Attention Deficit Hyperactivity Disorder Case Study
Attention Deficit Hyperactivity Disorder Case Study
BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider.Attention Deficit Hyperactivity Disorder Case Study
According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. Attention Deficit Hyperactivity Disorder Case Study
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.
SUBJECTIVE Attention Deficit Hyperactivity Disorder Case Study
Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.” Attention Deficit Hyperactivity Disorder Case Study
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. Attention Deficit Hyperactivity Disorder Case Study
MENTAL STATUS EXAM Attention Deficit Hyperactivity Disorder Case Study
The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
RESOURCES Attention Deficit Hyperactivity Disorder Case Study
§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.
Decision Point One Attention Deficit Hyperactivity Disorder Case Study
Select what the PMHNP should do:
Begin Wellbutrin (bupropion) XL 150 mg orally daily
Begin Intuniv extended release 1 mg orally at BEDTIME
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
- Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute
Decision Point Two Attention Deficit Hyperactivity Disorder Case Study
Change to Ritalin LA 20 mg orally daily in the MORNING
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
- Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Decision Point Three Attention Deficit Hyperactivity Disorder Case Study
Select what the PMHNP should do next:
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Increase Ritalin LA to 30 mg orally daily
Obtain EKG based on current heart rate
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
- Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Decision Point Three Attention Deficit Hyperactivity Disorder Case Study
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student
At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.
Review the posttest for the case study.
Week 9 discussion Attention Deficit Hyperactivity Disorder Case Study
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 Attention Deficit Hyperactivity Disorder Case Study
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. Attention Deficit Hyperactivity Disorder Case Study
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 Attention Deficit Hyperactivity Disorder Case Study
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. Attention Deficit Hyperactivity Disorder Case Study
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. Attention Deficit Hyperactivity Disorder Case Study
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. Attention Deficit Hyperactivity Disorder Case Study