Examine Case Study: A Young Girl with ADHD

Attention Deficit Hyperactivity Disorder (ADHD)

Neurodevelopmental disorders have undertaken several diagnostic evolutions in several past years.  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is one of the standard diagnostics tools used. A popular belief is that attention deficit hyperactivity disorder (ADHD) is prevalent among children. It is stereotyped that it only affects the attention of children. New information has however shown that ADHD not only affect attention in children, but also involves hyperactivity and impulsivity.

Examine Case Study: A Young Girl with ADHD

According to the National Institute of Mental Health (NIH) (2019), it is possible that this disorder can be present in adults contrary to common beliefs.  ADHD is usually recognized in early childhood, especially during the preschool years and early school years and can continue into adulthood. It can cause issues such as inattention, hyperactivity, and impulsivity and patients usually present with these as the core symptoms. Some ADHD patients only present with one of the behaviors while other present with a combination. Specific issues seen with ADHD include poor performance in school, inability to think properly and behavioral problems. According to Krull (2019), patients can also have a difficulty in expressing their feelings and building relationships.

Using the DSM-5 criteria, ADHD symptoms must be present before the age of 12 years and also in more than one setting (APA, 2013). To diagnose ADHD, an authorized medical practitioner such as a psychiatrist or a pediatrician should be present. An expert in ADHD who is licensed to determine the presence of this disorder can also make the diagnosis. The signs to look out for in order to make a diagnosis are inattention, hyperactivity and impulsivity that has been present over a long period.

ADHD management and treatment consists of counseling, behavioral therapy, medication, or a combination of these options. The goal in managing and treating ADHD is to ensure the patient regains full function and can perform better in school, or work and have better relationships. Another goal is to ensure the patient can function in a society by being able to follow the rules. Successful treatment will increase the patient’s attention span, regulate their level of activity to normal and decrease their impulsiveness.

In this paper, the focus will be on an 8-year-old Caucasian female presenting to the clinic with symptoms that indicate ADHD. The best treatment option for this patient will rely on three decisions informed by ethical and treatment guidelines for the disorder. The overall pharmacodynamics and pharmacokinetics for the drugs will be discussed

Decision 1

After reviewing the patient, a diagnosis of ADHD is made. Decisions have to be made in order to properly manage and treat this patient. My first treatment decision for this 8-year-old school-going female is to start her on Ritalin chewable tablet 10 mg orally in the morning. This choice is mainly influenced by the patient’s clinical manifestations, and the benefit-risk assessment of the available options. The objective of treatment is to improve the patient’s symptoms. According to Verbeeck et al. (2017), most pharmacological treatments for ADHD facilitate the transmission of catecholamines. ADHD patients are usually treated with stimulant drugs.

Ritalin is a stimulant agent which is FDA approved for use as the first-line treatment for ADHD. Approximately 90% of patients on Ritalin show improvement of symptoms (Verbeevk et al., 2017). Ritalin achieves this by increasing the action dopamine and noradrenaline in the prefrontal cortex thus stimulating the CNS. CNS stimulation helps foster cognition and attention and restores the patient’s ability to focus. The reason for prescribing the drug in the morning is because of the need to achieve concentration during the day. The drug also has a potential of causing insomnia.

The use of Bupropion is not selected because it is an antidepressant which is only used as an alternative when the patients cannot tolerate stimulants because of the side effects or if patients do not respond well to stimulants (Ng, 2017). Bupropion is registered as an antidepressant and is used off-label to treat ADHD. Despite its extensive use, it is not FDA approved for the treatment of ADHD in children. It is also associated with suicidal ideations as a side effect and evidence has shown that it is only effective in the treatment of ADHD that is comorbid with depression.

Intuniv is also not selected as it is a non-stimulant that is not recommended as the first-line treatment of ADHD. It usually takes long to start producing effects as opposed to Ritalin that takes a few minutes to start exhibiting its effects. Intuniv is however suggested as an augmenting agent if stimulants do not offer adequate improvement in symptoms (Stahl, 2017).

With the treatment option selected, I hope to see an improvement in the symptoms as soon as possible, with the patient reporting an improvement in school performance when she returns for a follow-up after 4 weeks. The patient returns four weeks later with improved symptoms but complains of some adverse effects including daydreaming and cardiac symptoms such as tachycardia. With this new information, a re-evaluation is necessary and another decision needs to made to manage this patient.

