| Course | D344 The Assessment and Diagnostic Process of Psychiatric Nurse Practitioner Practice |
|---|---|
| Task | Task 2 |
| Paper type | Diagnostic formulation |
| Length | About 800 words, 3 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D344 Task 2
Diagnostic Formulation: Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation, Argued Against Five Alternatives
Student Name
Leavitt School of Health, Western Governors University
D344: The Assessment and Diagnostic Process of Psychiatric Nurse Practitioners, Task 2
Course Instructor
Month Day, Year
Diagnostic Formulation: Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation, Argued Against Five Alternatives
Starting Point
This formulation builds on the earlier evaluation of the same composite patient, a paralegal in her late twenties whose primary care clinician asked whether a lifelong difficulty with focus might be ADHD. It uses only findings recorded there: her own report, her mother's collateral account, childhood report cards, a positive adult ADHD screener, the mental status examination and recent normal thyroid tests. No new history is introduced.
Criteria Matched to Findings
Attention-deficit/hyperactivity disorder (ADHD) in adults requires at least five of nine symptoms of inattention or of hyperactivity-impulsivity for at least six months, several symptoms present before age 12, symptoms in two or more settings, clear interference with functioning, and symptoms not better explained by another mental disorder (American Psychiatric Association [APA], 2022).
Inattention: she meets seven of nine symptoms: careless mistakes (citation errors), difficulty sustaining attention on long documents, not following through on tasks, difficulty organizing work, avoiding tasks needing sustained mental effort, losing things (keys and badge several times a week) and forgetfulness in daily activities. Hyperactivity-impulsivity: she meets three of nine (fidgeting, interrupting, and feeling internally restless), below the threshold of five. Onset before 12: her mother's account and third- and fifth-grade report cards describe daydreaming, incomplete work and lost belongings. Two settings: work and home (bills paid late, lost items). Impairment: a written warning at work and a six-year path through college. Together these meet criteria for ADHD, predominantly inattentive presentation, moderate severity.
Alternatives and Why Each Is Excluded
Major depressive disorder: depression can impair concentration, but she denies persistent low mood and loss of interest, her appetite and sleep are unchanged, and her attention problems began in childhood rather than with a mood change. Her current frustration follows the work warning. Excluded, with mood to be monitored.
Generalized anxiety disorder: worry can disrupt attention, but her worry is confined to work performance and follows her missed deadlines rather than preceding them; she does not worry across many domains. Excluded.
Bipolar disorder: distractibility is a feature of hypomania, but she denies any period of elevated mood, reduced need for sleep or impulsive behavior lasting days, and her symptoms are continuous rather than episodic. Excluded.
Sleep disorder, including obstructive sleep apnea: poor sleep erodes attention, yet her sleep is adequate in length, no partner has noticed breathing pauses or loud snoring, and she feels refreshed after weekend sleep. Excluded without a sleep study.
Substance or medical cause: her alcohol intake is light and limited to weekends, she uses no cannabis or stimulant drugs, coffee intake is moderate, and thyroid function was normal when checked this year. Excluded.
Specific learning disorder: this can coexist with ADHD, but she reads well, completed a degree, and her errors come from lapses in attention rather than difficulty decoding or calculating. Not diagnosed; could be assessed if problems persist after treatment.
Contributing Factors
Predisposing: a probable family history (her father's description) and childhood onset, consistent with the strong heritability described in current consensus on ADHD (Faraone et al., 2021). Precipitating: a job change two years ago that replaced one supervisor and a fixed routine with several attorneys handing her competing work, a load that exceeded the compensating strategies she had used. Perpetuating: reliance on deadline pressure to start tasks, a growing sense of failure, and no external organizing supports at work. Protective: good insight, a supportive partner, strong verbal ability and motivation to keep her job.
What Would Change the Diagnosis
Three kinds of new information would reopen the formulation. A history of a distinct period of elevated or irritable mood, reported later by the patient or a family member, would require reassessment for bipolar disorder before any stimulant is prescribed. Failure to improve with well-dosed treatment, or new symptoms after starting it, would prompt a closer look at anxiety, depression and a possible learning disorder. And any report of snoring, gasping or daytime sleepiness from her partner would justify a sleep evaluation. Naming these conditions in advance keeps the diagnosis provisional in the right way: settled enough to act on, open enough to revise.
