Brook – Complete Clinical Encounter 10
Year-Old Female 2026 Pediatric i-Human
Case Study: Avery Presenting with
Declining School Performance and Slipping
Grades
## SECTION 1: PATIENT DEMOGRAPHICS & CHIEF COMPLAINT
| **Patient Name** | Avery Brook |
| **Age** | 10 years old |
| **Sex** | Female |
| **Grade** | 4th–5th Grade |
| **Setting** | Outpatient Pediatric Primary Care Clinic |
| **Informant** | Mother (primary historian); Avery provides
supplemental history |
| **Chief Complaint (Mother's words)** | *"Her teacher says she is
not paying attention in class and her grades have dropped
significantly over the past year."* |
| **Chief Complaint (Avery's words)** | *"I'm not as smart as I used
to be."* |
| **Referred By** | School counselor and classroom teacher |
---
,## SECTION 2: HISTORY OF PRESENTING ILLNESS (HPI)
### OLDCARTS Framework
| Component | Findings |
|-----------|----------|
| **Onset** | Gradual onset approximately 6–8 months ago; subtle
signs may have begun in 3rd grade; significant worsening over past
2–3 months |
| **Location** | Symptoms present in **school AND home**
settings; particularly during structured tasks requiring sustained
attention |
| **Duration** | Persistent symptoms for ≥6 months; no symptom-
free periods reported |
| **Character** | Inattention, daydreaming, forgetfulness,
disorganization, difficulty following multi-step instructions, losing
school materials, incomplete assignments, careless errors |
| **Aggravating Factors** | Classroom settings with high stimulation,
unstructured time, lengthy reading assignments, homework requiring
sustained mental effort, afternoon hours, noisy environments |
| **Relieving Factors** | One-on-one adult supervision, high-interest
activities (art, preferred reading), physical activity breaks, quiet
environments |
| **Timing** | Symptoms present throughout school day; worsen as
day progresses; homework that should take 20–30 minutes often
takes 2–3 hours |
, | **Severity** | Grades dropped from A/B range to C/D range;
teacher reports only 40–50% of classwork completed; homework
frequently forgotten or lost |
### Narrative HPI
Avery Brook is a 10-year-old female presenting with her mother for
evaluation of declining academic performance and inattention.
Mother reports Avery was a bright, enthusiastic student through 2nd
grade, earning mostly A's and B's. Beginning in 3rd grade, teachers
noted increasing difficulty with attention, task completion, and
following multi-step instructions. Grades have since declined to C's
and D's in core subjects, with significant worsening over the past 2–3
months .
At home, Avery frequently loses school items (pencils, homework
folders, library books), requires multiple reminders to complete
simple tasks, and becomes easily frustrated with homework. Mother
notes homework takes 2–3 hours nightly despite being designed for
20–30 minutes of work. Avery frequently forgets to bring home
assignments and loses papers between school and home .
Teacher reports Avery stares out windows during instruction, does
not complete in-class assignments, misses transitions, and requires
individual redirection 6–10 times per class period. Teacher notes
Avery appears "in her own world" but is **not disruptive** to peers.
She is described as socially warm and cooperative when redirected,
with no oppositional behavior .
Year-Old Female 2026 Pediatric i-Human
Case Study: Avery Presenting with
Declining School Performance and Slipping
Grades
## SECTION 1: PATIENT DEMOGRAPHICS & CHIEF COMPLAINT
| **Patient Name** | Avery Brook |
| **Age** | 10 years old |
| **Sex** | Female |
| **Grade** | 4th–5th Grade |
| **Setting** | Outpatient Pediatric Primary Care Clinic |
| **Informant** | Mother (primary historian); Avery provides
supplemental history |
| **Chief Complaint (Mother's words)** | *"Her teacher says she is
not paying attention in class and her grades have dropped
significantly over the past year."* |
| **Chief Complaint (Avery's words)** | *"I'm not as smart as I used
to be."* |
| **Referred By** | School counselor and classroom teacher |
---
,## SECTION 2: HISTORY OF PRESENTING ILLNESS (HPI)
### OLDCARTS Framework
| Component | Findings |
|-----------|----------|
| **Onset** | Gradual onset approximately 6–8 months ago; subtle
signs may have begun in 3rd grade; significant worsening over past
2–3 months |
| **Location** | Symptoms present in **school AND home**
settings; particularly during structured tasks requiring sustained
attention |
| **Duration** | Persistent symptoms for ≥6 months; no symptom-
free periods reported |
| **Character** | Inattention, daydreaming, forgetfulness,
disorganization, difficulty following multi-step instructions, losing
school materials, incomplete assignments, careless errors |
| **Aggravating Factors** | Classroom settings with high stimulation,
unstructured time, lengthy reading assignments, homework requiring
sustained mental effort, afternoon hours, noisy environments |
| **Relieving Factors** | One-on-one adult supervision, high-interest
activities (art, preferred reading), physical activity breaks, quiet
environments |
| **Timing** | Symptoms present throughout school day; worsen as
day progresses; homework that should take 20–30 minutes often
takes 2–3 hours |
, | **Severity** | Grades dropped from A/B range to C/D range;
teacher reports only 40–50% of classwork completed; homework
frequently forgotten or lost |
### Narrative HPI
Avery Brook is a 10-year-old female presenting with her mother for
evaluation of declining academic performance and inattention.
Mother reports Avery was a bright, enthusiastic student through 2nd
grade, earning mostly A's and B's. Beginning in 3rd grade, teachers
noted increasing difficulty with attention, task completion, and
following multi-step instructions. Grades have since declined to C's
and D's in core subjects, with significant worsening over the past 2–3
months .
At home, Avery frequently loses school items (pencils, homework
folders, library books), requires multiple reminders to complete
simple tasks, and becomes easily frustrated with homework. Mother
notes homework takes 2–3 hours nightly despite being designed for
20–30 minutes of work. Avery frequently forgets to bring home
assignments and loses papers between school and home .
Teacher reports Avery stares out windows during instruction, does
not complete in-class assignments, misses transitions, and requires
individual redirection 6–10 times per class period. Teacher notes
Avery appears "in her own world" but is **not disruptive** to peers.
She is described as socially warm and cooperative when redirected,
with no oppositional behavior .
