Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Fear, according to the DSM-5-TR, is the emotional response to real or perceived imminent threat, whereas anxiety is a
Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
“Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2022). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.
For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5-TR criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR criteria.
- Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
- Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
- By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
- Identify at least three possible differential diagnoses for the patient.
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
- Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
- Objective: What observations did you make during the psychiatric assessment?
- Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
- Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
LEARNING RESOURCES
Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
- Chapter 9, Anxiety Disorders
- Chapter 10, Obsessive-Compulsive and Related Disorders
- Chapter 11, Trauma- and Stressor-Related Disorders
- Chapter 31.11 Trauma-Stressor Related Disorders in Children
- Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence
- Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence
WEEK 4 NRNP 6635 ASSIGNMENT DRAFT
Week 4: Anxiety Disorders, PTSD, and OCD
Your own experiences might tell you that expectations from family, friends, and work—as well as your own expectations regarding achievement, success, and happiness—can create stress. Stressors are a normal part of life, and stress traditionally has been viewed as an adaptive function with a set of physiological responses to a stressor. In a situation where stress is perceived, the organism is physiologically prepared to attack or flee from the threat. Those with effective fight or flight responses tended to survive long enough to reproduce, so we are descended from those who are genetically hardwired for self-protection. When you experience stress, your biology, emotions, social support, motivation, environment, attitude, immune function, and wellness all feel the ripple effect.
This stress response is an adaptive response the human body has to threats; however, stress can also be difficult to handle and—depending upon the nature and intensity of the stress—can result in anxiety disorders, obsessive-compulsive disorders, or trauma- and stressor-related disorders. This week, you will focus on these disorders and explore strategies to accurately assess and diagnose them.
Learning Objectives
Students will:
· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
· Formulate differential diagnoses using DSM-5-TR criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan
Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
“Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2022). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.
For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5-TR criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR criteria.
· Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
· Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
· By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
· Consider what history would be necessary to collect from this patient.
· Consider what interview questions you would need to ask this patient.
· Identify at least three possible differential diagnoses for the patient.
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
· Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
· Objective: What observations did you make during the psychiatric assessment?
· Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
· Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
·
LEARNING RESOURCES
Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
· Chapter 9, Anxiety Disorders
· Chapter 10, Obsessive-Compulsive and Related Disorders
· Chapter 11, Trauma- and Stressor-Related Disorders
· Chapter 31.11 Trauma-Stressor Related Disorders in Children
· Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence
· Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence
·
https://www.youtube.com/watch?v=-BwzQF9DTlY
PLEASE CHOOSE ONE VIDEO SELECTION TO WRIT ABOUT.
TRANSCRIPT 21 VIDEO (PTSD)
Search transcript
00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:00______________________________________________________________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERA Nice to meet you Sergeant. I'm Dr. Schwartz.
00:00:20SERGEANT Nice to meet you, sir.
00:00:25OFF CAMERA Can you tell me why you came here today.
00:00:30SERGEANT My fiance suggested, well demanded that I make an appointment.
00:00:40OFF CAMERA Why was she concerned?
00:00:45[Sighs]
00:00:45SERGEANT Three nights ago, we went with her sister and husband to a county fair. Carnival rides, cotton candy, toss balls at bottles, and win big panda bears, all that silly, old-fashioned stuff, but we were having a good enough time.
00:01:15OFF CAMERA So all was going well.
00:01:20SERGEANT Then these fire works go off. No warning. Just big, full sky explosions.
00:01:30OFF CAMERA Like county fairs do.
00:01:35SERGEANT I didn't know they did that.
00:01:40OFF CAMERA Then what happened?
00:01:45SERGEANT I took off running. Fast as I could. Tried to find cover.
00:01:55OFF CAMERA Frightened?
00:02:00SERGEANT [Sighs] Yeah, scared the… you know, out of me.
00:02:10OFF CAMERA You didn't expect the fire works.
00:02:10SERGEANT These two cops saw me running, I guess they thought I pickpocketed someone, maybe tried to rob a poor country person and I was running away. They took me down, tried to cuff me.
00:02:30OFF CAMERA Wow.
00:02:35SERGEANT So I yelled "I'm a combat veteran sir." Immediately they backed off. They were veterans, understood.
00:02:50OFF CAMERA They understood that the fireworks sounded like combat fire?
00:02:55SERGEANT Yeah, exactly sir. God. [Sighs, quivering]. They helped me to my feet, gave me some cold water. I was shaking pretty bad.
00:03:10OFF CAMERA So they were helpful?
00:03:15SERGEANT Yeah, absolutely.
00:03:20OFF CAMERA The explosive sounds took you back in time.
00:03:25SERGEANT I was… I was right back in the middle of enemy fire, sir.
00:03:35OFF CAMERA What about other loud noises?
00:03:40SERGEANT The same. Last week, a car backfired, I jumped behind a magazine rack. Even a sudden circular saw cutting into wood and I'm… right back there.
00:04:05OFF CAMERA Are there any smells that set you off?
00:04:10SERGEANT Yeah, it's funny you should ask. Yes sir. Diesel fuel. I hate smelling diesel fuel. Chopper smells. And last week, Charlie, my neighbor, was grilling for Jenna's birthday and he singed some hair on his arm. No injury but… the smell… I had to leave the party pretty fast.
00:04:55OFF CAMERA What came to mind?
00:05:00[He pauses, struggling to hold back tears].
00:05:10SERGEANT Two of my buddies, they got burned when their Humvee was blown and I smelled their… I'd rather not talk about that, sir.
00:05:40OFF CAMERA Memories are too strong?
00:05:45SERGEANT Yeah, way too strong.
00:05:50[sil.]
00:05:55OFF CAMERA Do you ever dream about these events?
00:06:00SERGEANT Every night, sir. Yeah, makes me not want to crawl in bed, not close my eyes.
00:06:10OFF CAMERA So you have nightmares. You startle easily. Are there any other problems that you've noticed?
00:06:20SERGEANT Like what, sir?
00:06:25OFF CAMERA Other cues that cause flashbacks or make you anxious?
00:06:35SERGEANT Traffic. I hate real busy, downtown traffic. Stopping at a traffic light, with people in front of you and behind you, on both sides of you. I can't stand that. I start breaking out in a sweat, I start shaking, and I can't catch my breath.
00:07:05OFF CAMERA What about traffic is so bad?
00:07:10SERGEANT Someone could roll an IED under your car. You're trapped. You can't get out.
00:07:25OFF CAMERA That happened overseas?
00:07:25SERGEANT Yeah. Yeah, to four of my buddies. Blew'em to hell. And I saw it happen to two other vehicles. I didn't know the guys but… God several times we'd be stuck in traffic, and people were staring at us. And I knew we were going down. Men, women, children. I mean, any of 'em could'a rolled an IED under us.
00:08:10[He breathes heavily]
00:08:15OFF CAMERA You look like you're breathing heavily right now just talking about it.
00:08:20[Holding back]
00:08:20SERGEANT Yeah, sorry, sir. I can't help it.
00:08:30OFF CAMERA Any other difficulties?
00:08:40SERGEANT Sometimes my fiance argues with her mother. It used to not matter. Now I can't handle it. It seems like any negative situation and I just want to crawl into a hole and hide. I'm a wimp, a freaking coward. I don't, I don't want to go anywhere. I don't want to go out to restaurants, or shopping or even to baseball parks. I just stay in my room all day. Afraid to sleep. It's bad.
00:09:40OFF CAMERA Have you talked to anyone else about this?
00:09:45SERGEANT Just you. Just now. I don't want to remember.
00:09:55OFF CAMERA You're very brave for sharing your story with me. I know that must be horribly difficult for you.
00:10:05SERGEANT Sometimes my stomach muscles get tight. I start getting nauseated.
00:10:15OFF CAMERA Your body is reacting normally to bad events that you've experienced.
00:10:20SERGEANT I don't want to be a whiner.
00:10:25OFF CAMERA You know, talking can actually help your brain to heal. Talking takes it out of the feeling mode and puts it into the thinking mode so that you don't hear those same stories over and over again. So in a way you feel like you're in control. We could work on this together.
00:10:55SERGEANT I would like that, sir. Very much.
00:11:00OFF CAMERA Good. Let's get you scheduled for an appointment then.
00:11:05SERGEANT Thank you, sir. Sometimes I feel like it's never going to end. You know I thought I was going to crazy. Sometimes my mind just sinks back into itself, like I can't see or hear or move. It's like I'm numb all over. Lose track of time.
00:11:40SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com
00:11:40END TRANSCRIPT
VIDEO 21 HISTORY
Training Title 21 Name: Sergeant Berry Sullivan Gender: male Age:27 years old T- 98.8 P- 86 R 18 B/P 122/7 Ht 5’8 Wt 160lbs Background: He entered the military just after high school and did three long tours of duty in warzones. He separated from active duty in the Marines (MOS 0800 Field Artillery) six months ago after eight years of service. He is engaged to be married in 8 months and is using his GI Education Bill to attend online college for accounting. He said he grew up poor and would not do much else if he didn’t go into the military. He denies ever using any drugs and avoids alcohol because his father was “abusive when he was drunk.” Father is still alive, unwell (DM, cirrhosis, HTN), still drinking. Paternal grandfather was also a veteran and suffered depression at times though he never told anyone except the patient because of their combat connection. He has one younger brother and one older sister. He lives in a different state, approximately five hours from his parents and siblings. After the military, he and his fiancé moved because she got a much better opportunity. They want kids someday. Has service-connected asthma, seasonal allergies; no hx of psychiatric or substance use treatment.
Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-21
TRANSCRIPT VIDEO 37( ANXIETY)
Search transcript
00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:00______________________________________________________________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15PATIENT I went to the emergency department last week, because I was feeling like I was dying from a heart attack, and they did one of those, what do you call it? Ah, an EKG. And it was normal. But I was sweating and I was having trouble like catching my own breath. And my heart was pounding really, really hard. And I, and I just felt like my, my heart was just going to explode out of my chest. It almost felt like, um, like when your… I don't know, when you're in the woods. Uh, alone and, and you… you, feel like someone is, is following or, or chasing you. Or something like that. I, I just, I just my heart felt like it was about to leap out of my chest. I… And uh… I don't know, probably twelve, fifteen minutes went by and, and the feeling just went away. It just passed. But then… the next day, it was the very same thing and I, for no reason at all. Just all of a sudden, I was making coffee and then WAM, that, that, that tightness in my chest came back and I was sweating and my heart was pounding, same exact feeling. Twelve, fifteen minutes, and then it just went it away. It was like… almost it was almost like my mother, I remember she would get the same thing, probably three to four times a week. It's just sheer panic for no particular reason at all.
00:02:20SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com
00:02:20END TRANSCRIPT
Training Title 37 Name: Mr. Luca Esposito Gender: male Age:21 years old T- 97.4 P- 112 R 22 122/68 Ht 6'1Wt 198lbs Background: Lives alone in Orlando, FL raised by parents in Buffalo, NY, only child. He is a full- time student obtaining a degree for graphic design. works part-time as Uber driver. Has a girlfriend from high school. No previous psychiatric history. No medical illnesses; no history of psychiatric treatment; denied drugs or alcohol; Allergies: NKDA; sleeps 6 hrs.; appetite eats 3 meals/day, likes to keep a routine schedule.
Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-37
TRANSCRIPT 55 VIDEO (OCD, ANXIETY, PTSD)
TRANSCRIPT OF VIDEO FILE:
00:00:00______________________________________________________________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERA Hi, Mrs. Johnson.
00:00:20MRS. JOHNSON Hi.
00:00:20OFF CAMERA I'm Dr. Gray.
00:00:20MRS. JOHNSON Hi, Dr. Gray.
00:00:20OFF CAMERA Very nice to meet you.
00:00:25MRS. JOHNSON This is Matilda. Matilda, this is Dr. Gray.
00:00:25OFF CAMERA Hi, Matilda. Very nice to meet you. Matilda, can you tell me about why you came here today?
00:00:30MRS. JOHNSON Yes, we sure can. Matilda has been having headaches and stomachaches and so we thought there might be something wrong. So we went to her pediatrician, Dr. Ferguson, but Dr. Ferguson, he couldn't find a thing. So he said we had to come here to see you. And in addition to having the headaches and the stomachaches, Matilda — she hasn't wanted to go to school and, you know, she cries, and then when she gets there, she says she has a stomachache. And the teacher calls me and, of course, I come and get her right away. But we just can't keep doing this.
00:00:55OFF CAMERA And how long has that been going on that she's been missing school?
00:01:00MRS. JOHNSON Right after the holidays, so about three months.
00:01:05OFF CAMERA Three months?
00:01:05MRS. JOHNSON Yeah, last week was really the last straw. I guess that's why we kept this appointment.
00:01:10OFF CAMERA What happened?
00:01:10MRS. JOHNSON Well – well, I took Matilda to school. When we got there she refused to get out of the car. And so I had to lock the door and go inside and get the principal and the principal had to come back out and carry her into the school. I mean, it was awful and it was embarrassing for me, it was embarrassing for Matilda. It just – we just can't go on like this.
00:01:30OFF CAMERA How many children do you have?
00:01:35MRS. JOHNSON Three; Matilda is my baby.
00:01:35OFF CAMERA Ah, the youngest.
00:01:35MRS. JOHNSON Yeah, I have a 12-year-old boy and a 14-year-old girl.
00:01:40OFF CAMERA And have they ever had any difficulty similar to this?
00:01:45MRS. JOHNSON No, I think that's why this is so surprising.
00:01:50OFF CAMERA Matilda, what do you think about school?
00:01:55MATILDA I hate it.
00:01:55OFF CAMERA You hate it? You hate school?
00:01:55MATILDA Mm-hmm.
00:01:55OFF CAMERA Why do you — what do you hate about it?
