A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment

A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment

Introduction

This assignment focuses on an eight-year-old Caucasian girl presented to the healthcare facility by her mother and father after a referral from their primary healthcare provider. The female is to be assessed by psychiatry to determine whether the girl has Attention-deficit disorder (ADHD). After her teacher concluded that the patient is inattentive, easily distracted, forgets things already learned, she has poor spelling, low reading abilities, and poor arithmetic based on the score obtained after the teacher filled out the “Conner’s Teacher Rating Scale-Revised.” One of the main observations is that the client’s parents deny that the client has the condition. The main objective of this paper is to highlight the approach that can be utilized to evaluate and create a personalized treatment plan for children diagnosed with ADHD, which is mainly based on the decision concerning the specific type of medication to prescribe to the patient, the effect of the medication to the client. The paper will also include the ethical and legal considerations related to prescribing treatment for children diagnosed with Attention-deficit disorder. A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment  In this phase of treatment, I will have to consider the development perspective of the patient considering the client is still a child. Taking a development perspective will positively affect the treatment plan and communication with the patient. Because care will be provided considering that the patient is still a child.

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Decision One

The treatment plan should begin with Ritalin (methylphenidate) chewable tablets 10 mg, administered orally in the morning. The main reason methylphenidate is selected as the first-line therapy is that the medication has a high level of effectiveness and is also the safest short-term drug treatment; hence it is the preferable first-choice medication for children diagnosed with ADHD (Ribeiro et al., 2021). Methylphenidate can improve some of the major symptoms of ADHD by decreasing hyperactivity and impulsivity and improving the child’s ability to concentrate. The medication is also effective in improving the overall behavior and quality of life of children diagnosed with ADHD. Methylphenidate’s way of working in the patient’s body is by blocking the reuptake of norepinephrine and dopamine in the body, increasing their level. The medication also enhances dopamine and norepinephrine actions in certain brain regions. Ritalin has various short-term adverse side effects such as headache, vomiting, agitation, high blood pressure, and wakefulness. Patients can also experience seizures in rare cases A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment . Wellbutrin (bupropion) XL 150 mg administered orally daily is not a good decision in this case because the medication is categorized as an anti-depressant and should be utilized for treating depression and in smoking management based on its approval standards by Food and Drug Administration (FDA) (Kweon & Kim, 2019). Therefore, bupropion cannot be used in the treatment plan because it is not approved by FDA to treat and manage attention deficit hyperactivity disorder. Even though some healthcare professionals can recommend the medication to treat ADHD, the medication cannot be utilized because its safety and effectiveness are not well defined (Ogundele, 2021). Intuniv extended-release 1 mg administered orally during bedtime was also not selected because the medication has various side effects such as high blood pressure, sedation, fatigue, and somnolence despite being approved by FDA for treatment of ADHD for patients aged six to seventeen years of age (Mattingly & Young, 2021). Ritalin remains the medication of choice at this level of treatment.

I hope that the patient will experience improved social and school functioning by decreasing inattentiveness and hyperactivity symptoms after making this decision. The client reported back to the clinic after four weeks. Based on the parent’s report, the patient’s teacher noted that her symptoms have improved in the morning, resulting in improved school performance. Despite the improvement, the patient was daydreaming in the afternoon, and she also reported that she had a funny feeling in the heart area, and her heart was beating at approximately 130 beats per minute which implies that the patient is tachycardic.

Decision Two

            My decision in this treatment phase is to change to Ritalin LA (long-acting) 20 mg orally daily in the morning A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment . Baker et al. 2021. highlight that Ritalin LA is an agent administered once daily; the medication is designed to copy the effect of the two doses of immediate-release methylphenidate by releasing methylphenidate from beads. The medication works by releasing 50 percent immediately in the morning and the remaining 50 percent in the afternoon for approximately eight hours. The design of the medication enables it to maintain its effectiveness throughout the day, which effectively manages the symptoms of the condition, hence preventing the patient from being tachycardic. The main reason why the decision to continue with the same dose of Ritalin and reevaluate in 4 weeks is not a good decision for this specific patient is that the medication’s effect is only experienced in the morning but causes an increase in heart rate, which can result in life-threatening health conditions. Discontinuing Ritalin and beginning Adderall XR 15 mg administered orally daily is also not an appropriate decision because changing medication at this point in treatment is not good considering the patient is still adjusting to the current medication and there are significant changes in the patient’s behavior due to the current medication. Adderall can also result in various side effects such as irritability, insomnia, dizziness, and weight loss.

