Treatment of ADHD Assignment

The case study is about Katie an eight-year-old girl who presented with a suspected case of ADHD from a primary care provider. According to the “Conner’s Teacher Rating Scale-Revised”. Katie was forgetful, inattentive, poor in reading, math, and spelling, and easily distracted. The teacher reported that Katie was also not interested in schoolwork, did not complete her school activities, manifested a short attention span, and was unable to follow instructions. From the subjective and objective data, she was diagnosed with attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. According to the DSM-5 diagnostic criteria, ADHD-predominantly inattentive is characterized by inattentiveness to details and making careless mistakes in classwork or other activities; difficulties in maintaining attention in activities or when playing; does not normally listen during conversations and appears absent-minded; leaves school work uncomplete and does not follow instructions; difficulties in organizing activities and tasks; avoids activities and tasks that need sustained mental effort; normally loses essential items such as school materials or phone; easily distracted and forgetful (de la Peña et al., 2020). The client in this case study presented with the majority of these symptoms and this justified the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. This paper will thus discuss the appropriate treatment choices for the client while considering factors likely to affect her pharmacokinetic and pharmacodynamic processes.

Decision Point One

The treatment choice for the first decision is for Katie to begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING. This decision was chosen because Ritalin is the first-line treatment choice for ADHD. The medication is also approved by the FDA for the treatment of ADHD in the pediatric population. Ritalin acts on the norepinephrine and dopamine transporters to prevent the reuptake of dopamine and norepinephrine and hence increases their levels in the brain; this helps to control and reduce ADHD symptoms (Masha & Dickerson, 2019). Ritalin also has few side effects and it is well tolerated in the pediatric population. Wellbutrin was not chosen due to its numerous side effects and also evidence indicates that Wellbutrin is associated with suicidal ideations (Ng, 2017). The reason why Intuniv was not considered is also due to its numerous and severe side effects such as hypotension, bradycardia, and low heart rate (Kaar et al., 2020).

The treatment goal for this decision was that the client would manifest symptom improvement as indicated by the ability to be attentive, increased concentration, reduced forgetfulness, among other symptom improvements. This is due to the efficacy of Ritalin in improving ADHD symptoms (Matthijssen et al., 2019). It is also hoped that the client would not experience side effects.

The treatment outcome for this decision was that the client manifested significant symptom improvement in the morning hours and also her performance at school improvement. However, symptoms such as inattentiveness and reduced concentration would resurface in the afternoon. The reason for the ADHD symptoms resurfacing in the afternoon hours is because methylphenidate is an immediate release preparation and therefore its efficacy is short-acting (Matthijssen et al., 2019). This means that the medication’s efficacy could not last for the whole day. Moreover, the client reported side effects that her heart rate was high. Increased pulse rate is a common side effect with Ritalin (Matthijssen et al., 2019).

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Decision Point Two

The treatment decision in decision point two was to change to Ritalin LA 20 mg in the morning. This decision was chosen so that the effect of Ritalin can last the whole day and enable the client to maintain attention and concentration the whole day. Ritalin LA is a long-acting preparation and hence its effects are last for a long time. Moreover, the dose was increased and therefore the efficacy of the medication is expected to be higher (Pakdaman et al., 2018). The reason for not choosing the decision to continue with the same dose of Ritalin is because with this decision Katie was unable to maintain attention and concentrate the whole day. The reason why the decision to have Ritalin discontinued and begin Adderall XR was not considered is because it is recommended to evaluate the maximum effective dose of the first-line treatment choice before discontinuing. Additionally, Adderall has similar side effects with Ritalin and therefore there is no clinical reason to change Ritalin to Adderall (Weyandt et al., 2018).

The treatment goal of Ritalin 20 LA was that there would be improved and long-lasting efficacy of the medication and hence Katie would be able to concentrate and maintain attention the whole day. According to Pakdaman et al (2018), higher doses of Ritalin are more effective in improving ADHD symptoms. Secondly, it was hoped that the client would stop experiencing increasing pulse rates because the body would get used to the medication over time.

The treatment outcome for the decision was that the client manifested significant symptom improvement as indicated by the ability to maintain attention the whole day and continued improved academic performance. This is due to the long-lasting efficacy of Ritalin LA (Pakdaman et al., 2018). Additionally, the client reported that the heart rate had stabilized.

Decision Point Three

The third treatment choice was to maintain the current dose of Ritalin and reevaluate in 4 weeks. This treatment choice was considered because Ritalin LA 20 mg is controlling the ADHD symptoms adequately for the client as she can maintain attention and concentration the whole day at school. This indicates the efficacy of Ritalin long-acting preparations in the treatment of ADHD symptoms (Masha & Dickerson, 2019). Additionally, Katie did not report side effects with Ritalin 20 mg indicating that she is tolerating the dose and medication well. The reason why Ritalin LS 30 mg was not considered is because the lowest effective dose of stimulants such as Ritalin should be used. Katie is adequately responding to Ritalin 20 mg and hence there is no reason to increase the dose. The decision to obtain EKG for Katie was not considered because her current pulse rate is 92 and this is within the normal range for her age. Moreover, she reported that the pulse rate had stabilized.

