Assignment: Assessing and Treating Patients With ADHD

Assignment: Assessing and Treating Patients With ADHD

Walden University Assignment: Assessing and Treating Patients With ADHD-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assignment: Assessing and Treating Patients With ADHD assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assignment: Assessing and Treating Patients With ADHD                           

Whether one passes or fails an academic assignment such as the Walden University Assignment: Assessing and Treating Patients With ADHD depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assignment: Assessing and Treating Patients With ADHD                         

The introduction for the Walden University Assignment: Assessing and Treating Patients With ADHD is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for Assignment: Assessing and Treating Patients With ADHD                         

After the introduction, move into the main part of the Assignment: Assessing and Treating Patients With ADHD assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assignment: Assessing and Treating Patients With ADHD                         

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assignment: Assessing and Treating Patients With ADHD                           

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assignment: Assessing and Treating Patients With ADHD

The management of attention deficit hyperactivity disorder (ADHD) among the pediatric population is quite challenging due to the limited amount of evidence supporting the safety of several recommended drugs for this disorder. To illustrate further the management of ADHD, the case of an 8-year-old Caucasian female has been provided. The patient presents with symptoms of ADHD as suggested by her teacher who completed the Conner’s Teacher Rating Scale-Revised. Her teacher claims that the patient is forgetful most of the time, and easily distracted with a very short concentration time. The patient also displays poor language, spelling, and arithmetic skills, hurting her overall school performance. The teacher also reported that lately, the patient has been failing to follow instructions, leaving her homework incomplete. Despite the patient’s parents refusing their daughter has ADHD, the patient reports that she gets bored most of the time at school with a lack of interest in school work. She however denies bullying of any kind at school with a good home life experience. With the findings of the conducted mental status examination and the Conner’s Teacher Rating Scale-Revised, the patient has been diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation.

Several factors were considered when deciding on the specific pharmacological agent and the right dosage to prescribe in the management of the patient’s condition. Such factors include the young age of the patient, her Caucasian race, her ADHD diagnosis, and the reported symptoms. The completed Conner’s Teacher Rating Scale-Revised can also help determine the severity of the patient’s condition which is crucial in determining the dosage of the selected drug. As such, this discussion aims at developing the most effective treatment plan for the 8-year-old patient in the management of ADHD, with a rationale for each decision made.

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Decision#1

Selected Decision and Rationale

Administering Methylphenidate 10mg chewable tablets once a day in the morning was selected as the initial intervention. Methylphenidate is a stimulant to the central nervous system that acts via noncompetitive blockage of noradrenalin and dopamine reuptake into the terminals, by inhibiting the action of the dopamine and noradrenaline transporters thus raising dopamine and noradrenaline levels in the synaptic cleft (American Psychiatric Association, 2013; Cipriani et al., 2018). Previous evidence supports the substantial effectiveness of Methylphenidate in the management of children diagnosed with ADHD, with a great safety profile and high tolerability levels (Hodgkins et al., 2012). The drug is only recommended for children of age 6 and above (Grimmsmann & Himmel, 2021). Finally, with consideration of the patient’s Caucasian race, the drug is metabolized in the liver via the CYP3A4 pathway, which is predominant among this ethnic population, hence limiting the risks of toxicity (Bonati et al., 2018). The chewable tablet formulation is normally recommended for children to promote compliance (Kikuchi et al., 2021).

Intuniv was an inappropriate choice for this patient given that previous studies report that the drug being a non-stimulant is more effective in the management of ADHD when used together with a stimulant (Pelham III et al., 2022). Wellbutrin on the other hand is a norepinephrine-dopamine reuptake inhibitor (NDRI) discouraged among children below the age of 9 years old due to its elevated risks of seizures (Kikuchi et al., 2021).

Expected Outcome.

            Up to 50% of the patient’s symptoms will be resolved within the following 4 weeks (Kikuchi et al., 2021). She will be able to concentrate for longer hours with increased attention and memory (Hodgkins et al., 2012). Her overall academic performance will also improve significantly.

Ethical Consideration

            Based on the provisions of legal and ethical guidelines for nurses, the PMHNP is obliged to consider the patient ethnicity and race to promote culturally sensitive care (Bonati et al., 2018). The patient’s parents also have a legal right to information concerning the health of their child, for sound decision-making (American Psychiatric Association, 2013). Respecting the patient’s autonomy is key to promoting patient satisfaction.

