Decision Tree: A Young Girl with Difficulties in School

Decision Tree: A Young Girl with Difficulties in School

Decision Tree A Young Girl with Difficulties in School

 

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder seen in children. ADHD makes children unable to pay attention, control impulsive behaviors or become overly active (Doernberg & Hollander, 2016). It occurs in three forms which include predominantly inattentive presentation, predominantly hyperactive-impulsive presentation or a combined presentation. The purpose of this paper is to review a case study of a young girl with difficulties in school. The paper will follow a decision tree to execute a differential diagnosis and offer treatment to the client. The paper will also summarize with ethical issues that will guide communication and treatment plan.

Case Study

The case presents an 8-year-old Caucasian female named Katie. Her parents brought her to the clinic after being on ADHD medication without reprieve. The patient requires a new diagnosis.  The parents believe that their child had ADHD after reading through the internet. As a clinician, the duty at hand is to confirm or refute the parents’ diagnosis. To make the diagnosis, interviews, and observations of the child, her parents and assessment of parents and teacher will be followed. For instance, Conner’s Teacher Rating Scale-Revised report from the teacher indicates that Katie’s attention is poor, she is easily distracted, makes careless mistakes in her schoolwork, she forgets things already learned and has poor arithmetic, reading and spelling skills (Laureate Media, 2020). She pays attention to things of interest and has poor interaction with peers. From the parents’ report, they state that she has difficulty socializing with peers, quiet at home and watches TV most of the time. An observation of the patient shows that she cannot sit still and she interrupts conversations. The patient states that school is OK and admits that her mind wanders during class. The parents appear anxious. The mental exam shows a neutral affect and euthymic mood. The patient denies voices in the head but admits having an imaginary friend ‘Audrey’. She has limited concentration since she provides short answers to questions.

Decision One

314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

Reason for Selecting the Decision

Katie fulfills the DSM-5 criteria for ADHD predominantly inattentive presentation. According to DSM-5, a child should present with six or more symptoms of inattention for at least six months to a point they are inappropriate for developmental level. Katie has seven out of eight symptoms required for inattention. Her attention is class is poor, she has trouble keeping attention on tasks, does not follow through on instructions, has trouble organizing activities, avoids things requiring mental effort, loses things needed for tasks and is easily distracted and forgetful (Rigler et al., 2016). Katie only has one hyperactivity symptom, which is an inability to sit still and one impulsivity symptom, which is interrupting others.

Presence of 299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder is refuted because although Katie has difficulty settling down, impulsivity, social awkwardness and ability to focus on things that interest her, she lacks other symptoms of ASD. Her communication is not impaired, she does not portray a restricted repertoire of activities and interest and she does not have poor social interaction (Doernberg & Hollander, 2016). Additionally, she has no reported social phobia that would point towards social anxiety disorders.  The presence of 315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics is also refuted.  Although Katie has inattention, as well as poor arithmetic, spelling and reading skills, her inattention is not caused by frustration, lack of interest or lack of ability during academic work (Friedman et al., 2019). Additionally, her inattention appears in a non-academic setting unlike most patients with specific learning disorders.

Expected Results

The clinician expects to make the right diagnosis to help in coming up with an intervention that resolves Katie’s symptoms and dissipates the concern displayed by her parents. An accurate diagnosis will aid in reviewing treatment options and help in planning a course of appropriate medical and psychosocial interventions.

Differences between the Results

Although the DSM-5 indicated that the patient has ADHD, predominantly inattentive presentation, the clinician decided to administer child behavior checklists to assess Katie’s emotional and behavioral problems. The CBCL offered information on mood and behaviors, social competence and academic functioning (Hong & Comer, 2019). The parents and the teacher filled the checklists and the scores confirmed the diagnosis made. The clinician initiated the treatment plan.

Decision-Two

Begin Adderall XR 10mg orally daily

Reason for Selecting the Above Option

Adderall XR is a stimulant medication and the first-line treatment for ADHD symptoms. It enhances arousal in the prefrontal cortex

and works by blocking dopamine and norepinephrine transporters, dampening monoamine oxidase action and enhancing the release of dopamine into the synaptic space (Brown, Samuel & Patel, 2018). Research shows it improves symptoms for 70-80% of people with ADHD. It improves focus and reduces impulsivity and hyperactive behaviors. The XR is a long-acting medication that reduces the need for in-school dosing, enhances compliance and offers more after school treatment effects.

Wellbutrin 75 mg is avoided because it is an antidepressant and less effective than stimulants when managing ADHD. Additionally, it is not FDA approved for ADHD and it is used as an ‘off-label’ medicine (Brown et al., 2018). It also has a high risk of inducing suicidal ideation. Strattera 25mg is a second-line treatment for ADHD and has a slow response compared to Adderall. It also has a risk for suicidal ideation as well as adverse events like sedation and decreased appetite which may result in compliance issues (Brown et al., 2018).

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Expected Results

The clinician expects that the patient’s symptoms will improve with minimal side effects. The Conner’s Teacher Rating Scale-Revised report should indicate better concentration, less distraction, fewer mistakes, better memory and improved arithmetic, reading and spelling skills.

Differences between the Results

After four weeks the parents appeared happy and they reported that Katie was paying more attention at school. The only problem was that Katie maintained concentration in the morning classes while she daydreamed in the afternoon (Laureate Media, 2020).  Her appetite had also decreased.

Decision Three

Add a small dose of immediate-release Adderall in the afternoon.

Reason for Selecting the Option

The main aim of the treatment was to arrest ADHD symptoms and dispel Katie’s parents’ concerns. The initial dosage offered a therapeutic response although it did not sustain attention for the whole day. Therefore, a small dose of immediate-release Adderall in the Afternoon will help sustain attention for the entire day and even into the early evening to help Katie tackle her homework (Laureate Media, 2020). The decreased appetite can be linked to weight loss which is a common side effect of stimulant medication. Assuring Katie’s parents about weight loss does not tackle their concern on the return of symptoms in the afternoon. Lastly, adding family therapy to the current medication does not handle the inattentive symptoms in the afternoon although it may increase knowledge on the disease, challenges faced and ways of managing the symptoms.

Expected Results

The clinician expects sustained concentration throughout the day and into the early evening.

Difference between Expected and Actual Results

The patient appeared as expected.

Ethical Considerations

In terms of ethics, when handling ADHD in children, it is essential to make an accurate diagnosis. The child should be thoroughly evaluated and information gathered from multiple sources (Zuddas, Banaschewski, Coghill & Stein, 2018). Informed consent is also essential to ensure that the client understands the risk and benefits of medication taken as well as alternative interventions available. Autonomy should also be maintained by allowing the child to participate in the decision-making process. For Katie, her objective and subjective report were taken, the Conner’s Teacher Rating Scale-Revised report adopted and the CBCL used to guide diagnosis. After diagnosis, the parents were informed of the available interventions and they consented to the selected medication. Katie’s opinions were taken into consideration as well.

 

Assignment: Practicum: Decision Tree

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.
Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
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: Treatment Plan for Psychotherapy
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: Treatment Plan for Psychopharmacology
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 and their families.
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.

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource