Treating Clients with ADHD ✓ Solved

Treating Clients with ADHD

This week’s scenario concerns an 8-year-old Caucasian female with symptoms of possible Attention-Deficit Hyperactivity Disorder (ADHD) per her primary care provider. ADHD is primarily a problem with sustained attention, concentration, and task persistence. Statistics show that, in 2016, 9.4 percent of 2 to 17-year-olds in the United States had received a diagnosis of ADHD at some time (CDC, 2019). ADHD has three forms: Inattentive, Hyperactive/impulsive, and Combined.

This patient will be assessed for a medication regime which can decrease or control her behavior issues related to her diagnosis of ADHD inattentive and engage the patient with some counseling for additional support and techniques useful for this disorder.

Decision Making for ADHD Treatment

Decision #1

I chose to start Ritalin (methylphenidate) chewable tablets 10mg orally in the morning. Stimulants are considered the first-line of therapy for children with ADHD and appear to be more favorable in children than amphetamine-type stimulants (Stahl, 2008). Methylphenidate is a stimulant that enhances arousal in the prefrontal cortex, boosting norepinephrine and dopamine neurotransmission (Sulkes, 2019).

Common side effects may include sleep disturbances, appetite suppression, depression, anxiety, headaches, and elevated heart rate (Stahl, 2008). I did not choose to use Intuniv extended release as it is a non-stimulant and used as second- or third-line therapy. I also avoided Wellbutrin due to its association with potential suicidal thoughts in children (Stahl, 2008).

Expected Outcomes

By initiating this treatment, I aimed to decrease the patient’s inattentive behavior, thus improving her attention span and academic performance. However, after four weeks, the parents reported improvements in the morning but noted a loss of focus by the afternoon. The patient experienced a racing heart, which prompted a reevaluation of the treatment.

Adjustments to Treatment

Decision #2

I decided to change to Ritalin LA 20mg orally daily in the morning, as the original dosage only lasted a short time. Ritalin LA provides extended coverage for symptoms, ideally improving performance throughout the entire day (Stahl, 2008). The expected positive outcomes included sustained attention and improved behavioral performance.

Results of Revision

Upon the follow-up visit, the patient's performance had improved throughout the day, and her complaints of racing heartbeat had ceased, indicating a favorable response to the medication at the new dosage.

Decision #3

After observing continued symptom improvement, I chose to maintain the current dose of Ritalin LA and reevaluate in another four weeks. I expected the patient’s well-controlled symptoms and minimal side effects to enhance her classroom engagement. Ritalin LA’s immediate effects were promising, but it may take several weeks for maximum benefit (Stahl, 2008).

Ethical Considerations

Several ethical factors surround the use of stimulant medications, such as potential abuse and adverse side effects. It's essential to monitor the patient’s overall health by assessing cardiac history, weight, height, and blood parameters. Additionally, it is vital to consider the psychological ramifications ADHD can impose on girls and women, which may include chronic stress, low self-esteem, and depression.

Conclusion

The treatment goal for ADHD is to mitigate symptoms effectively while minimizing side effects. Patterns in medication response signal a need for continued monitoring to ensure the patient’s educational and social success.

References

  • Centers for Disease Control and Prevention (CDC). (2019). Attention-Deficit/Hyperactivity Disorder. Retrieved from: CDC.gov

  • Sulkes, S. B. (2019). Attention-deficit/hyperactivity disorder (ADHD). Merck Manual Professional Version. Retrieved from: Merck Manual

  • Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved from: Essential Psychopharmacology

  • Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved from: Essential Psychopharmacology

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Faraone, S. V., & Biederman, J. (2016). A 10-Year Review of the Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder. Psychiatric Clinics of North America, 39(3), 457-470.

  • Brown, T. E. (2013). Attention Deficit Disorder: The Unfocused Mind in Children and Adults. Yale University Press.

  • Müller, A., & Fiedler, T. (2015). Alternating between stimulant and non-stimulant medication for attention-deficit/hyperactivity disorder: a systematic review. BMC Psychiatry, 15, 222.

  • Fisher, M. I., & Fuchs, D. (2017). Combination Treatment of ADHD: A Statement of Current Knowledge. American Family Physician, 95(11), 708-714.

  • Pascualvaca, D., & Pineda, D. (2018). The Impact of Different ADHD Medications on Quality of Life in Children with ADHD. Journal of Attention Disorders, 22(4), 328-339.