Decision#2

Selected Decision and Rationale

Out of the options provided, the most effective second intervention was to change the treatment regimen to a long-acting Ritalin 20mg administered once daily in the morning. The patient has reported the potential effectiveness of the drug in managing ADHD symptoms (Hodgkins et al., 2012). However, since the dose is quite limited to resolving the patient’s symptoms all day, using a long-acting agent will help prolong the duration of action, improving the patient’s attention, concentration, and memory the entire day (Cipriani et al., 2018). Studies show that long-acting Methylphenidate lasts in the body system for up to 10 to 12 hours (American Psychiatric Association, 2013). The side effect reported of elevated heart rate is common among pediatric patients on methylphenidate which resolves as the patient continues taking the drug (Pelham III et al., 2022). Consequently, previous evidence confirms that using a long-acting agent, hence reduces the concentration of the drug at one point, reducing the risks of toxic doses, when used for a long time (Kikuchi et al., 2021).

Maintaining the dose of methylphenidate was not necessary as the patient will continue experiencing limited effectiveness of the drug later in the day (Grimmsmann & Himmel, 2021). Administering Adderall in place of Methylphenidate was also inappropriate at the moment given that the former is associated with increased risks of cardiovascular complications which would compromise the health of the patient (Bonati et al., 2018).

Expected Outcome

            The patient will be able to attain full concentration and attention level with the use of the drug for 4 weeks (Pelham III et al., 2022). This should help promote her overall academic performance and interest in school activities. The side effect of increased heart rate is expected to return to normal within this period (Grimmsmann & Himmel, 2021).

Ethical Considerations

            “Not harm” is one of the main ethical obligations of nurses, especially when taking care of children (Bonati et al., 2018). As such, the PMHNP needed to explain to the parents of the patient why the side effect occurred and the main cause of action to resolve the side effect and promote the health of their child (Kikuchi et al., 2021).

Decision#3

Selected Decision and Rationale

            Advising the patient to continue taking the long-acting Methylphenidate 20mg once daily and report for reevaluation after 4 weeks was considered the final decision. The patient reported completely resolved side effects with improved effectiveness of the drug in the management of ADHD symptoms all day (Hodgkins et al., 2012). Previous evidence demonstrates that patients on Ritalin may exhibit maximum benefit within 8 to 12 weeks of treatment therapy (American Psychiatric Association, 2013; Cipriani et al., 2018). Most pediatric patient on Methylphenidate has reported great tolerance to the medication with a desirable safety profile in long-term use (Grimmsmann & Himmel, 2021). However, in rare cases, the patient may exhibit ineffectiveness to the medication which might call for the dose titration, hence the need for reevaluating the patient after four weeks (Kikuchi et al., 2021).

At this point, it was not appropriate to increase the dose of methylphenidate to 30mg as studies show that low effective doses are safer for use by children, with reduced risks of adverse effects (Pelham III et al., 2022). Consequently, based on the current patient heart rate, it is not necessary to obtain EKG, as her pulse is within the normal limits of a child of her age (Bonati et al., 2018).

Expected Outcome

            For the next four weeks, the patient will report further improvement in ADHD symptoms all day (Grimmsmann & Himmel, 2021). She should display appropriate language, spelling, and arithmetic skills, with improved attention and concentration level (Hodgkins et al., 2012). No side effects are expected.

Ethical Consideration

            In the final decision, the PHMNP had to consider several ethical principles including nonmaleficence, beneficence, and justice (American Psychiatric Association, 2013). Since the patient was fully satisfied with the treatment outcome, the clinician needed to utilize his/her clinical judgment to advise the patient to continue using the medication for optimal benefits (Pelham III et al., 2022).

Conclusion

The pediatric patient described in the case study provided presents with symptoms of ADHD as reported by her teacher. In the development of the treatment plan for this patient, her young age, Caucasian gender, ADHD diagnosis, and presenting symptoms were considered in the selection of the safest and most effective drug. As such, the initial decision was to administer methylphenidate 10mg once daily in the morning (American Psychiatric Association, 2013). Methylphenidate is a stimulant medication that has been proven to be safe and effective in managing ADHD symptoms in both children and adults. Wellbutrin and Intuniv were not considered in this decision as a result of safety issues among children associated with increased risks of side effects (Hodgkins et al., 2012). After 4 weeks, the patient reported significantly improved ADHD symptoms earlier in the day, with minimal effect of the medication later in the day, in addition to side effects of elevated heart rate (Pelham III et al., 2022). It was thus necessary to administer long-acting Methylphenidate 20mg once daily to promote management of the patient’s symptoms the entire day. The long-acting formulation has a longer duration of action (Bonati et al., 2018). Maintaining the dose of Methylphenidate or switching the drug with Adderall was not appropriate at this point (Kikuchi et al., 2021).