00:02:00MATILDA I don't like the classwork they give me and stuff like that.
00:02:05MRS. JOHNSON Matilda makes very good grades.
00:02:05OFF CAMERA So she does okay?
00:02:05MRS. JOHNSON Yes, she's a very good student.
00:02:10OFF CAMERA Do you have friends there at school?
00:02:10MATILDA Yeah.
00:02:10OFF CAMERA Yeah? And what about the teachers? Are they nice? What's it like leaving home to go to school?
00:02:25MATILDA Scary.
00:02:25OFF CAMERA Scary? Matilda, there's no reason to be frightened.
00:02:30OFF CAMERA What — what is it that scares you when you leave home to go to school?
00:02:35MATILDA That I might get kidnapped or something.
00:02:40OFF CAMERA Kidnapped?
00:02:40MRS. JOHNSON Kidnapped?
00:02:40OFF CAMERA Have you ever known someone to get kidnapped?
00:02:45MATILDA No.
00:02:45OFF CAMERA Is anybody ever said that they were going to do that to you?
00:02:50MATILDA No.
00:02:50OFF CAMERA But that scares you when — that something is going to happen to you when you go to school?
00:02:55MATILDA Right.
00:02:55OFF CAMERA And how old are you?
00:02:55MATILDA Nine.
00:03:00OFF CAMERA Nine? Okay, and what grade are you in?
00:03:00MATILDA Third.
00:03:00OFF CAMERA Third. Is this a new kind of problem over the last few months?
00:03:10MRS. JOHNSON Yes, I had no idea that she was frightened.
00:03:15OFF CAMERA Do you know if any traumatic things have happened around the school? Or any special things at home?
00:03:20MRS. JOHNSON No, no, nothing. Nothing's has been happening at all.
00:03:20OFF CAMERA Well, Mrs. Johnson, I'd like to talk to Matilda alone for a few minutes — maybe about five minutes or so. If you could just wait in that room where you came from right next door there and then Matilda and I will talk, okay?
00:03:35MRS. JOHNSON I think that would be okay; Matilda, is that okay with you?
00:03:35MATILDA Yeah.
00:03:40MRS. JOHNSON Okay, you sure? Okay, because you know I'm always here for you, Matilda. You need me you just tap on the wall, okay, and I'll come right in.
00:03:45MATILDA Okay.
00:03:45MRS. JOHNSON Okay.
00:03:45OFF CAMERA Okay. Thanks, Mrs. Johnson.
00:03:50MRS. JOHNSON Matilda, it's okay, I'm just going to be right next door. Okay? You okay?
00:03:55MATILDA Yeah.
00:03:55MRS. JOHNSON Okay.
00:04:00OFF CAMERA Okay, Matilda, Matilda; can you just stay here — just have a seat for just a moment. We're just going to talk for about five minutes. Your mom's in the room right next door and then we'll just — and then I'll let you go get her and you can bring her back, okay? Thank you very much for sitting there. What is that like for you when your mom's away in the next room, away from you?
00:04:15MATILDA Scary.
00:04:20OFF CAMERA Scary? What's scary?
00:04:20MATILDA That she might leave and not come back.
00:04:20OFF CAMERA Like to stay away for a long time? Or forever?
00:04:25MATILDA Forever.
00:04:25OFF CAMERA Forever. Did she ever threaten that she was going to do that?
00:04:30MATILDA No.
00:04:30OFF CAMERA Did she ever leave you before?
00:04:30MATILDA No.
00:04:30OFF CAMERA Anybody ever leave you?
00:04:35MATILDA Hmm-mm.
00:04:35OFF CAMERA But you fear that's what's going to happen? You have nightmares?
00:04:40MATILDA Mm-hmm.
00:04:40OFF CAMERA When you have nightmares, what is it you dream about?
00:04:45MATILDA That mommy or daddy will be in an accident.
00:04:45OFF CAMERA In an accident? What kind of accident?
00:04:50MATILDA A car accident.
00:04:50OFF CAMERA Have they ever been in a car accident?
00:04:55MATILDA No.
00:04:55OFF CAMERA What about almost had an accident?
00:04:55MATILDA No.
00:04:55OFF CAMERA Have you ever known someone who was in a car accident?
00:05:00MATILDA No. Can she come out and –
00:05:00OFF CAMERA Just, just a minute. When it gets dark and night time, what's that like for you?
00:05:10MATILDA Scary.
00:05:10OFF CAMERA The dark scares you? What is it about the dark?
00:05:15MATILDA That people are staring at me. Can she come now?
00:05:20OFF CAMERA Just a moment — just want to sit — do you feel that people are staring at you? Can you see these people?
00:05:25MATILDA No.
00
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