The treatment goal for this decision is that Katie would continue manifesting symptom improvement and finally achieve complete symptom remission. This is due to the efficacy of Ritalin in improving symptoms of ADHD (Masha & Dickerson, 2019).

Conclusion

ADHD is a disorder characterized by a pattern of inattention and hyperactivity-impulsivity that interferes with an individual’s functioning. The client in the case study has ADHD predominantly inattention and this means that she has difficulties in staying on tasks, concentrating, being organized, and sustaining focus. This is manifested where Katie is forgetful, has a short attention span, is easily distracted, and inattentive. This has affected her academic performance. Therefore, the first treatment choice was for Katie to begin Ritalin because of the medication’s efficacy in improving ADHD symptoms. However, with Ritalin 10 mg, the client only maintained attention and focus in the morning hours but in the afternoon the inattentiveness symptoms resurfaced. Therefore, the second decision included changing to Ritalin LA 20 mg in order to increase the efficacy of the medication and ensure that the effect of the medication lasts the whole day. Consequently, the client manifested significant symptom improvement as she maintained attesting the whole day and did not report any side effects with the increased dose. Therefore, the last decision involved maintaining the current dose of Ritalin LA 20 mg because Katie is adequately responding to this medication and dose and also because she is tolerating the Ritalin dose as she did not report any side effects. Risk factors such as brain injury, social environment, and nutrition may contribute to the development of ADHD and hence the parents will be advised to ensure Katie is in a safe environment both physically and emotionally and she is provided with a healthy diet. Since other conditions such as learning disabilities and anxiety disorder are comorbidities in ADHD, it is important to screen Katie for any other condition (Haft et al., 2019).

References

de la Peña, I. C., Pan, M. C., Thai, C. G., & Alisso, T. (2020). Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies. Brain sciences, 10(5), 292. https://doi.org/10.3390/brainsci10050292

Haft, S. L., Chen, T., Leblanc, C., Tencza, F., & Hoeft, F. (2019). Impact of mentoring on socio-emotional and mental health outcomes of youth with learning disabilities and attention-deficit hyperactivity disorder. Child and adolescent mental health, 24(4), 318–328. https://doi.org/10.1111/camh.12331

Kaar, S. J., Natesan, S., McCutcheon, R., & Howes, O. D. (2020). Antipsychotics: mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology, 172, 107704.

Masha, N., & Dickerson, K. (2019). The Use of Methylphenidate in the Treatment of ADHD: What is the Mechanism for Treating Working Memory Deficits? Journal of Young Investigators, 37(5).

Matthijssen, A. F. M., Dietrich, A., Bierens, M., Kleine Deters, R., van de Loo-Neus, G. H., van den Hoofdakker, B. J., … & Hoekstra, P. J. (2019). Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: a randomized placebo-controlled discontinuation study. American Journal of Psychiatry, 176(9), 754-762.

Ng, Q. X. (2017). A systematic review of the use of bupropion for attention-deficit/hyperactivity disorder in children and adolescents. Journal of child and adolescent psychopharmacology, 27(2), 112-116.

Pakdaman, F., Irani, F., Tajikzadeh, F., & Jabalkandi, S. A. (2018). The efficacy of Ritalin in ADHD children under neurofeedback training. Neurological Sciences, 39(12), 2071-2078.

Weyandt, L. L., White, T. L., Gudmundsdottir, B. G., Nitenson, A. Z., Rathkey, E. S., De Leon, K. A., & Bjorn, S. A. (2018). Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students. Pharmacy (Basel, Switzerland), 6(3), 58. https://doi.org/10.3390/pharmacy6030058

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https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_09/index.html

1^st choice: Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

2^nd choice: change to Ritalin LA 20mg orally in the AM

3^rd choice Maintain current dose of Ritalin and reevaluate in 4 weeks

Examine Case Study: A Young Caucasian Girl with ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases. Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option – why is it the best option, using clinically relevant data from primary literature (clinical trials, treatment guidelines) and patient specific data AND why you did not choose the other options (with clinically relevant data from primary literature and patient specific data).

Introduction to the case (1 page)

Briefly explain and summarize the disease state you are treating this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1.5+ 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. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start!

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. You should provide me with a clear understanding of the stimulant vs. non-stimulant clinical decision you’ve made. Be sure to cite specific guidelines for pediatric ADHD.

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.

Decision #2 (1 page)

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.

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Decision #3 (1 page)

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. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start!

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.

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.

I keep losing so much point on the conclusion
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