Sample Answer for NURS 6630 Discussion: Presentations of ADHD Included After Question
NURS 6630 Discussion: Presentations of ADHD
Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”
Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.
Chapter 4, “ADHD Treatments”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
For ADHD
armodafinil
amphetamine (d)
amphetamine (d,l)
atomoxetine
Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty
Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter
Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
Review the posttest for the case study.
NURS 6630 Discussion: Presentations of ADHD Grading Rubric Guidelines
| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions. |
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| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations |
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| Performance Category | 5 | 4 | 3 | 2 | 0 |
| Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread) |
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Summarizes what was learned from the lesson, readings, and other student posts for the week. |
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| Minus 1 Point | Minus 2 Point | Minus 3 Point | Minus 4 Point | Minus 5 Point | |
| Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition |
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| Total Participation Requirements
per discussion thread |
The student answers the threaded discussion question or topic on one day and posts a second response on another day. | The student does not meet the minimum requirement of two postings on two different days | |||
| Early Participation Requirement
per discussion thread |
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. | The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |
A Sample Answer For the Assignment: NURS 6630 Discussion: Presentations of ADHD
Title: NURS 6630 Discussion: Presentations of ADHD
Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, impulsivity, and hyperactivity. It is regarded as a neurodevelopmental disorder, and it impairs an individual’s development in personal, academic, social, or occupational functioning. It has three types: predominantly hyperactive/impulsive, predominantly inattentive, and combined. The purpose of this paper is to describe the case of a child with ADHD and discuss the treatment approaches using a decision tree.
Introduction to the Case
The case scenario concerns Katie, an eight-year-old girl accompanied by her parents after being referred for psychiatric evaluation by her PCP. Her teacher mentioned that she could have ADHD. The client’s teacher filled the Conner’s Teacher Rating Scale-Revised questionnaire, which reveals that she lacks concentration, is easily distracted, has a poor memory of what she learns, and performs poorly in reading, spelling, and calculation. Katie’s teacher stated that she has a shortened attention span and concentrates only on things she finds interesting. Besides, the teacher mentioned that Katie is distracted and has minimal interest in school work. Katie initiates tasks that she never finishes, hardly follows instructions, and does not complete her school assignments. Nonetheless, her parents disagree that she has ADHD since she is not rebellious or throws temper outbursts.
When interviewing Katie, she says she does not understand the issue and that school is okay with art and recess being her favorite. Katie finds other subjects boring and often difficult since she feels lost. She reports that her mind wanders when in class and thinks of more fun activities. Her mind goes blank in class, the teacher calls her name, and she realizes she does not know what is happening. Mental status exam findings are unremarkable, and she is diagnosed with ADHD-inattentive presentation. Patient factors influencing treatment decisions include the child’s height and weight, medical history, current medication, baseline heart rate and blood pressure, and cardiovascular assessment findings.
Decision #1
Initiate Ritalin (methylphenidate) chewable tablets 10 mg PO in the Morning.
Reason for this Decision
Ritalin was selected because it is recommended as a first-line agent in treating ADHD in children. Drechsler et al. (2020) assert that methylphenidate is the most effective medication for treating core ADHD symptoms since it has a favorable efficacy and side effects profile. Coghill et al. (2021) found favorable evidence supporting the general efficacy and tolerability of methylphenidate in treating ADHD in children and adolescents.
Why Other Decisions Were Not Selected
Wellbutrin was not an ideal agent due to its slow onset of action compared to Ritalin. Besides, there lack enough randomized controlled trials supporting the use of Wellbutrin and its efficacy in treating ADHD in children (Coghill et al., 2021). Intuniv was not selected because it is a second-line agent in treating ADHD in children. Drechsler et al. (2020) explain that Intuniv should only be prescribed if a patient cannot tolerate methylphenidate or if the symptoms do not respond to methylphenidate within six weeks.
What I Was Hoping To Achieve By Making This Decision
The PMHNP hoped that prescribing Ritalin would improve Katie’s attention and concentration in class and her academic performance. Posner et al. (2020) found that Ritalin improved children’s academic performance, general productivity, and accuracy in arithmetic. Besides, Ritalin exhibits an immediate reduction of ADHD symptoms at an adequate dose (Drechsler et al., 2020).
Ethical Considerations Impact on Treatment Plan and Communication
Beneficence and patient right to autonomy influence treatment and communication with the patient. The PMHNP had to select a medication associated with the best outcomes and consequently prescribed Ritalin because there is evidence supporting its efficacy in treating ADHD in children. Besides, the PMHNP has to seek consent from the child’s parents to initiate treatment which impacts communication.
Decision #2
Switch to Ritalin LA 20 mg PO in the Morning.
Reason for this Decision
The PMHNP switched to long-acting (LA) Ritalin because the drug’s effects were not sustained throughout the day in the short-acting formulation. Storebø et al. (2018) explain that Ritalin LA takes 8-16 hours to wear off and works in phases to alleviate ADHD symptoms throughout the day. According to Drechsler et al. (2020), if medications are to be used in children with ADHD, long-acting formulations of psychostimulants like Ritalin should always be the first choice since they sustain the effects of CNS stimulation the whole day.
