Assessing and Treating Patients With ADHD Case Study Assignment

Assessing and Treating Patients With ADHD Case Study Assignment

Assessing and Treating Patients With ADHD Case Study Assignment

Assessing and Treating Patients With ADHD

Introduction to the Case

            The case scenario is about Katie being an 8-year-old Caucasian female accompanied by her parents to the office today. The reveals that they were referred to the clinic by their primary care provider upon informing her that Katie’s teacher claims that she might have ADHD. Thus, their primary intention for visiting psychiatry is to have an evaluation conducted to rule out if their daughter has ADHD. The parents present a rating scale form filled by her teacher to be presented to their family primary care provider for further action. The form indicates that Katie is easily distracted, inattentive, forgets things easily, and she is poor in reading, spelling, and arithmetic. Kattie only pays attention to what she is interested in, and she has a relatively short span of attention. Her teacher indicates that Kattie lacks interest in her studies and school work. She is easily distracted when doing her school work. Katie is also poor in adhering to instructions. She also starts things but stops before finishing them. This habit is demonstrated in her school work. However, Katie’s parents strongly deny the claim that their daughter has ADHD. They claim that she would be hyperactive if she has ADHD. The father adds that her daughter does not have temper outbursts and is never defiant. Additionally, Kattie claims that everything in school is okay, and her favorite subjects are art and recess. Nonetheless, she states that other subjects are boring. Additionally, Kattie claims that these subjects are sometimes hard, making her feel “lost” and wander during class. She pays more attention to the activities that she finds to be fun and interesting. She denies being bullied or abused at school. However, Katie claims that her life at home is just fine. The mental status exam reveals that the client seems appropriately developed for her age. She is logical and has a clear speech. She appears to be appropriately oriented to various factors, including place, person, event, and time. She is smartly and appropriately dressed. She portrays notable gestures and mannerisms throughout the interview. Her affect is bright, and she has a euthymic self-reported mood. She denies auditory or visual hallucinations. The interview reveals that her concentration and attention are intact. She can count backward. She denies any homicidal or suicidal thoughts. The provided subjective data, and the mental status exam results necessitate further action to manage the presented clinical symptoms. The treatment plan for this client involves three decision points.

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Decision Point One

The Selected Decision

            The selected decision involves beginning the treatment with Wellbutrin (bupropion) XL 150 mg orally daily.

Reason for Selecting this Decision

            Wellbutrin (bupropion) XL 150 mg orally daily was preferred in treating this client due to its efficacy and safety in managing the symptoms of ADHD (Verbeeck et al., 2017). Specifically, bupropion reduces the severity of ADHD symptoms, thus enhancing the clinical outcomes of pediatrics diagnosed with ADHD symptoms. Additionally, Bupropion was preferred due to its low-risk for addiction (Prince et al., 2016).

Reason for Rejecting the other Two Available Options

            Other treatment options, including Intuniv extended-release 1 mg orally at bedtime and Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning, were rejected as the initial dosage the treatment of this client. First, the use of Intuniv extended-release 1 mg orally at bedtime is attributed to various side effects, including sleepiness, insomnia, tiredness, low blood pressure, nausea, dizziness, stomach pain, and dry mouth (Cunha, 2020). Additionally, the use of this medication in treating ADHD as monotherapy in children has been ineffective. Moreover, Intuniv extended-release 1 mg orally at bedtime has not been proven safe for children below 12 years diagnosed with ADHD (Cunha, 2020). Similarly, Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning are ineffective and unsafe for treating pediatrics with ADHD (Wigal et al., 2017).

Expected Outcomes

            It was expected that the severity of the presented clinical symptoms, including lack of concentration in class, inattention, and stopping activities before completing them, would reduce upon taking the prescribed dosage, Wellbutrin (bupropion) XL 150 mg orally daily. Nonetheless, the client and her parents return to the clinic after four weeks. The mother claims that she discontinued the prescribed medication after two weeks following Katie’s thoughts of hurting herself. These thoughts were scary to the parents leading to immediate termination of the current medication. Thereby, another decision was necessary to manage Katie’s condition.