The patient reported resolved side effects with well-managed ADHD symptoms the entire day after 4 weeks. This shows that she was tolerant to the drug with great safety and effectiveness hence the need to continue the same medication at the same dose for another 4 weeks before the reevaluation (Grimmsmann & Himmel, 2021). Increasing the dose of Methylphenidate or obtaining an EKG was not appropriate at this point. The PMHNP also encountered several ethical considerations when taking care of the patient with the main one being “no harm.” Additional ethical principles observed include justice, nonmaleficence, and beneficence (Cipriani et al., 2018).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bonati, M., Reale, L., Zanetti, M., Cartabia, M., Fortinguerra, F., Capovilla, G., … & Lombardy ADHD Group. (2018). A regional ADHD centre-based network project for the diagnosis and treatment of children and adolescents with ADHD. Journal of attention disorders, 22(12), 1173-1184. https://doi.org/10.1177/1087054715599573

Cipriani, A., Adamo, N., Del Giovane, C., Coghill, D., Banaschewski, T., Hollis, C., … & Cortese, S. (2018). Unbalanced risk-benefit analysis of ADHD drugs–Authors’ reply. The Lancet Psychiatry, 5(11), 871-873. https://doi.org/10.1016/S2215-0366(18)30396-1

Grimmsmann, T., & Himmel, W. (2021). The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. European journal of clinical pharmacology, 77(1), 107-115. https://doi.org/10.1007/s00228-020-02948-3

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000

Kikuchi, D., Obara, T., Tokunaga, M., Shiozawa, M., Takahashi, A., Ito, M., … & Watanabe, Y. (2021). Drug prescription for attention deficit hyperactivity disorder drugs in pediatric outpatients: A retrospective survey of Japanese Administrative Data (2012–2018). Asian Journal of Psychiatry, 57, 102512. https://doi.org/10.1016/j.ajp.2020.102512

Pelham III, W. E., Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., … & Pelham Jr, W. E. (2022). The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. Journal of consulting and clinical psychology, 90(5), 367. https://doi.org/10.1037/ccp0000725

Sample Answer 2 for NURS 6630 Assignment: Assessing and Treating Patients With ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in child psychiatry with the prevalence increasing over the years. It is characterized by inattention, hyperactivity, and impulsivity. It has a male predilection with a male to female ratio of 2:1. The hyperactive and impulsive subtype is the most prevalent. The inattentive subtype occurs in 18.3% of the condition and mostly affects females (Magnus et al., 2020). ADHD is diagnosed before the age of 12 years. It affects an individual’s ability to form and maintain close social ties.

This week’s case study focuses on Katie an 8-year-old Caucasian female brought into the office by her parents following a referral. She is referred for a psychiatry assessment to determine if she has ADHD. From the Conner’s Teacher Rating Scale-Revised, Katie is inattentive, easily distracted, forgets things already learned, and poor in spelling, reading, and arithmetic. Of note is that she has a short attention span, lacks interest in school work, is easily distracted, starts things but never finishes them, seldom follows through on instructions, and fails to finish her school work. She has no open defiance or temper outbursts. In subjective history, her favorite subjects are art and recess. She finds other subjects hard and boring. She admits her mind wanders off from class most of the time. There is no history of abuse or bullying at school. She reports that her home life is fine and her parents are good to her. The Mental State Exam is normal. She is appropriately developed for her age. She has a clear, coherent, and logical speech. She is oriented to time, place, person, and event. She has no mannerisms or tics. Her subjective mood is euthymic with a bright affect. She has no hallucinations, delusions, or abnormalities of thought. Attention and concentration are intact. Insight and judgment are age appropriate. Her diagnosis is ADHD, predominantly inattentive presentation. Decision-making in the prescription of ADHD medication is influenced by the patient’s gender, the subtype of ADHD displayed, level of academic impairment, age, and the parent’s socioeconomic status (Kamimura-Nishimura et al., 2019). These factors act together to influence the drug to be used, the dosage, and the duration of therapy. The purpose of this paper is to discuss the decision points on the treatment of this patient in regards to the choice of drug, the expectations post initiation of therapy, and the ethical considerations.

