Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD

Case Study Overview

In this week, the client is an 8-year-old Caucasian female named Katie who was accompanied by her mother and father as a referral from their primary care provider with reports from her teacher that she could be having ADHD. The PCP was certain that Katie needed to be evaluated by a psychiatrist to establish whether or not she had ADHD. Upon conducting a thorough evaluation, a diagnosis of Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation was made. Based on the client’s presentation, the purpose of this paper is to determine the best psychopharmacologic drugs to use in the management of the client based on three decisions. The reasons for selecting each decision will have a rationale from currently existing academic resources. The expected and actual outcomes for each decision will be discussed alongside the ethical considerations and how they are likely to impact the client’s treatment plan and communication with the family and client.

Decision #1

Decision Selected

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

Reason for Selecting This Decision

According to Thomas et al., (2015), Ritalin is a stimulant medication that has been used for decades in the management of ADHD since it is a cognitive enhancer. It functions by promoting the presence of neurotransmitters dopamine and norepinephrine in the CNS which speeds up the activity of the brain. Ritalin is fast acting and gets to the peak performance faster than other stimulant medications (Tarrant et al., 2018).  Besides, it is also affordable and readily available in the market, and therefore the best choice in this case. Wellbutrin could be a good choice since it is also used off label for managing ADHD but in adults. It works by increasing the availability of norepinephrine and dopamine in the frontal cortex, which explains its effectiveness in managing symptoms of ADHD. However, it has suicidal ideation as a major side-effect in adolescents and children thus not a good choice for this patient who is 8 years old (Briars & Todd, 2016). Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Intuniv could also be a good choice since it a non-stimulant drug used in the management of oppositional behaviors in children with ADHD. It, however, has a major side effect of sedation which can make a patient be very sluggish in a whole day (Briars & Todd, 2016). It also has very minimal or no effect on improving a child’s attention. Therefore, for Katie in this case, it wouldn’t be a good choice since sedation will negatively impact her quality of life, social functioning, and academic performance.

Expected Outcome

            By starting Katie on Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning, it was expected that Katie would have some improvement in terms of paying attention at school and that her academic performance will also improve. Ritalin has been approved by the FDA for treatment of ADHD in patients aged 6 years and older, although it can also be used for managing children who are younger than 6 years of age and diagnosed with ADHD. It targets norepinephrine and dopamine in the brain to reduce common symptoms of attention, concentration, fidgeting and enhancing listening skills (Huss, et al, 2017). Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Difference between Expected Outcome and Actual Outcome

The client returned to the clinic after four weeks accompanied by her parents who reported that according to Katie’s teacher reports,  her symptoms were much better in the morning, the progress that has resulted to her overall improvement in her academic performance. However, her teacher noted that, in the afternoon, Katie often stared into space and started to daydream again. Katie’s parents were also concerned about Katie’s reports that her heart felt funny. Upon taking a pulse rate, I found that Katie’s heart was regular and beating at about 130 beats per minute. The fast heartbeat that the patient reported was a side effect of Ritalin. The immediate release form of Ritalin has tachycardia as a common side effect (Huss, et al, 2017).   Besides, the immediate release form cannot help Katie maintain her attention throughout the day.

It also worth noting that, since the heartbeat was regular with no other signs of cardiac abnormality, the best way to address this issue is by switching to a long-acting preparation (Huss, et al, 2017).

Decision # 2

Decision Selected

Change to Rita