Ethical Considerations that might Impact the Treatment Plan and Communication with Patients

            Some ethical guidelines influence the treatment plan and communication with patients. The treatment plan is influenced by the ethical principles of nonmaleficence and autonomy. The ethical principle of nonmaleficence states that a healthcare practitioner should not harm the client. In this case, the care provider should ensure that the preferred treatment option should not harm the client. Secondly, the ethical principle of autonomy holds that a client has a right to decide treatment procedures. Therefore, the healthcare provider should allow Kattie’s parents to decide about her treatment plan. The clinician should not interfere with their decision even if the selected treatment procedure is not the most appropriate for Kattie’s case. For instance, the care provider should respect the parents’ decision to rely on behavioral therapy in treating Kattie’s ADHD. Finally, a treatment plan is influenced by the ethical principle of health maximization. This ethical guideline states that clinicians should strive to optimize client’s health. In this case, the care provider should combine therapies with medication to enhance the treatment procedure’s outcomes, thus resolving the presented ADHD symptoms. Additionally, ethical principles have an impact on communication between the care provider and the patients. Practitioners should adhere to the ethical principle of confidentiality when communicating with clients. They should consider the client’s information as private and confidential, thus protecting it from unauthorized parties. Thereby, these ethical guidelines prohibit clinicians from disclosing Kattie’s information to other multidisciplinary team members.

Decision Point Two

The second decision involves educating the parents that suicidal ideation is among the primary side effects of bupropion in children diagnosed with ADHD. Therefore, they should re-start taking the initially prescribed medication, Wellbutrin (bupropion) XL 150 mg orally daily, even if Kattie reports some thoughts of harming herself. Kattie’s parents agreed to continue with the medication. The client and her parents return to the clinic after four weeks. Her parents report that Katie started experiencing similar symptoms after using Bupropion for two weeks. In addition to thinking about hurting herself, the client started dreaming about being dead. Her parents were scared by her thoughts and the weird dream, thus discontinuing the medication. At this point, her parents are frustrated with the prescribed drug results, and they are convinced that their daughter’s condition cannot be resolved through mediation. The presented complaints necessitated the third decision.

Decision Point Three

            The third decision involves referring the client to a pediatric psychologist. The psychologist will treat Katie’s ADHD using behavioral therapy. Most pediatric psychologists are skilled in treating children with ADHD using behavioral therapies (Mitchell et al., 2017). However, the parents should be informed that behavioral therapies effectively resolve the symptoms of ADHD when they are combined with pharmacological treatment (Johnston & Park, 2015). Nonetheless, behavioral therapy can be used in treating Kattie’s ADHD if her parents insist on using a monotherapy.

Recommendations on the Treatment Options

            It is recommendable for the client to begin the treatment with Wellbutrin (bupropion) XL 150 mg orally daily due to its efficacy and safety in managing the symptoms of ADHD in children (Verbeeck et al., 2017). Additionally, Bupropion is appropriate for this client due to its low-risk for addiction (Prince et al., 2016). The second treatment option involves referring the client to a pediatric psychologist who will use behavioral therapy to treat Katie’s ADHD. However, behavioral therapies should be combined with pharmacological treatment to enhance its efficacy in resolving the symptoms of ADHD. According to Johnston and Park (2015), ADHD symptoms are resolved completely through the combination of behavioral therapy and pharmacological treatment. Thus, combining the two therapies will resolve Kattie’s symptoms such as being easily distracted, inattentiveness, forgetting things easily, and inability to read, spell, and compute arithmetic.

References

Cunha, J, P. (2020). Guanfacine: What is Guanfacine Used for? RXLIST. https://www.rxlist.com/consumer_guanfacine/drugs-condition.htm

Johnston, C., & Park, J. L. (2015). Interventions for attention-deficit hyperactivity disorder: a year in review. Current Developmental Disorders Reports, 2(1), 38-45.

Mitchell, J. T., McIntyre, E. M., English, J. S., Dennis, M. F., Beckham, J. C., & Kollins, S. H. (2017). A pilot trial of mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: impact on core symptoms, executive functioning, and emotion dysregulation. Journal of attention disorders, 21(13), 1105.

Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.

Verbeeck, W., Bekkering, G. E., Van den Noortgate, W., & Kramers, C. (2017). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews, (10).

Wigal, S. B., Childress, A., Berry, S. A., Belden, H., Walters, F., Chappell, P., … & Palumbo, D. (2017). Efficacy and safety of a chewable methylphenidate extended-release tablet in children with attention-deficit/hyperactivity disorder. Journal of child and adolescent psychopharmacology, 27(8), 690-699.

ORDER A CUSTOMIZED, PLAGIARISM-FREE Assessing and Treating Patients With ADHD Case Study Assignment HERE

rubric score.
Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #3 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.
12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.
11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.
0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS_6630_Week9_Assignment_Rubric
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-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.

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.

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, 279-291.

Decision Point One
Select what you should do:

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

Begin Wellbutrin (bupropion) XL 150 mg orally daily
RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks
Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks
*****Please note *****
Decision Point Two

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose
RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks
Katie\’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication
At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer
*****Please note*****
Decision Point Three

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD
Guidance to Student
Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.

At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.

In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.

You should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow you to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

please pay close attention to answering the reason for your choice. can you us the recommended book for the course and cite some from it
***.Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.
please email me if you have questions ,. I have not gotten a 100% from your writers.