Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl
Attention-deficit hyperactivity disorder or ADHD is a neurobiologic/ neurodevelopmental disorder that starts in childhood and often progresses into adulthood. In childhood, it is characterised by learning difficulties and inattention or hyperactivity (or both). As an adult, the person with ADHD has difficulties establishing and sustaining interpersonal relationships. This makes them change jobs frequently and become somewhat socially isolated (APA, 2013; Sadock et al., 2015). The prevalence of ADHD in children is between 5% and 8.6% (ANA, 2014; APA, 2013).Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl . Katie is an eight year-old female Caucasian girl presenting with inattention and academic difficulties. She isolates herself from her peers and her Connor’s Teacher rating Scale scores show inattention, distractibility, and careless mistakes in academic work. They also reveal problems with arithmetic, memory lapses, short attention span, and disinterest in most school activities. Katie had already been prescribed some ADHD medications which appear not to have helped. This paper is about the review of this diagnosis as per the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) diagnostic criteria for ADHD as well as a change of treatment for Katie.Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl .
Decision Point 1: Differential Diagnosis
Based on the Connor’s Teacher Rating Scale tool results, the subjective history by the parents and Katie, and the mental status examination (MSE); the selected decision or diagnosis is 314.00 (attention-deficit/ hyperactivity disorder or ADHD, predominantly inattentive presentation). This choice is informed by the fact that Katie’s symptoms of inattention as per observations during the second clinic visit and Connor’s Teacher Rating Scale conform perfectly to the DSM-5 criteria for ADHD diagnosis. This is specifically true for criterion A. 1 (a)-(i) (APA, 2013). Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl .However, Katie also displayed hyperactivity in the clinic as observed objectively by the psychiatric-mental health nurse practitioner (PMHNP) during the diagnostic interview and MSE. This also places Katie in conformity with DSM-5 diagnostic criteria for ADHD of A. 2 (a), (b), (e), (g), (h), and (i). She gave short answers, wondered in thought constantly, and could not stay in one place. Because of these assessment considerations, the diagnosis is modified to moderate ADHD (combined presentation). This means that the ADHD that Katie has presents with both inattention (attention deficit) and hyperactivity (Wender & Tomb, 2017; Sadock et al., 2015; APA, 2013; Stahl, 2013). Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl .Katie also met all the other DSM-5 diagnostic criteria for ADHD. These are criteria B, C, D, and E (APA, 2013). The most likely differentials would be specific learning disorder, autism spectrum disorder, and oppositional defiant disorder. Half of the children with combined presentation ADHD such as Katie have oppositional defiant disorder as comorbidity (APA, 2013). This is most likely true for Katie too. Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl .
What was hoped to be achieved by this diagnosis was the change to a more effective psychopharmacologic agent that would bring about better patient outcomes in terms of symptom remission. The difference between what was expected to be achieved with decision 1 and the results of the decision is only in the presentation of the ADHD. This is from predominantly inattentive presentation to combined presentation. The reason for this difference is that a more thorough assessment was done by the PMHNP in the second instance. The clarification would now guide proper and more effective choice of psychopharmacologic treatment. Decision Tree: Attention-Deficit/ Hyperactivity Disorder (ADHD) in an 8 Year-Old Caucasian Girl .
Decision Point 2: Psychopharmacologic Treatment Plan
The decision selected at this stage was to start Katie on dextroamphetamine as Adderall XR 10 mg orally per day. This is because this drug is FDA-approved for the treatment of ADHD in children between the ages of 6 and 17 years (Katzung, 2018; Stahl, 2017). The hope in making this prescription was to have Katie beginning to be free of symptoms within a span of four weeks. Indeed, in the subsequent v
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