Treatment Plans For Clients With ADHD Discussion Paper

Discussion: Presentations of ADHD

Questions for the Patient

Several preschoolers, school-going children, teenagers, and even adults are at greater risk of having ADHD. The disease is usually defined by a trend of reduced prolonged concentration and heightened impulsive behavior (Nigg et al., 2016). Usually, the etiology of ADHD is hereditary, and variables such as prematurity and prenatal toxic influences may result in the development of the condition. The questions I would have asked the patient, according to the given case of an eight-year old girl who is naughty would include the following: Treatment Plans For Clients With ADHD Discussion Paper

ORDER YOUR PAPER HERE

  • Do you feel like you are different from your peers? The justification to pose the question lies in the fact that the patient has a connection with her peers.
  • Do you normally finish your classwork? The rationale for this is to recognize whether or not the patient has difficulties with academics.
  • Do you still get sufficient sleep at night? The purpose of posing the question is to make sure that the patient has no indications of sleep disorder.

People in Patient’s Life

The mother and teacher will be the individuals in the life of the patient who I would involve in gathering more patient information. I would inquire from the mother the time in which the symptoms started to present and ways in which she typically tackles the behavior of her child. I would inquire from the teacher regarding the child’s conduct at school whether she finishes her assignments timely and the child’s connection with her classmates.

Physical Exams and Diagnostic Tests

The patient’s physical exam would involve a look at her conduct, temperament, judgment, recollection, ADHD signs, nutritional status, and relationships of the patient with family and peers as well as her grooming. Additionally, I would carry out intelligence tests on the patient to assess her IQ and whether she has a learning impairment which is typical in individuals suffering from ADHD. The broadband scales would be another test performed to determine the patient’s behavioral manifestations, particularly the key clinical manifestations of ADHD Treatment Plans For Clients With ADHD Discussion Paper.

Differential Diagnoses

  • ADHD
  • Conduct disorder:
  • Oppositional defiant

The patient most likely has ADHD because she has a lack of attention which is common in ADHD. She also has defiant conduct. It is reported that both at school and home she has trouble performing well. Several of the symptoms displayed indicate ADHD except for hyperactivity.

Pharmacologic Agents

Guanfacine XR is a norepinephrine receptor agonist drug that acts primarily on alpha 2A agonist areas in the brain’s prefrontal cortex and is a non-stimulant drug for ADHD patients (Stahl, 2013). The drug works by helping with concentration, recollection, hyperactivity, coordination, and balance. The required dose is 1 mg orally a day.

Methylphenidate is a medication most widely used for ADHD patients between 6-17 years of age. This medication acts by suppressing dopamine reabsorption while enhancing dopamine and norepinephrine activation, which improves focus, concentration, impulsivity, and alertness (Stahl, 2013). The dosage of this drug is 10 mg per 9 hours, which can be raised by 5 mg every week to relieve ADHD symptoms.

Lesson Learned

Knowledge about the treatment, diagnosis, and evaluation of psychiatric illnesses like ADHD has been gained from the case study. I have learned that there are cases where more than one medication regimen is required. It is necessary to educate patients and families on compliance and conformity to a medication regimen. Moreover, it is important to develop a strong relationship with the child and mother, particularly in this case study, to gain information and to help in developing a treatment strategy. As a potential PMNHP, the manifestations of various PMNHP psychiatric conditions must be understood systematically, so that effective treatment is established Treatment Plans For Clients With ADHD Discussion Paper.

References

Fønhus, M. S., Ekeland, E., Jamtvedt, G., & Strøm, V. (2017). Physical exercise for oppositional defiant disorder and conduct disorder in children and adolescents. The Cochrane database of systematic reviews, 2017(1).

Nigg, J. T., Johnstone, J. M., Musser, E. D., Long, H. G., Willoughby, M. T., & Shannon, J. (2016). Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: New data and meta-analysis. Clinical psychology review, 43, 67-79.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

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. 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 Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy 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 Treatment Plans For Clients With ADHD Discussion Paper.

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. Review the posttest for the case study. ASSIGNMENT: Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty The Case: The 8-year-old girl who was naughty The Question: Do girls get ADHD? The Dilemma: How do you treat ADHD with oppositional symptoms? Post a response to the following: Provide the case number in the subject line of the Discussion. List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions. Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used. List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why. List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided Treatment Plans For Clients With ADHD Discussion Paper.

ORDER YOUR PAPER HERE

Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. Patient Intake 8-year-old girl brought to her pediatrician by her 26-year-old mother Chief complaint: fever and sore throat Psychiatric History: While evaluating the patient for an upper respiratory infection, the pediatrician asks if school is going well The patient responds “yes” but in the background the mother shakes her head “no” The mother states that her daughter is negative and defiant at home and she has similar reports, mostly of disobedience, from her teacher at school The patient has had temper tantrums since age 5 but these have decreased over the past 3 years, especially the past year Still angry and resentful since her little sister was born 6 years ago Academicproblems Fights with other children, mostly arguments and harsh words with other girls at school Social and Personal History: Goes to public school Has a younger sister age 6 Does not see her father much, lives in a nearby city Not many friends Spends most of her time with her sister and either her mother or her maternal grandmother who helps with after school supervision and baby sitting Medical History: • None Family History: None known for medical or psychiatric disorders other than the father who drinks a bit too much and his father (paternal grandfather) who some think might be an alcoholic Mother was adopted and no family history known Pediatrician’s Notes: Initial Evaluation Not enough time to do any more evaluation Instead, the mother is given the parent and teacher version of the Conners ADHD rating scale and is instructed to bring the completed forms to the followup visit A variety of rating scales are available, some without charge (see http://www.neurotransmitter.net/adhdscales.html). The Connors scale charges a fee but other rating scales available at this link, or listed in the Two-Minute Tute below are free. Pediatrician’s Notes: Followup Visit Week 3 At the followup visit, the mother admits to having been too busy to fill out the parent form Also admits to having forgotten to send the rating form to the teacher Mother acknowledges being more disorganized since her second child started school this year Since then it has also been extremely difficult to keep the patient organized and focused on school The mother is on the verge of tears “Two children are too much for a single mother” The pediatrician offers to send the teacher form to the school and gives the mother tips on how to remember to fill out her own form When the teacher form is sent back to the pediatrician’s office the mother will be contacted for a followup visit Pediatrician’s Notes: Followup Visit Week 6 At the followup visit, the mother comes alone Teacher’s ADHD rating scale responses state that the patient has significant problems with – Talking excessively – Sustaining attention – Being organized – Being distracted – Being forgetful Treatment Plans For Clients With ADHD Discussion Paper