Decision 2

With new findings in the patient, my decision is to change to Ritalin LA 20 mg orally in the morning. The reason for this is that the symptoms shown could be as a result of Ritalin 10 mg chewable tablets being a short acting agent. The symptoms could also be prevented by reducing the dose to 5 mg. This would reduce the potential side effects but also the efficacy. A longer acting agent is therefore the best option to use on this patient. This way she gets a pulse dose in the morning and another dose four hours later. I would not want to switch to another drug option because Ritalin seems to be effective in improving the symptoms.

Keeping her on the same dose would not change anything in terms of relieving or minimizing the side effects. She would still have symptoms of tachycardia on the same dose. Changing her medication to Adderall is not an option I would consider because she seems to be responding well to Ritalin, an aspect Cortese et al. (2018) identify as a basis for sticking to the current treatment medication. It is recommended that when patients experience side effects, waiting and making adjustments on the current medications are made before switching to a different drug. If the patient does not show any improvement, then a change in medication can be made (Stahl, 2017).

The goals of treatment remain the same as before but with a new target of reducing the patients heart rate without affecting her concentration throughout the day. The patient returns to the clinic after four weeks and reports a relief of the side effects. Her heart rate is at 92 beats a minute. This shows that the new treatment with Ritalin LA 20 mg is working with significant improvement recorded over the past four weeks.

Decision 3

Because the patient seems to be doing well on the current treatment regimen, my plan would be to maintain her on the current dose of Ritalin LA and do a re-evaluation after four weeks. Ritalin seems to be working as Katie’s heart rate is back to normal and her attention is sustained throughout the day. She also reports no additional side effects. It is recommended that the lowest dose of a stimulant needed should be used to correct a disorder and for this reason, I would not increase the dose to 30 mg. Her heart rate of 92 is within the normal range for her age and an EKG is unnecessary at this point.

Ethical Considerations

When treating patients with ADHD, many ethical considerations have to be taken into account. These include choosing the right medication for the treatment of the condition. This is important as some drug classes such as nonstimulants have harmful side effect which the patient may not be able to tolerate. This is also important because the patients are still developing and some of these drugs may impede their development. Another consideration is the patient autonomy. Because the patient is a minor, she is not able to make any decisions as regards their health and treatment.

Parents therefore have to be incorporated in making decisions that pertain to the treatment of this patient and they have a right to agree to or deny treatment they don’t agree with. It is also important to try and involve the child in the treatment and breakdown everything to a language they can understand (NIH, 2019). Another ethical consideration is the cardiac effects that are associated with psychostimulants. A family history of cardiac disease should be taken into account before commencing treatment with stimulants. The last consideration is the side effects and the lowest effective dose should be prescribed and the patients monitored regularly for side effects (NIH, 2019). The patient should also be educated on these side effects.


In conclusion, ADHD is a disorder that starts in early childhood and can progress into adulthood if not managed well with psychotherapy and pharmacotherapy. ADHD usually present with three core symptoms i.e., inattention, hyperactivity and impulsiveness but not all patients present with all the symptoms at once. The NP has the ethical obligation to treat ADHD with the most effective options available. The first-line treatment for ADHD are stimulants such as Ritalin.

Other options of treatment include non-stimulants amphetamines and antidepressants such as bupropion. When treating patients with stimulants it is important to consider the potential side effects such as cardiac effects such as tachycardia as seen in the patient. It is also important to use the lowest effective dose to treat the patients. The patient should also be involved in their treatment and patient preference is key to ensure compliance to medication.

Examine Case Study: A Young Girl with ADHD References

NURS 6630 Week 9: Therapy for Clients with ADHD Instructions

Tyler, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Tyler, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Tyler was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).

ADHD is a prevalent disorder for clients across the lifespan, as more than 6 million children (CDC, 2016) and 8 million adults (ADAA, 2016) have been diagnosed with the disorder. Like Tyler, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, clients often respond well to therapies and have positive health outcomes.

This week, as you study ADHD therapies, you examine the assessment and treatment of clients with ADHD. You also explore ethical and legal implications of these therapies.

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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

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.
  • 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.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who were assigned to a different case than you. For example, if you were assigned to Case Study 1, respond to one colleague assigned to Case Study 2 and one colleague assigned to Case Study 3. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

Assignment: Assessing and Treating Clients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.

Learning Objectives

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
  • Evaluate ethical and legal implications related to prescribing therapy for clients with ADHD

The Assignment

Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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