Decision 1

Chewable Methylphenidate tablets 10mg orally in the morning

Reason for Selection

Methylphenidate is considered the first-line drug therapy for childhood, adolescent, and adult ADHD (Cortese et al., 2021). The American Academy of Pediatrics recommends parent training in behavior management, and classroom training, along with medications. Methylphenidate is highly efficacious in the resolution of emotional dysregulation, and propensity to violent behavior and increases susceptibility to learning and rehabilitation of social skills (Asherson et al., 2019). The availability of methylphenidate also influences its wide use.

The few Randomized Control Studies done show that Bupropion is considered as effective as Methylphenidate in the treatment of ADHD. It also has fewer adverse symptoms compared to methylphenidate. For therapy, several trials agree that there is still a need for a further trial of the medication. Some serious adverse effects like paresthesia, agitation, and palpitations were marked in bupropion (Pozzi et al., 2020). For this reason, its suitability for treatment is reduced especially in children and adolescents.

In trials of Intuniv, there was significant symptomatology improvement in inattention, hyperactivity, and impulsivity. Intuniv is however associated with severe side effects such as polydipsia, hypotension, nasopharyngitis, and hypersomnolence (Iwanami et al., 2020). This limits its use despite having a decent efficacy.

Expectation

There is an expected beginning of the resolution of symptomatology within a few days of therapy. These changes include an enhanced concentration with a slightly increased concentration span, improved attention, reduced distractibility, and a reduction in antisocial behaviors like violence and breaking of school rules (Jaeschke et al., 2021). These changes must be supported by both classroom and parent training.

Ethical Considerations

The ethical considerations are hinged on the four principles of justice, do no harm, beneficence, and respect for autonomy. Considering the best treatment for the child’s condition is approved through research findings. The autonomy of children is an important factor. A child’s flexibility in preference is important in character development. A small room for guided autonomy is associated with better outcomes. For this reason, the parents act in the best interest of the child. Informed consent is key. Informed consent in children is proven to strengthen the morals and structure of the child by improving esteem and social interactions (Díaz-Pérez et al., 2020). Providing adequate information and education regarding the condition is n important tenet. Providing top-notch care in the best interest of the child through offering follow-up is vital.

Decision 2

Change to Ritalin LA 20mg orally daily in the morning

Reason for Selection

The slow-release long-acting Ritalin is considered effective in controlling symptoms of inattention and hyperactivity (Karahmadi et al., 2020). The long-acting Ritalin has increased compliance with medication. Although the adverse effects of the long-acting and short-acting Ritalin are comparatively the same, Ritalin LA could be responsible for a reduction in side effects as it causes a maintained plasma concentration of the drug over time.

Arrhythmias and increased systolic blood pressure are common adverse effects of Ritalin (Liang et al., 2018). Continuation with the same dose of Ritalin could cause further development in other side effects of cardiovascular disease such as stroke which would be detrimental (Nauman et al., 2021). Adderall has a very high potential for abuse and dependence. In women, Adderall can cause infertility. Sudden stoppage of the drug also comes with severe withdrawal effects such as suicidal ideas, delusions, and psychosis. These side effects occur in both the short term and the long term.

Expectations

Due to a change to Ritalin LA, there is expected maintenance in improved concentration and consequently a good performance. Resolution of the daydreaming in the afternoon. There is also an expected decrease in the presenting side effects like high heart rate; there is an expected reduction in heart rate.

Ethical Considerations.

Informed consent to the change of drug is important with adequate education on the dosage. Autonomy of the child should be guided by the parents as at the same time the child is allowed to express their preference (Díaz-Pérez et al., 2020). Continuous counseling of the family on how best to handle and train the child. A cordial patient-doctor relationship is very vital for this particular case as it eases subsequent clinic visits for follow-up.

