Backgroundkatie Is An 8 Year Old Caucasian Female Who Is Brought To Yo ✓ Solved
BACKGROUND Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition. The parents give you a copy of a form titled “Conner’s Teacher Rating Scale-Revisedâ€. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider.
According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. Katie’s parents actively deny that Katie has ADHD.
“She would be running around like a wild person if she had ADHD†reports her mother. “She is never defiant or has temper outburst†adds her father. SUBJECTIVE Katie reports that she doesn’t know what the “big deal†is. She states that school is “OKâ€- her favorite subjects are “art†and “recess.†She states that she finds her other subjects boring, and sometimes hard because she feels “lostâ€. She admits that her mind does wander during class to things that she thinks of as more fun.
“Sometimes†Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.†Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. MENTAL STATUS EXAM The client is an 8 year old Caucasian female who appears appropriately developed for her age.
Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic.
Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation RESOURCES § Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998).
Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, . Decision Point One Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING RESULTS OF DECISION POINT ONE · Client returns to clinic in four weeks · Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space†and “daydreaming†again · Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.†You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute Decision Point Two Change to Ritalin LA 20 mg orally daily in the MORNING RESULTS OF DECISION POINT TWO · Client returns to clinic in four weeks · Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day · Katie’s reports of her heart feeling “funny†have gone away.
Pulse was 92 during today’s office visit Decision Point Three Maintain current dose of Ritalin LA and reevaluate in 4 weeks Guidance to Student At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.
Paper for above instructions
Assignment Solution: ADHD Evaluation and Management - A Case StudyI. Introduction
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development (American Psychiatric Association [APA], 2013). This case study will explore the clinical evaluation and management of an 8-year-old Caucasian female, Katie, presenting with symptoms suggestive of ADHD, particularly the predominantly inattentive presentation.
II. Case Presentation Overview
Katie is evaluated after concerns were raised by her teacher regarding her inattentiveness. The teacher’s observations, recorded in the Conner’s Teacher Rating Scale-Revised, indicated several areas of concern, including inattention, distractibility, and academic difficulties (Conners et al., 1998). Despite the teacher's concerns, Katie’s parents deny ADHD symptoms, noting that she does not display hyperactive behaviors.
Katie herself expresses a sense of confusion about academic requirements, indicating a preference for subjects like art and recess while feeling bored with traditional classroom activities. The mental status exam reveals a well-functioning child without delusions or hallucinations, whose insight and judgment appear appropriate for her age.
III. Diagnostic Criteria and Assessment Tools
To determine if Katie qualifies for a diagnosis of ADHD, her symptoms must meet the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include symptoms persisting for at least six months, with onset before age 12, and causing impairment in social, academic, or occupational functioning (APA, 2013).
Katie's symptoms match several DSM-5 criteria for ADHD, particularly within the "predominantly inattentive presentation" category. The Conner’s Teacher Rating Scale has been recognized for its reliability and validity in assessing attention disorders (Kollins, 2008). The assessment reveals difficulties with organization, task completion, and sustained attention, consistent with ADHD diagnosis.
IV. Treatment Options and Decision-Making Process
The initial treatment option proposed was Ritalin (methylphenidate), a stimulant medication that typically acts to increase dopamine and norepinephrine in the brain. Following the medication regimen, Katie's parents noted improvements in the mornings; however, her inattentive symptoms returned by afternoon, as reflected in the clinical observation. Notably, Katie reported concerning cardiovascular symptoms, which prompted a reassessment of her treatment protocol.
Switching to Ritalin LA (long-acting) preparation proved beneficial, providing sustained relief from attention deficits throughout the school day without the side effects of increased heart rate. Monitoring heart rate is important in pediatric patients treated with stimulant medications, as stimulants can cause tachycardia (Wilens et al., 2008).
V. Maintenance Treatment and Monitoring
After the successful shift to Ritalin LA, which resulted in improved symptoms and absence of adverse effects, the decision was made to maintain the current dosage while continuing to monitor Katie’s progress. Using the lowest effective dose is a key tenet in pediatric pharmacotherapy to minimize side effects and potential long-term complications associated with stimulant use (Findling et al., 2016).
Regular follow-ups will be critical for ongoing assessment of Katie's progress. Strategies such as behavioral therapy may also be incorporated to provide comprehensive management of her condition (Molina et al., 2009). Engaging parents and teachers in the treatment process helps monitor Katie's behaviors across different settings, ensuring improved outcomes.
VI. Conclusion
Katie's presentation of symptoms consistent with ADHD, predominantly inattentive type, calls for a multidisciplinary approach to evaluation and management. Utilizing standardized assessment instruments like the Conner's Teacher Rating Scale provides valuable insights into the child's functioning. Through thoughtful prescribing of stimulant medications along with regular monitoring of efficacy and side effects, Katie's academic and behavioral trajectories can be positively impacted.
Continued collaboration with Katie's parents and teachers, combined with adjustments in treatment strategies as necessary, will contribute to her overall success. Treating ADHD is dynamic and necessitates continued vigilance to ensure that interventions remain effective and aligned with Katie's developmental needs.
References
1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 45-68.
3. Findling, R. L., Naylor, M. W., and Black, K. (2016). Long-acting methylphenidate: An overview of pharmacokinetics and clinical utility. CNS Spectrums, 21(5), 377-389.
4. Kollins, S. H. (2008). Pharmacotherapy for attention-deficit/hyperactivity disorder. Primary Psychiatry, 15(8), 42-52.
5. Molina, B. S. G., & Pelham, W. E. (2009). Childhood ADHD and adult functioning: Implications for the treatment of children. Journal of Attention Disorders, 13(4), 328-337.
6. Wilens, T. E., et al. (2008). Current concepts in the evaluation and treatment of attention-deficit/hyperactivity disorder in adults. The Journal of Clinical Psychiatry, 69(2), 508-520.
7. Biederman, J., & Faraone, S. V. (2005). Attention-deficit hyperactivity disorder. The Lancet, 366(9481), 237-248.
8. Barkley, R. A., & Murphy, K. R. (2010). Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. New York: Guilford Press.
9. Pliszka, S. R. (2000). ADHD: Diagnosis and management. Journal of the American Academy of Child and Adolescent Psychiatry, 39(5), 609-613.
10. Nigg, J. T. (2013). Attention-deficit/hyperactivity disorder and adverse health outcomes. The Clinical Neuropsychologist, 27(3), 415-438.