Diagnosis and Next Steps
Diagnosis: attention-deficit/hyperactivity disorder, predominantly inattentive presentation, moderate. Screening results supported the evaluation but were not used alone to make the diagnosis, since screeners identify people who need a full assessment rather than confirming the disorder (Kessler et al., 2005). The diagnosis will be reviewed if new information emerges, particularly any sign of a mood episode. Treatment options, including medication and skills-based therapy, will be discussed at the next visit, with baseline blood pressure, heart rate and a cardiac history documented before any stimulant is considered.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., . . . Wang, Y. (2021). The World Federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789-818. https://doi.org/10.1016/j.neubiorev.2021.01.022
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256. https://doi.org/10.1017/S0033291704002892
What the D344 Task 2 instructions ask
The second D344 task asks you to formulate a diagnosis from the evaluation. Most versions ask you to match findings to diagnostic criteria, consider and exclude alternatives, describe contributing factors and state the diagnosis with specifiers and next steps. Evaluators look for criteria matched one by one to specific findings, alternatives excluded with evidence from the evaluation rather than assertion, and a formulation that remains open to new information. The formulation should build on Task 1 without repeating it. A diagnosis stated as a conclusion, without showing how each criterion is met and why alternatives do not fit, will not meet the reasoning aspects. Some versions ask for rating scales that would confirm the diagnosis.
How this D344 Task 2 example is built
The formulation begins by summarizing the starting point in two sentences. Criteria are matched to findings in order, with the symptom count and the requirements for onset, duration, settings and impairment each addressed. Alternatives are handled one at a time, each with the finding that makes it less likely, such as the absence of persistent low mood. Contributing factors are sorted into predisposing, precipitating and perpetuating groups. A short section states what would change the diagnosis, which shows the reasoning is honest about uncertainty. The final section names the diagnosis with presentation and severity and lists next steps, including rating scales and a discussion of treatment options. Each excluded alternative names the finding that argues against it.
Where the D344 Task 2 rubric puts the marks
D344 Task 2 aspects are marked competent, approaching competence or not evident. A criteria aspect checks that diagnostic criteria are matched accurately to findings. A differential aspect rewards alternatives excluded with evidence. A contributing factors aspect looks for a structured explanation of why this person has this condition now. A diagnosis aspect wants the correct name, presentation and severity. A next steps aspect asks what the clinician would do to confirm and begin care. Evaluators check that criteria are cited from the current diagnostic manual and that the formulation is consistent with the evaluation. Reasoning that openly states what would change the conclusion is credited. Evaluators notice when the formulation names both the presentation specifier and severity.
D344 Task 2 help: what sends it back
Formulations are returned most often when criteria are named but not matched. For each criterion, point to the finding that meets it. Second, alternatives are dismissed in one line. Give the specific finding that argues against each. Third, onset and impairment requirements are forgotten, which matter greatly for adult ADHD. Address them explicitly. Fourth, contributing factors are listed without structure; a predisposing, precipitating and perpetuating frame keeps them clear. Finally, avoid repeating the evaluation. Refer to it and focus on reasoning, since the formulation is scored on how you think, not on how much you rewrite. Keep the formulation shorter than the evaluation it builds on.
Get a D344 Task 2 example written to your instructions
Send the D344 Task 2 instructions and rubric aspects, plus the assessment findings or the case parameters you were given. We write a custom example to those aspects, with the differential argued from findings and the exclusions reasoned, and return it in 24-48h. The first custom sample is free.
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D344 Task 2 questions, answered
How many conditions belong in the differential?
Check your instructions, since some versions name a number. Where the choice is open, three or four genuine candidates give the reasoning enough to do, and each one needs supporting features, contradicting features and a resolution. A longer list usually thins the argument, because every condition still has to be answered on evidence rather than dismissed in passing.
Is it acceptable to leave the diagnosis provisional?
Often yes, and honest uncertainty reads stronger than false confidence when the findings genuinely do not settle it. State what is provisional, what evidence is missing and what would resolve it, then say how you would proceed in the meantime. What gets returned is uncertainty used as cover for reasoning that was never done.
Does the formulation repeat the history?
No, and treating it as a summary is a frequent cause of revision. The history says what happened; the formulation says why this person presents this way, at this moment, with these vulnerabilities and these supports. Longstanding risk, the precipitant, what sustains the problem and what protects against it should each add something the narrative alone did not explain.
How many conditions belong in the D344 differential?
Enough to cover the conditions that could explain the findings, often four to six. The sample excludes five alternatives, each with the finding that argues against it.
Where can I find a free D344 Task 2 sample paper?
The whole formulation, criteria table and differential included, is on this page with comments. Send your D344 task and evaluation for a first tailored formulation at no charge.