Assignment: Assessing and Treating Clients With ADHD
Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.
Learning Objectives
Students will:
Assess client factors and history to develop personalized therapy plans for clients with ADHD
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
Evaluate efficacy of treatment plans
Evaluate ethical and legal implications related to prescribing therapy for clients with ADHD
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: Review all materials from the Discussion.
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.
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
This case study will serve as the foundation for this week’s Assignment.
The Assignment
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.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD
A Young Girl With ADHD
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 the PMHNP 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 #1:
The first decision I would make is to initiate a comprehensive assessment of Katie’s ADHD symptoms and overall functioning. This would involve gathering information from multiple sources, including her parents, teacher, and potentially conducting additional rating scales and interviews. The assessment would aim to establish the presence and severity of ADHD symptoms, identify any comorbid conditions or contributing factors, and evaluate the impact of these symptoms on Katie’s academic and social functioning.
I selected this decision because a thorough assessment is essential to accurately diagnose and develop an appropriate treatment plan for ADHD. The Conners’ Teacher Rating Scale (CTRS-R) provided by Katie’s teacher can be a useful tool in gathering information about her symptoms and their impact in the classroom setting (Conners et al., 1998).
By conducting a comprehensive assessment, I hope to achieve a clear understanding of Katie’s ADHD symptoms, their impact on her functioning, and any other relevant factors that may influence treatment decisions. This information will serve as the foundation for developing an individualized therapy plan tailored to her specific needs.
The results of Decision #1 align with my expectations, as conducting a comprehensive assessment is a necessary step in evaluating ADHD. It allows for a more accurate diagnosis and helps identify any additional factors that may need to be addressed in the treatment plan. By obtaining a detailed understanding of Katie’s symptoms and functioning, it will be easier to determine appropriate treatment options.
Decision #2:
The second decision I would make is to consider non-pharmacological interventions as an initial approach to managing Katie’s ADHD symptoms. These interventions may include behavioral therapy, parent training, and classroom accommodations. Non-pharmacological interventions have been shown to be effective in reducing ADHD symptoms and improving functioning in children (AACAP, 2019). Considering Katie’s age and the predominantly inattentive presentation of her ADHD, non-pharmacological interventions can play a significant role in addressing her symptoms.
I selected this decision because non-pharmacological interventions should be considered as first-line treatment options for ADHD, especially in children. These interventions can provide valuable strategies to manage symptoms, enhance self-regulation skills, and improve academic and social functioning (AACAP, 2019).
By choosing non-pharmacological interventions, I hope to achieve a reduction in Katie’s ADHD symptoms, improved attention and focus, better organizational skills, and enhanced overall functioning. These interventions can also empower Katie and her parents with effective strategies to cope with ADHD-related challenges.
The results of Decision #2 are aligned with my expectations. Non-pharmacological interventions are often recommended as part of the initial treatment approach for ADHD, and they can be effective in reducing symptoms and improving functioning. By implementing these interventions, Katie and her family can benefit from strategies and support to manage her ADHD symptoms.
Decision #3:
The third decision I would make is to consider medication therapy as an adjunct to non-pharmacological interventions if Katie’s symptoms persist and significantly impair her functioning. Stimulant medications, such as methylphenidate or amphetamines, are commonly prescribed for the treatment of ADHD and have shown to be effective in reducing symptoms in children (AACAP, 2019).
I selected this decision because medication therapy can be beneficial for individuals with ADHD, especially when symptoms are severe and significantly impact daily functioning. It is important to consider the potential risks and benefits of medication, individualize the treatment plan, and closely monitor the response and any side effects.
By considering medication therapy, I hope to achieve a further reduction in Katie’s ADHD symptoms, improved attention, and better impulse control, which would contribute to enhanced academic performance and overall functioning. Medication can be a valuable tool in managing ADHD symptoms, but it should always be used in conjunction with non-pharmacological interventions and closely monitored for effectiveness and side effects.
The results of Decision #3 may vary.