Decision 3

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Reason for Selection

At this point, the current dose is effective in perfectly controlling the symptoms and the side effects have vanished. It is advised that in drug usage, the lowest effective dose is indicated. Here heart rate of 92 beats per minute falls in the range appropriate for her age. For this reason, maintaining the current dosage is the most plausible option. Increasing Ritalin LA  to higher doses is not advisable firstly because the symptoms are well controlled without any adverse effects. Secondly higher doses are associated with increased side effects (Karahmadi et al., 2020). Obtaining an EKG based on her heart rate is futile. The heart rate of 92 beats per minute is normal for her age.

Expectations

The current dose of Ritalin in conjunction with the psychosocial treatments should be able to abate the symptoms. There should be a net effect of improved concentration and learning. The girl should be able to get better grades. There will be improved interest in school work and not easily distractible. There will be minimal side effects of the drug as it is set at the lowest effective dose.

Ethical Considerations

The mere fact of not doing any harm and providing recommended drug treatment at the minimal effective dose is not enough. Respectful handling of the patient in a child-friendly manner and her parents by the healthcare provider is an essential part of treatment as it builds patient confidentiality and trust (Díaz-Pérez et al., 2020). The success of long-term follow-up is also greatly dependent on this relationship. Sound patient education on the side effects and dosage of the drug is key.

Conclusion

ADHD is a common encounter in child psychiatry. It is mostly overdiagnosed even in patients who show a few symptoms but don’t meet the diagnostic criteria (Magnus et al., 2020).  It is characterized by reduced attention, hyperactivity, and impulsivity. These symptoms have to occur for no less than 6 months and the patient less than 12 years for a primary diagnosis to be made. Although ADHD is more common in boys, the inattention subtype is common in girls. This case study provides a perfect example of the inattention subtype. It involves an 8-years-old Caucasian girl who displays markedly reduced attention in class, easy distractibility, and poor academic performance but does not have violent properties. There is no demarcated precipitating factor for her condition. Methylphenidate is the first-line drug used in the management of ADHD in all age groups (Cortese et al., 2021). Methylphenidate is highly efficacious in the resolution of emotional dysregulation, and violent behavior and increases susceptibility to learning and rehabilitation of social skills (Asherson et al., 2019). The availability of methylphenidate also influences its wide use. Studies show that Bupropion is as effective as Methylphenidate in the treatment of ADHD. For therapy, several trials agree that there is still a need for a further trial of the medication. Intuniv use is marred by adverse effects such as increased thirst, nasopharyngitis, and somnolence which makes its use unpopular  (Iwanami et al., 2020). Studies comparing the efficacies of Ritalin LA and the short-acting Ritalin show only a minimal difference in their profiles. The slow release of Ritalin reduces the dosing interval hence improving medication adherence. In the dissolution of symptoms, there is no major difference although clinically, Ritalin LA is associated with reduced side effects (Karahmadi et al., 2020). The principle of monotherapy and usage of the lowest effective dose is a key facet in the treatment of ADHD. The drug choice is influenced by the pharmacokinetic profile of the drug, availability, age of the patient, symptomatology, level of academic and social impairment, subtype of ADHD, gender, and the socio-economic status of the patient (Kamimura-Nishimura et al., 2019). Ethical considerations include informed consent, guided autonomy, providing the best treatment possible, formation of meaningful patient and healthcare provider relationships that improve treatment, and constant counseling and education of the patient concerning the different aspects of management.

References

Asherson, P., Johansson, L., Holland, R., Fahy, T., Forester, A., Howitt, S., Lawrie, S., Strang, J., Young, S., Landau, S., & Thomson, L. (2019). Randomised controlled trial of the short-term effects of OROS-methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder (CIAO-II). Trials, 20(1). https://doi.org/10.1186/s13063-019-3705-9

Cortese, S., Newcorn, J. H., & Coghill, D. (2021). A Practical, Evidence-informed Approach to Managing Stimulant-Refractory Attention Deficit Hyperactivity Disorder (ADHD). CNS Drugs, 35(10), 1035–1051. https://doi.org/10.1007/s40263-021-00848-3

Díaz-Pérez, A., Navarro Quiroz, E., & Aparicio Marenco, D. E. (2020). Moral structuring of children during the process of obtaining informed consent in clinical and research settings. BMC Medical Ethics, 21(1). https://doi.org/10.1186/s12910-020-00540-z

