Decision #1 (1 page) 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

Assessing and Treating Patients with ADHD

The patient described in the case study is a Caucasian female aged eight years named Katie, who is presented to the clinic by her parents upon a referral from a primary healthcare provider. This referral resulted from suspicion of attention deficit hyperactive disorder (ADHD) in the child. An evaluation tool filled by the teachers indicates that Katie is not only easily distracted in her classwork but is also inattentive, forgets things she learns from class quickly, and is poor at spelling, reading, and arithmetic. The teacher also noted that Katie has a short attention span and is only attentive to things that interest her. Additionally, she exhibits considerable difficulties in finishing chores and following instructions.

On subjective examination, Katie admits to having subject favorites in art and recess, with other subjects boring. She further explains that the tedious nature of those subjects is because she feels lost in these subjects. She also notes that she experiences episodes in which the teacher would call her name in class and find her not relating to what the teacher is discussing. However, she reports being okay at school and home and also denies any form of bullying or abuse at school. Mental examination reveals that she is developed appropriately for her age and exhibits clarity, logic, and coherence in speech. She is also oriented adequately to time, place, and event and is appropriately dressed for the weather. She denies any auditory or visual hallucinations and exhibits age-appropriate insight and judgment.

Katie has a positive diagnosis of ADHD. ADHD is a mental disorder characterized by short attention span, easy distractibility, forgetfulness, task organization difficulty, inability to stick to tasks, inability to get instructions, and difficulty in concentration. The symptoms exhibited by Katie are consistent with ADHD. As evident in the Conner Teacher Rating Sale revised tool, Katie exhibits easy distraction, is forgetful, is inattentive, has a short attention span, and has difficulty accomplishing tasks. All these symptoms are consistent with ADHD and formed the basis of diagnosis.

Decision point 1

The best clinical decision for Katie is to begin methylphenidate (Ritalin) chewable tablets at 10mg once daily in the morning. Methylphenidate is a stimulant that is FDA-approved as a first-line agent in the treatment of ADHD among children and adolescents (Shier et al., 2016). This drug maintains considerably high efficacy in the alleviation of symptoms attributable to ADHD. Methylphenidate enhances the release of the neurotransmitters dopamine and norepinephrine by blocking their reuptake, thus increasing their levels in the brain’s prefrontal cortex. Their level of efficacy in ADHD informed my selection as the first-line agent to be used in this patient.

The other two options available in the management of this patient were bupropion 150mg and Intuniv extended-release at 1mg once daily. Bupropion is an antidepressant that has an off-label utility in the treatment of ADHD. Bupropion is equally highly efficacious in the alleviation of symptoms of ADHD (Brown et al., 2018). This medication, however, exhibits adverse drug reactions that limit its use in children. Such adverse effects include suicidal thoughts, tachycardia, diaphoresis, and headaches, among others. These effects make it unfavorable for utility in children. Intuniv(guanfacine), on the other hand, is a non-stimulant anti-ADHD agent of the alpha two agonist class that is used in ADHD. It also maintains high efficacy in symptom alleviation in this disorder but is linked to intolerable side effects such as marked sedation, xeropthalmia, constipation, and headache, which limits its use (Brown et al., 2018). The toxicity profile of these two drugs was the basis for their exclusion as agents of choice for the management of ADHD in an 8-year-old child.

The aim of selecting Ritalin as the first choice in the management of ADHD in this child was to offer symptomatic relief while preventing adverse drug effects that may be debilitating to the patient. Ritalin is one of the first-line medications utilized in ADHD. This drug is generally effective and safe in children and adolescents. They, however, present with some cardiovascular side effects, such as tachycardia, although this increase may not be sufficient to be classified as abnormal (Shier et al., 2016). They are generally well-tolerated and have been utilized in the long-term management of ADHD. ADHD is a mental disorder that can present with issues such as stigma. Therefore, healthcare providers must maintain confidentiality with the patient and treat them respectfully as human beings.

Decision point #2

After four weeks, the patient returned to the clinic with improved symptoms and