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Case Study: A Young Caucasian Girl with ADHD
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 cPMHNP ondition. The parents give the 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 presentationDecision Point One Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute Decision Point Two Change to Ritalin LA 20 mg orally daily in the MORNING RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit Decision Point Three Maintain current dose of Ritalin LA and reevaluate in 4 weeks Guidance to Student At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.
Decision Point One
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute
Decision Point Two
Change to Ritalin LA 20 mg orally daily in the MORNING
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Decision Point Three
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Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student
At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.
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 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.
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 #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.
After writing up your rationale at each decision point, I would ask yourself the following questions:
Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient?
Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal?
Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions
Also include how ethical considerations might impact your treatment plan and communication with clients.
ntroduction 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 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)
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• 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.
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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.References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required. As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making.
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Case Study: A Young Caucasian Girl with ADHD
Introduction
The case study involves an 8-year-old Caucasian female, named Katie. Katie presented to the clinical accompanied by her parents after being referred by the primary care provider for suspected attention deficit hyperactivity disorder (ADHD). ADHD is a mental disorder that is characterized by a persistent inattention and hyperactivity-impulsivity that interferes with an individual’s functionality (Drechsler et al., 2020). The parents reported that the primary care provider suggested that Katie needed a psychiatry assessment to determine if she had ADHD. The Conner’s Teacher Rating Scale-Revised” that had been filled by the teacher indicated that Katie was easily distracted, inattentive, forgetful, and poor in arithmetic, reading, and spelling. The teacher further indicated that Katie’s attention span was short and she paid attention only to the things she was interested in. According to the teacher, Katie lacked interest in schoolwork, started things but never finished, failed to complete her school work, and rarely followed through on instructions. Katie also admitted that her mind wanders during class. The MSE indicated that Katie was appropriately developed for her age and her speech logical, clear, and coherent. She was also appropriately oriented to event, time, place, and person. Katie did not manifest any noteworthy tics, mannerisms, or gestures and her mood was euthymic and bright affect. The MSE however showed that her attention and concentration were grossly intact. As a result, her diagnosis was confirmed as ADHD, predominantly inattentive presentation. This paper will discuss the treatment choices for Katie and provide a rationale for each treatment decision.
Decision Point One
The first treatment decision for Katie is to start Ritalin (methylphenidate) 10mg in the morning. Methylphenidate was selected because it is the first-line treatment choice for treating ADHD. The medication is also approved by FAD in the treatment of ADHD in the pediatric population (Chamakalayil et al., 2021). Methylphenidate works by acting on the dopamine and norepinephrine transporters (Faraone, 2018) and thus inhibits the reuptake of both dopamine and norepinephrine (Faraone, 2018). This increases the levels of norepinephrine and dopamine in the brain and this helps to control ADHD symptoms. The other rationale for choosing methylphenidate is due to its few side effects. Wellbutrin was not chosen due to its many side effects (Patel et al., 2016). Additionally, Wellbutrin has been shown to trigger suicidal ideation (Kweon & Kim, 2019), and this is another reason it was not selected. On the other hand, Intuniv was not chosen because it is also associated with numerous side effects such as hypotension, reduced pulse rate, and bradycardia.
The treatment goal for this decision was that the client would manifest significant symptom reduction. This is due to the efficacy of methylphenidate in improving ADHD symptoms (Pitzianti et al., 2020). It was expected the client would tolerate the medication and not experience adverse effects. The treatment outcome for this decision was that the client experienced symptom improvement in the morning hours and also her academic performance improved. However, in the afternoon, the symptoms would resurface. The resurfacing of the symptoms in the afternoon is attributable to the fact that methylphenidate being an immediate release preparation and also the low start dose was short-acting (Karahmadi, Saadatmand & Tarahi, 2020). Therefore, the efficacy of the medication would not last the whole day. Additionally, the client also reported a high pulse rate as a side effect of the medication.
Before selecting thi treatment decision, an informed consent was sought from the client’s parents by providing information about the available treatment options to enable them make an informed decision. Additionally, the principle of beneficience was applied to promote the wellbeing of the client (Varkey, 2021).