From this decision, I expect the patient’s daydreaming and staring off into space will be eliminated by changing from immediate release to long-acting. I also hope the patient’s heart rate will be maintained to normal limits and the condition’s symptoms will continue to be under control. I also hope that the client will continue with the existing treatment plan with minimum side effects and symptom management. After four weeks, the client returned to the health facility with an improvement in school performance. The switch to long-acting medication also lasts throughout the day. The client also reported that the funny feeling around the heart area had gone away, and her heart rate was 92 during the visit to the facility. Based on ethical considerations, I should also be able to engage with the patient respectfully and appropriately to ensure that the treatment provided to the patient will not cause any harm to the client.

Decision Three

At this phase of treatment, the best decision is to maintain the current dose of Ritalin LA and reevaluate in 4 weeks. This decision is appropriate because the patient showed improvement based on the current medication. There is registered improvement in the patient’s school performance and her level of concentration throughout the day improved greatly, and she is not experiencing any significant side effects from the medication. Increasing Ritalin LA to 30 mg orally daily is not an appropriate decision because the current dose effectively reduces the symptoms of the condition and the patient are tolerating the dose, and she is not experiencing any side effects. Subjecting the patient to a high dosage can result in adverse side effects, which should be considered. It is also not important to obtain EKG based on the current heart rate because the patient’s current heart rate of 92 is within the normal heart rate limits for an individual of that age. My main expectation from this decision is that the patient will continue with the treatment plan and process until all the systems of ADHD are under control and there is persistent health improvement. Considering that the patient is still a child and cannot make decisions or provide informed consent, it is ethical to involve the child’s parents in the decision-making process to ensure that they provide informed consent on behalf of their child A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment .

Conclusion

Attention-deficit hyperactivity disorder is categorized among the common mental conditions diagnosed in children and adults. The symptoms associated with the condition include high activity levels and difficulty remaining still for a long time. Individuals diagnosed with the condition also have limited attention spans, a symptom that is mainly observed in young children. The main reason I selected methylphenidate as a therapy for ADHD compared to other options provided is that the medication is very effective in reducing the main symptoms of the condition, resulting in improvement in the child’s level of concentration. Methylphenidate is also effective in improving the overall behavior and quality of life. The main reason for not selecting the other options is that they have many adverse side effects, and the FDA does not approve them for children’s use.

References

Baker, M., Huefner, J. C., Bellonci, C., Hilt, R., & Carlson, G. A. (2021). Polypharmacy in the management of attention-deficit/hyperactivity disorder in children and adolescents: a review and update. Journal of child and adolescent psychopharmacology, 31(3), 148-163.

Kweon, K., & Kim, H. W. (2019). Effectiveness and safety of bupropion in children and adolescents with depressive disorders: a retrospective chart review. Clinical Psychopharmacology and Neuroscience, 17(4), 537.

Mattingly, G. W., & Young, J. (2021). A clinician’s guide for navigating the world of attention deficit hyperactivity disorder medications. CNS spectrums, 26(2), 104-114.

Ogundele, M., & Ani, C. (2021). 314 Disparity between different reference values for hypertension among children and adolescents treated for ADHD: experience from a North West England CCH clinic. BMJ Paediatrics Open, 5(Suppl 1) A Young Caucasian Girl with ADHD – Assessing and Treating Patients With ADHD Case Study Assignment .

Pereira Ribeiro, J., Arthur, E. J., Gluud, C., Simonsen, E., & Storebø, O. J. (2021). Does Methylphenidate Work in Children and Adolescents with Attention Deficit Hyperactivity Disorder? Pediatric Reports, 13(3), 434-443.

 

The Assignment: 5 pages

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