Why Other Decisions Were Not Selected
It was not ideal for maintaining the initial Ritalin dose because it did not sustain the CNS stimulation effect the entire day. Storebø et al. (2018) explain that the short-acting formulation of Ritalin takes 3 to 6 hours to wear off, which explains why Katie was losing concentration in the afternoon. Stopping Ritalin and switching to Adderall XR was also not ideal because Ritalin should only be changed if the patient cannot tolerate the drug or if there is no adequate improvement after six weeks (Drechsler et al., 2020).
What I Was Hoping To Achieve By Making This Decision
The PMHNP hoped that changing to LA would sustain the drug’s effects the whole day, and Katie would exhibit an increased concentration span throughout the day (Drechsler et al., 2020). The PMHNP also expected the LA formulation would have no side effects of palpitations and tachycardia. Storebø et al. (2018) explain that LA Ritalin should be titrated as per the patient’s needs to maximize benefits and reduce potential side effects.
Ethical Considerations Impact on Treatment Plan and Communication
Beneficence and nonmaleficence impacted treatment since the practitioner had to select a therapy that would improve the patient’s outcomes without compromising safety. For example, the PMHNP switched Ritalin from a short-to long-acting formulation to enhance the patient’s outcomes and alleviate the side effects of short-acting Ritalin. Confidentiality impacted communication since the PMHNP had to assure the patient’s parents that the information would be kept confidential and only shared after their consent. Decision #3
Maintain current Ritalin LA dose and reevaluate in 4 weeks.
Reason for this Decision
The Ritalin LA dose was maintained because the patient exhibited improved academic performance, and the attention span was sustained throughout the day. Coghill et al. (2021) explain that for patients attaining suboptimal symptom control, long-acting Ritalin formulations are more beneficial. In addition, LA Ritalin formulations have a modest effect on inattention, impulsivity, and hyperactivity in children with ADHD.
Why Other Decisions Were Not Selected
It was not ideal to titrate Ritalin LA to 30 mg since the current 20 mg dose was effective in alleviating the patient’s ADHD symptoms. Posner et al. (2020) assert that the lowest but most effective dose of stimulants should be used to minimize adverse effects. In addition, performing an EKG was unnecessary since the patient had a heart rate of 92, which is within the normal range. Cardiac assessment is recommended if a patient presents with sustained syncope, chest discomfort, and symptoms pointing to cardiac disease (Brown et al., 2018).
What I Was Hoping To Achieve By Making This Decision
The practitioner expected that Ritalin LA 20 mg would improve the patient’s ADHD symptoms and school performance without adverse effects. Posner et al. (2020) found that the efficacy of psychostimulants in alleviating ADHD symptoms in short-term therapy is evident in various clinical trials of children and adults. In addition, Ritalin LA has been linked with a decrease in several adverse effects (Storebø et al., 2018).
Ethical Considerations Impact on Treatment Plan and Communication
Beneficence affected treatment since the PMHNP had to maintain Ritalin LA since it was associated with better outcomes, and studies support its efficacy in alleviating ADHD symptoms. The PMHNP had to involve the patient’s parents in making treatment decisions, which shows respect for autonomy and affects communication.
Conclusion
The patient was diagnosed with ADHD-inattentive presentation based on her short attention span and lack of concentration in school. Patient factors influencing treatment include height and weight, medical history, current medication, baseline heart rate and blood pressure, and cardiovascular assessment findings. The patient was initiated on Ritalin 10 mg since it is the most effective medication for alleviating core ADHD symptoms owing to its favorable efficacy and side effects profile (Drechsler et al., 2020). Wellbutrin was not selected because it has a slow onset of action and lacks adequate evidence from RCTs supporting its efficacy (Coghill et al., 2021). In addition, Intuniv was not ideal because it is recommended as a second-line agent in treating ADHD in children.
Ritalin 10 mg alleviated the patient’s ADHD symptoms, but the effects were not sustained throughout the day. Consequently, the PMHNP switched to Ritalin 20 mg LA formulation since it takes longer to wear off with 8-16 hours (Storebø et al., 2018). The long-acting preparation effectively sustained the drug’s effects for longer and alleviated the side effects associated with the short-acting formulation like tachycardia and palpitations. As a result, the clinician maintained the Ritalin LA 20 mg to alleviate the ADHD symptoms further and improve the patient’s academic performance (Posner et al., 2020). Beneficence and nonmaleficence impacted treatment since the practitioner had to prescribe a medication established to promote better health outcomes and patient safety. The right to autonomy and confidentiality also impacted communication since the clinician had to seek consent before starting treatment and ensure the patient’s health information is not shared without consent.
References
Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02
Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics, 51(5), 315–335. https://doi.org/10.1055/s-0040-1701658
Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., … & Simonoff, E. (2021). The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). European Child & Adolescent Psychiatry, 1-25. doi: 10.1007/s00787-021-01871-x
Posner, J., Polanczyk, G. V., & Sonuga-Barke, E. (2020). Attention-deficit hyperactivity disorder. Lancet (London, England), 395(10222), 450–462. https://doi.org/10.1016/S0140-6736(19)33004-1
Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., … & Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents–assessment of adverse events in non-randomized studies. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD012069.pub2