Case Study: A Young Caucasian Girl With ADHD

Case Study: A Young Caucasian Girl With ADHD

The Assignment

Case Study: A Young Caucasian Girl With ADHD Analysis

Assessing and Treating Clients with ADHD

            Attention Deficit Hypersensitivity Disorder (ADHD) is one of the most common psychiatric problems encountered by children. According to Harpin (2017), this disorder is mostly diagnosed among children below the age of 12 years. Studies also show that the symptoms of ADHD improve with age, but when the disorder is diagnosed later in life, the patient might exhibit worsened symptoms. However, several treatment options have been proposed to help in the management of ADHD among the pediatric population.

Case Summary

The case involves an 8-year old Caucasian child called Katie, who came to the clinic to undergo a psychiatric evaluation in the company of her mother. Her primary care provider suspects that the patient might be having ADHD. When her teacher used the Conner’s Teacher Rating Scale-Revised, it

was realized that symptomatology such as forgetfulness, reading issues, spelling limitations, arithmetic limitations, vulnerability to distractions and lack of attentiveness manifested in the patient. The patient’s attention span is low. She displays a lack of interest in schoolwork, and she is also easily distracted. The patient’s parents are reluctant with ADHD diagnosis, claiming that the patient does not display defiant behaviors or temper outbursts. According to Katie, there are no issues with her home life while no incidences of bullying have occurred at her school. However, the child was diagnosed with attention deficit hyperactivity disorder, the predominantly inattentive one when she underwent a mental health assessment.

Patient Factors

The paper demonstrates decisions made in formulating the most effective care plan in the management of the patient’s condition. Patient factors such as age and race, which affect the pharmacokinetics and pharmacodynamics of drugs will be considered when prescribing medications for this patient. Other important factors include the scores displayed by the Conner’s Teacher Rating Scale-Revised which reveals an ADHD diagnosis and the patient’s symptoms. Therefore, the purpose of this paper entails focusing on the decisions made when prescribing drugs for the patient to achieve the treatment goals such as improving the Conners’ Rating Scales – Revised (CRS-R) scores, and managing the patient’s symptoms to promote her school performance and social functioning within the next 4 to 12 weeks.

Decision #1

Selected Decision

The best initial treatment option for the patient is Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.

Reason Behind Decision 1:

            I made this decision as a result of the safety profile of the drug exhibited among children above the age of 6 years, with great effectiveness in the management of ADHD symptoms, as demonstrated by the research conducted by Huss et al., (2017). Ritalin (Methylphenidate) has an FDA approval regarding the management of ADHD in children such as Katie. Harpin (2017) postulates that the drug acts via noncompetitively inhibiting the reuptake of dopamine and noradrenaline at the noradrenaline transporter (NAT) as well as dopamine transporter (DAT) sites. This actions ensures that the levels of dopamine as well as noradrenaline become elevated at the synaptic cleft. Another study conducted by Patwardhan (2021) shows that Ritalin displays great tolerance, adherence, and effectiveness in the management of ADHD among children between the ages of 6 to 17 years. Additionally, by considering the patient’s race, methylphenidate undergoes hepatic metabolism through the CYP3A4 pathway, which is predominant among Caucasian females, displaying the highest level of activity (Mucci et al., 2021).

Intuniv is a long-acting non-stimulant medication for the management of ADHD. I preferred Ritalin to Intuniv since studies show that the latter displays great effectiveness as an adjunct to stimulant medication, rather than mono-therapy (Huss et al., 2017). Additionally, a study carried out by Patwardhan (2021) revealed that the drug is associated with increased side effects of somnolence in approximately 38% of patients taking this medication, which is very rare with Ritalin.

According to Mucci et al. (2021), Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI) whose functions entails ADHD management. The drug is also appropriate as an adjunct to stimulants and not considered as the first choice for the management of ADHD in children as displayed by most study guidelines (Patwardhan, 2021).

Expected Outcome

            The patient is expected to display at least a 50% reduction in ADHD symptoms within the next four weeks, as displayed by a study carried out by Patwardhan (2021). She should be able to regain interest in doing daily activities, homework and even going to school (Mucci et al., 2021). Her attentiveness and class performance are expected to improve within this time. Her scores on the Conners’ Rating Scales – Revised (CRS-R) are also expected to improve within this time.

Ethical Considerations Impact on Treatment Plan

According to the legal and ethical guidelines, the PMHNP must take into account the patient’s race and ethnicity in formulating the most effective treatment plan (Harpin, 2017). Consequently, given that the patient is a minor, the parents must be involved in making healthcare decisions concerning their daughter. As such the PMHNP must create a balance between beneficence and autonomy when taking care of this patient.

Case Study: A Young Caucasian Girl With ADHD 

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 the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. 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.

 Case Study: A Young Caucasian Girl With ADHD SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. 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.

 Case Study: A Young Caucasian Girl With ADHD-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.

 Case Study: A Young Caucasian Girl With ADHD Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.)

Choices for Decision 1: Select what the PMHNP should do:

1. Begin Wellbutrin (bupropion) XL 150 mg orally daily
2.  Begin Intuniv extended release 1 mg orally at BEDTIME
3.  Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Decision Choice Chosen: Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

***Explain why other two choice were rejected (not adequate choices)***

 Case Study: A Young Caucasian Girl With ADHD Outcome: 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” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Choices for Decision 2: Select what the PMHNP should do:

1.  Continue same dose of Ritalin and re-evaluate in 4 weeks
2.  Change to Ritalin LA 20 mg orally daily in the MORNING
3.  Discontinue Ritalin and begin Adderall XR 15 mg orally daily

Decision Choice Chosen: Change to Ritalin LA 20 mg orally daily in the MORNING

***Explain why other two choice were rejected (not adequate choices)***

 Case Study: A Young Caucasian Girl With ADHD Outcome: 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

Choices for Decision 3: Decision Point Three Select what the PMHNP should do next:

1.   Maintain current dose of Ritalin LA and reevaluate in 4 weeks
2.  Increase Ritalin LA to 30 mg orally daily
3.  Obtain EKG based on current heart rate

Decision Choice Chosen:  Maintain current dose of Ritalin LA and reevaluate in 4 weeks

***Explain why other two choice were rejected (not adequate choices)***

 Case Study: A Young Caucasian Girl With ADHD Outcome: Guidance to Student

RESULT FROM CHOOSING TO MAINTAIN CURRENT DOES OF RITALIN LA AND REEVALUATE IN 4 WEEKS

 Case Study: A Young Caucasian Girl With ADHD: 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.

Make sure that this paper has at least 6 References from 2014. Please use in-text citations for each section of each decision.Don’t forget the ethical considerations for this assignment. Make it a section by itself.***

***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.***

SOME RESOURCE for Case Study: A Young Caucasian Girl With ADHD Assignment

Note: Review all materials from the Discussion.

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, 279-291.

Course Texts These course texts are available through Stahl Online Resources http://stahlonline.cambridge.org/ Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.