Iwanami, A., Saito, K., Fujiwara, M., Okutsu, D., & Ichikawa, H. (2020). Efficacy and Safety of Guanfacine Extended-Release in the Treatment of Attention-Deficit/Hyperactivity Disorder in Adults. The Journal of Clinical Psychiatry, 81(3). https://doi.org/10.4088/jcp.19m12979

Jaeschke, R. R., Sujkowska, E., & Sowa-Kućma, M. (2021). Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology, 238(10), 2667–2691. https://doi.org/10.1007/s00213-021-05946-0

Kamimura-Nishimura, K. I., Epstein, J. N., Froehlich, T. E., Peugh, J., Brinkman, W. B., Baum, R., Gardner, W., Langberg, J. M., Lichtenstein, P., Chen, D., & Kelleher, K. J. (2019). Factors Associated with Attention Deficit Hyperactivity Disorder Medication Use in Community Care Settings. The Journal of Pediatrics, 213, 155-162.e1. https://doi.org/10.1016/j.jpeds.2019.06.025

Karahmadi, M., Saadatmand, S., & Tarahi, M. J. (2020). Investigation of Efficacy of Short-Acting Methylphenidate (Ritalin) and Long-Acting (Matoride) on Symptoms of Attention Deficit Hyperactivity Disorder in Children Aged 6–18 Years: A Single-Blind, Randomized Clinical Trial. Advanced Biomedical Research, 9. https://doi.org/10.4103/abr.abr_9_20

Liang, E. F., Lim, S. Z., Tam, W. W., Ho, C. S., Zhang, M. W., McIntyre, R. S., & Ho, R. C. (2018). The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression. International Journal of Environmental Research and Public Health, 15(8), 1789. https://doi.org/10.3390/ijerph15081789

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2020). Attention Deficit Hyperactivity Disorder (ADHD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Nauman, M., Hahn, C., Nketiah, E., Ahmad, S., & Karmali, R. (2021). Adderall induced dilated cardiomyopathy in an adult male with ADHD. Journal of the American College of Cardiology, 77(18), 2325. https://doi.org/10.1016/s0735-1097(21)03680-9

Pozzi, M., Bertella, S., Gatti, E., Peeters, G. G. A. M., Carnovale, C., Zambrano, S., & Nobile, M. (2020). Emerging drugs for the treatment of attention-deficit hyperactivity disorder (ADHD). Expert Opinion on Emerging Drugs, 25(4), 1–13. https://doi.org/10.1080/14728214.2020.1820481

Sample Answer 3 for NURS 6630 Assignment: Assessing and Treating Patients With ADHD

This case study is about Katie, an 8-year-old Caucasian female that has been brought to the office for assessment by her parents. Their primary care provider referred Katie for psychiatric evaluation, as she felt that she might have ADHD. The parents submit the Conner’s Teacher Rating Scale-Revised that shows that Katie’s teacher reported Katie to be inattentive, easily distracted, forgets things easily, and poor in spelling, arithmetic and reading. She also has short attention span, lacked interest in schoolwork, and rarely follows instructions or starts things but never finishes them. Katie’s parents denied that their daughter has ADHD, as she has not demonstrated abnormal behaviors. Katie acknowledged that she finds other subjects besides arts and recess boring. She also reported feeling lost, her mind wandering, and distracted in class activities. Mental status examination revealed Katie having grossly intact attention and concentration with euthymic mood and absence of delusions, hallucinations or suicidal thoughts.

The patient factors that would influence decisions made when prescribing medications for Katie are varied. One of them is age. Age influences the pharmacokinetics and pharmacotherapy of medications, hence, selective prescription when dealing with children and the elderly. The other factor is the Conner’s Teachers Rating Scale-Revised score. The aim will be to improve to score, as way of enhancing Katie’s behaviors and functioning in social and academic activities. Therefore, the aim of the treatment in this case study would be to improve the Conner’s Teacher Rating Scale-Revised, as it will indicate an improvement in Katie’s cognitive and behavioral functioning. The treatment seeks to improve aspects such as attention span and Katie’s ability to engage in complex tasks as well as complete assigned tasks and follow instructions.

Decision Point One

Selected Decision

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.

