ in an attempt to meet their Needs, are referred to by the Gestalt therapist as which of the following?
B. Figure and ground
C. Layers of personality
D. Organismic self-regulation
The loss of control over the intense urge to take a drug even at the expense of adverse consequences is known as which of the following?
D. A craving
The advanced practice psychiatric nurse using a Dialectical Behavior Therapy approach with a patient with Borderline Personality Disorder explains the four essential elements which includes all but which of the following?
A. Bi-weekly individual therapy sessions for the patient of about 1 hour each.
B. Weekly group skills training sessions for the patient of 2.5 hours each.
C. Skills coaching via telephone or other electronic means as needed by the patient to manage I vivo situations
D. Team consultation to the therapist to maintain treatment fidelity and adherence
The patient in Dialectical Behavior Therapy (DBT) is focusing of self-efficacy, interdependence and self-dependence. At times, the patient seems bored with therapy, and reports dealing quickly and effectively with self-harming urges that have resurfaced. The advanced practice psychiatric nurse using the DBT model would do which of the following?
A. Do nothing different.
B. Increase the frequency and intensity of contact.
C. Decrease the frequency and intensity of contact.
D. Express concern to the patient about premature distancing and regression
Recovery, according to behavioral health leaders, is considered a lifelong process that encompasses which four major dimensions:
A. Health, Wealth, Relationships, Sleep
B. Health, Home, Purpose and Community
C. Purpose, Personality, Health, Relationships
D. Community, Relationships, Wealth, Health
In using trauma-focused cognitive behavioral therapy with a child exposed to domestic violence the advanced practice psychiatric nurse realizes the first component of this structured approach includes which of the following?
A. Relaxation skills
B. Problem solving skills
C. Constructing the trauma narrative
D. Psychoeducation with child and parent about trauma response and what causes it.
The purpose of Mindfulness-Based Stress Reduction in the older adult is
A. To avoid using psychotropic medications
B. To escape from stressful situations and relationships
C. To learn to be present in the moment non-judgmentally.
D. To avoid stigma of traditional psychotherapy
Challenges assessing psychiatric symptoms in the elderly include which of the follow
A. Denial of symptoms.
B. Age-related variations in symptom presentation.
C. Making of symptoms by comorbid disorder and medications.
D. Difficulty in obtaining an accurate mental health history.
When using a Dialectical Behavior Therapy (DBT) approach with a patient with Borderline Personality Disorder the advanced practice psychiatric nurse knows which of the following is inconsistent DBT assumptions about patients?
A. Patients can fail in therapy.
B. Patients are doing the best they can.
C. Patients need to do better, try harder and be more motived to change.
D. Patients may not have caused all their problems, but they need to solve them anyway.
The patient in Dialectical Behavior Therapy (DBT) complains the skills being taught in DBT don’t work, struggles with keeping diary cards, and doing assigned homework. This is consistent with which stage of treatment within the DBT model?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Which of the following is not consistent with a “traditional” treatment frame?
A. Enforcing established starting and ending times for each session.
B. Establishing and enforcing a clear policy in regard to payment.
C. Canceling sessions if the patient arrives under the influence of alcohol or psychoactive drugs.
D. Disclosing home or cellular phone number of therapist for emergency use only.
Which of the following would be an appropriate response by the advanced practice psychiatric nurse to a mother of a three-year-old who is concerned that her child is not able to regulate emotions?
A. Let me refer you to a behavioral therapist to help you with that.
B. For children younger than 4 years, inability to regulate emotions is the norm.
C. You have a valid concern, a three-year-old should be able to regulate emotions.
D. This may be an early indication of ADHD, we will need to do a comprehensive assessment.
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