Decision Point Two
The second treatment choice was to change the methylphenidate 10mg, to methylphenidate LA 20mg. The reason why methylphenidate LA 20mg was chosen was to make the effect of the medication last the entire day (Weiss et al., 2021). This would ensure that Katie would be attentive throughout the day because methylphenidate LA 20mg is a long-acting preparation. Evidence has shown that higher doses of methylphenidate are more effective in improving symptoms of ADHD (Weiss et al., 2021). The decision to continue with methylphenidate 10 mg was not chosen since the efficacy of the treatment choice did not last the whole as Katie would be inattentive in the afternoon. On the other hand, the decision to discontinue methylphenidate and begin Adderall XR was not chosen is because Adderall has similar side effects as methylphenidate (Steingard, et al., 2019); therefore, there is no clinical reason to change the treatment regimen.
The treatment goal for this decision was that the effect of the medication would last the whole day and thus she would be attentive the whole day. This is because higher doses of methylphenidate have been shown to be more effective in improving ADHD symptoms when compared to lower doses of methylphenidate (Weiss et al., 2021). Another expectation was that Katie would not report any side effects, including the high heart rate as her body would get used to the medication.
The treatment outcome for this decision was that the client was able to maintain attention the whole day. Additionally, Katie’s academic performance continued improving. This is attributable to the increased efficacy of the higher dose and the ability of the long-acting preparation to have its effects last the whole day (Weiss et al., 2021). The client also reported that the high pulse rate had stabilized and that she was no longer having a funny feeling in the heart. Therefore, the treatment goals for this decision match the treatment outcomes.
When choosing the second treatment decision, the ethical principles of beneficience and non-malficience were applied. Beneficience involved ensuring that the wellbeing of patients is promoted while non-maleficince involves ensuring no harm occurs to the patient (Varkey, 2021). Therefore, the treatment option considered to be the most effective and with least side effects was selected.
Decision Point Three
The selected treatment decision was to maintain the current dose of methylphenidate LA and have the client examined after four weeks. The rationale for choosing the decision to maintain methylphenidate LA 20 mg because Katie is responding to this dose as indicated by the ability to maintain attention throughout the day. This is because methylphenidate LA is a long-acting preparation as therefore the effects of the medication lasted longer (Weiss et al., 2021). Secondly, the client tolerated this dose as she did not report any side effects as she reported that the pulse rate was stable and also, she was no longer having a funny feeling in the heart. The reason why Ritalin LA to 30 mg was not chosen was that there was no clinical reason to increase the dose because Katie was already responding to Ritalin LA 20 mg. Additionally, evidence supports the use of the lowest effective dose of stimulants when treating ADHD. The decision to have the EKG for the client obtained was not selected because the current pulse rate for the client is within the normal range (92) for children aged 8 years.
By selecting this decision, it is expected that Katie would continue manifesting symptom improvement by being able to maintain attention throughout the day, reduced forgetfulness, and improved academic performance. This is due to the efficacy of methylphenidate LA in improving ADHD symptoms and the effects of the medication being long-lasting (Weiss et al., 2021).
Similarly, in this treatment decision ethical principles of beneficience and non-malficience were applied where the treatment option considered to be the most effective and with least side effects was selected.
Conclusion
The client in this case study was diagnosed with ADHD, inattention. The symptoms of inattention in children below 16 years include making careless mistakes in schoolwork, trouble maintaining attention on activities, not listening during conversations, not following through instruction, disorganization, losing things, being easily distracted, and forgetfulness. Therefore, the first treatment decision was for Katie to start methylphenidate 10 mg due to the medication’s efficacy in improving symptoms of ADHD. However, even though Katie manifested symptom improvement with this decision, the symptoms would resurface in the afternoon, making her not concentrate in the afternoon. Katie also reported side effects like high heart rate. In order to ensure that the client maintained attention throughout the day, the second decision was to change to methylphenidate LA 20 mg. This is because methylphenidate LA is a long-acting preparation and therefore the medication’s effect would last the whole day. As a result, she would maintain attention throughout the day. The increased dose was also expected to be more effective because higher doses of stimulants are associated with higher efficacy. As expected, Katie manifested significant symptom improvement as she was able to maintain attention throughout the day. Additionally, she did not report any side effects because the pulse rate stabilized. Therefore, the last treatment dose was to maintain the current dose of methylphenidate LA 20 mg because the client manifest significant symptom improvement with this dose and tolerated the increased dose well.
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