Reason for Selection

Ritalin is a central nervous system stimulant recommended for use in treating ADHD in children. It exerts its effects on the dopaminergic system in the prefrontal complex to cause inhibitory control of the limbic system (Tarrant et al., 2018). The findings in the study by Pertermann et al., (2019) informed the decision to administer Ritalin. Besides it being the recommended drug for children with ADHD aged above 6 years according to the study by Tarrant et al. (2018), Ritalin also modulates the neural noise that contribute to the cognitive and behavioral symptoms associated with ADHD in children (Pertermann et al., 2019).

Why the Other Options Were Not Selected

I did not select the option to begin Wellbutrin (bupropion) XL 150 mg orally daily because it is recommended for use in treating ADHD in adults (Deang et al., 2019). The findings by Xiang (2017) also do not recommend the use of Wellbutrin in children, as they found that Wellbutrin has smaller effect sizes when compared to Ritalin. I also did not select the decision to begin Intuniv extended release 1 mg orally at bedtime because it is only indicated for use in cases where patients cannot tolerate stimulants such as Ritalin. It is also indicated in cases where stimulants have been found ineffective (Webb, 2019). The effectiveness of other stimulants has not been established, hence, the decision not to administer Intuniv.

What I Was Hoping to Achieve

I was hoping to achieve improvement in the attention span of Katie with the administration of Ritalin. I was also hoping to witness improvement in her cognitive skills, as evidenced by improved engagement in complex tasks and following instructions due to modulation of neural noise contributing to ADHD symptoms (Pertermann et al., 2019).

Ethical Consideration

While Ritalin has comparable effectiveness to that of Wellbutrin in treating ADHD in children, its large effect size influenced the adopted decision. The decision is also despite the fact that the prevalence of side effects such as headache is high in the use of Ritalin when compared to Wellbutrin (Xiang, 2017). However, the fact that Ritalin produces sustained, long-term effectiveness in managing the symptoms of ADHD informed the decision (Matthijssen et al., 2019). Therefore, it shows the ethical dilemma of balancing between safety of treatment and promotion of patient autonomy.

Decision Point Two

Selected Decision

Change Ritalin to LA 20 mg orally daily in the morning.

Reason for the Selection

Katie returned to the office four weeks later with symptom improvement. However, the teacher noted her staring into space and daydreaming by the afternoon. The implication is that the therapeutic effect of Ritalin wore off by the afternoon. According to the recommendations by the American Academic of Pediatrics, Ritalin dosage can be titrated for maximum benefit and minimum adverse effects. Sources of evidence-based data also recommend the titration of Ritalin to optimal doses to achieve the desired effect in symptom improvement (Ching et al., 2019). Safety issues such as seizures and abuse potential should be monitored with titrations (Cortese et al., 2021). Therefore, the above data informed the decision to increase dosage of Ritalin.

Reason For Not Selecting The Other Options

The decision to continue the same dose of Ritalin and re-evaluate in 4 weeks was not selected because it could not have contributed to the realization of the required treatment objectives. According to Ching et al., (2019), titrating Ritalin to optimum dose that produces the desired treatment outcomes can result in enhanced self-esteem, academic achievement and social functioning in children with ADHD. Continuing the current treatment may not lead to the above outcomes. Discontinuing Ritalin and beginning Adderrall XR 15 mg orally daily was not selected because of its lack of stronger evidence supporting its use over Ritalin (Chan, 2021).

What I Was Hoping To Achieve

I was hoping to achieve sustained improvement in symptoms of ADHD. Increasing the dosage of Ritalin would have led to improvement in social functioning, academic performance, and attention span of Katie due to increase in the therapeutic effect of the drug (Ching et al., 2019).

Ethical Consideration

Adderrall is may be used for treating ADHD for children aged 3 years and above. This makes it the desired drug for use in dealing with pediatrics. However, Adderrall being an older drug with weak evidence on its efficacy, Ritalin was considered due to adept of evidence supporting its use in ADHD (Ching et al., 2019). Therefore, I applied the ethical principle of ensuring benevolence safety and quality in making the above decision.

Decision Point Three

Selected Decision

Maintain the current dose of Ritalin LA and reevaluate in 4 weeks.

Reason for the Selection

I selected the above decision because the desired treatment objectives had been achieved. The teacher reports that Katie’s academic performance is still improved. The switch in medication lasts Katie throughout the day. The side effect of palpitation is no longer being experienced. According to Ching et al., (2019), Ritalin should be titrated until the optimum treatment outcomes, as long as patients report minimal or no side effects with titration or switch in medications.

