Attention deficit hyperactive disorder (ADHD) is a disorder that affects a significant percentage of the population globally. The diagnosis of ADHD is largely made during the early childhood stage based on the observed behaviors and learning difficulties that children demonstrate. Therefore, this essay focuses on Katie’s case study. Katie has ADHD, which was diagnosed following her primary care provider’s recommendation for her psychiatric review.
Katie’s teacher completed the Conner’s Teacher Rating Scale-Revised, which shows that Katie has symptoms of ADHD. They include her lack of attention, being distracted easily, forgetting things, and being poor in arithmetic reading, and spelling. Katie also has a short attention span, does not pay attention to things she dislikes, is disinterested in schoolwork, fails to complete tasks, and does not follow through with instructions. Based on these symptoms, Katie was diagnosed with attention deficit hyperactive disorder, predominantly inattentive presentation.
This essay makes three treatment decisions for Katie. It also examines the basis for not selecting the other options and ethical considerations that guided the decisions. The patient-specific factors influencing treatment decisions made in the case study include Katie’s age, presenting symptoms, and experiences with the selected decisions.
Decision 1
Selected Decision
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning
Why the Decision Was Selected
Methylphenidate was chosen because FDA has approved its use for ADHD in children. Clinical studies also support methylphenidate use in treating ADHD to improve functioning and academic performance. According to Sugaya et al., (2022), methylphenidate effectively reduces the core symptoms of ADHD as well as improves children’s and adolescents’ quality of life. Methylphenidate is also more effective than other treatments such as behavioral training for ADHD. Sugaya et al., (2022) found out that methylphenidate improved teachers’ and parents’ composite scores on the Swanson, Nolan, and Pelham-IV scale, the Children’s Global Assessment Scale, and the Clinical Global Impressions Severity Scale. The improvements translated into enhanced functioning among children with ADHD, unlike the use of behavioral training alone. The study by de Faria et al., (2022) found improved academic performance while Matthijssen et al., (2019) found the long-term effectiveness of methylphenidate use in ADHD children.
Reasons for not Selecting the Other Options
Katie was not started on Wellbutrin (bupropion) XL 150 mg orally daily since it is not an evidence-based treatment for ADHD. Bupropion is recommended for use by patients intending to quit smoking. Katie was not administered Intuniv extended release 1 mg orally at bedtime due to its safety concerns such as hypotension, syncope, and electrocardiography changes(Iwanami et al., 2020).
Intended Outcomes
Methylphenidate improves patient’s functioning and academic performance. As a result, I hoped Katie’s academic and social performance would be better. I expected Katie’s parents and teacher to report positive improvements in Katie’s performance in arithmetic, reading, spelling, and attention and socialization skills(Iwanami et al., 2020).
How Ethical Considerations May AffectMy Treatment Plan
Katie is a minor. Her parents make decisions on the care that she needs. The parents have the authority to accept or reject ADHD-recommended treatments. PMHNP should provide adequate information about the benefits, risks, and alternatives for Katie’s parents to make informed decisions about their daughter’s treatment(Buka, 2020).
Decision 2
Adopted Decision
Change to Ritalin LA 20 mg orally daily in the morning
Reasons for the Decision
Katie was brought to the clinic after a month with evidence of improved ADHD symptoms. There were reports that Katie’s teacher noticed that her symptoms improved in the morning, resulting in enhanced performance in her academics. However, Katie seems lost and daydreams by the afternoon hours. Katie’s parents are concerned about their daughter’s heart as it feels funny. Katie’s pulse is around 130 bpm. The above information demonstrates mild improvements in Katie’s symptoms with the current methylphenidate 10 mg tablets. The desired therapeutic dose of methylphenidate was inadequate to last throughout the day. An effective solution would be changing the treatment to another form of methylphenidate. The long-acting methylphenidat
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