Why The Other Options Were Not Selected

The decision to increase the dosage of Ritalin LA to 30 mg orally daily was not selected since high doses of Ritalin may predispose the patient to seizures and stimulate dependence (Cortese et al., 2021). Besides, treatment outcomes have been achieved. The decision to obtain EKG was not selected because the pulse rate is within the normal range.

What I Was Expecting To Achieve

I was expecting to achieve sustained improvement in symptoms. I was also hoping to ensure that the client tolerates the current dosage of Ritalin.

Ethical Considerations

The decision to increase the dosage of Ritalin to 30 mg orally daily may appear appropriate to cause further improvement in the symptoms of ADHD. However, evidence-based data and guidelines recommend the titration of dose until the set treatment objectives have been achieved. Similarly, guidelines assert that higher doses increase the risk of adverse side effects such as seizures and drug dependence (Ching et al., 2019; Cortese et al., 2021). Therefore, it informed the decision to ensure benevolence and non-maleficence in Katie’s treatment.

Conclusion

The aim of treatment in this case study was to improve the social and cognitive functioning of Katie. The score of Conner’s Teachers Rating Scale-Revised guided the evaluation of the effectiveness of the adopted treatment. It included a focus on treatment outcomes such as changes in the attention span of Katie, her ability to engage in complex task, follow instructions, and engage in social activities.

The adopted treatments were effective in improving the symptoms of ADHD that Katie experienced. The decision to initiate Katie on Ritalin was appropriate, as it led to minimal improvements in the symptoms of ADHD. The improvements could not be sustained throughout the day due to the short acting form of the Ritalin that was administered. Ritalin is the recommended first-line drug for ADHD in children, hence, the consideration in the phase. The decision to administer Wellbutrin was not considered because it is used in treating ADHD in adults. It also has smaller effect size on ADHD symptoms when compared to Ritalin (Cortese et al., 2021). The decision to administer Intuniv was not considered since the effectiveness of the other stimulants had not been explored (Webb, 2019). Therefore, I aimed at ensuring safety and optimum outcomes in treatment by selecting Ritalin in this stage.

The second step entailed the administration of extended release Ritalin, which was effective in symptom management. I did not select the decision to continue with the earlier dose of Ritalin, as it has short-lived effectiveness in symptom management. The third decision entails the continued use of the extended form of Ritalin, 20 mg, as the desired treatment objectives had been achieved (Chan, 2021). Therefore, I believe that the adopted interventions were effective in managing the symptoms of ADHD that Katie experienced.

References

Chan, C. (2021). A2As or stimulants: Which is better for treatment of ADHD in young children? Pharmacy Today, 27(8), 25. https://doi.org/10.1016/j.ptdy.2021.07.010

Ching, C., Eslick, G. D., & Poulton, A. S. (2019). Evaluation of Methylphenidate Safety and Maximum-Dose Titration Rationale in Attention-Deficit/Hyperactivity Disorder: A Meta-analysis. JAMA Pediatrics, 173(7), 630–639. https://doi.org/10.1001/jamapediatrics.2019.0905

Cortese, S., Newcorn, J. H., & Coghill, D. (2021). A Practical, Evidence-informed Approach to Managing Stimulant-Refractory Attention Deficit Hyperactivity Disorder (ADHD). CNS Drugs, 35(10), 1035–1051. https://doi.org/10.1007/s40263-021-00848-3

Deang, K. T., Sidi, H., Zakaria, H., Adam, R. L., Das, S., Hatta, N. H., Hatta, M. H., & Wee, K. W. (2019). The Novelty of Bupropion As a Dopaminergic Antidepressant for the Treatment of Adult Attention Deficit Hyperactive Disorder. Current Drug Targets, 20(2), 210–219. https://doi.org/10.2174/1389450118666170511145628

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Pertermann, M., Bluschke, A., Roessner, V., & Beste, C. (2019). The Modulation of Neural Noise Underlies the Effectiveness of Methylphenidate Treatment in Attention-Deficit/Hyperactivity Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(8), 743–750. https://doi.org/10.1016/j.bpsc.2019.03.011

Tarrant, N., Roy, M., Deb, S., Odedra, S., Retzer, A., & Roy, A. (2018). The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review. Research in Developmental Disabilities, 83, 217–232. https://doi.org/10.1016/j.ridd.2018.08.017

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