Assignment: Assessing and Treating Patients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people 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 nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.

The Assignment: 5 pages

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

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Week 9: Therapy for Patients With ADHD/ODD

Diego, 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 Diego, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Diego was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).

ADHD is a prevalent disorder for patients across the lifespan, as more than 6 million children (CDC, n.d.) have been diagnosed with the disorder. Further, consider that about 60% of children with ADHD in the United States become adults with ADHD (ADAA, n.d.). Like Diego, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, patients often respond well to therapies and have positive health outcomes.

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

References:
Centers for Disease Control and Prevention. (n.d.). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html

Anxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd

Learning Objectives

Students will:

• Assess patient factors and history to develop personalized therapy plans for patients with ADHD
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for ADHD
• Synthesize knowledge of providing care to patients presenting for ADHD
• Analyze ethical and legal implications related to prescribing therapy for patients with ADHD
• Identify concepts related to psychopharmacologic treatments and therapy for patients across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000

Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric Times.
https://www.psychiatrictimes.com/view/5-question-quiz-adhd

Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

• armodafinil
• amphetamine (d)
• amphetamine (d,l)
• atomoxetine
• bupropion
• chlorpromazine
• clonidine
• guanfacine
• haloperidol
• lisdexamfetamine
• methylphenidate (d)
• methylphenidate (d,l)
• modafinil
• reboxetine

Required Media (click to expand/reduce)

Case Study: A Young Caucasian Girl with ADHD 
Note: This case study will serve as the foundation for this week’s Assignment.

Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD

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 you 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. 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.

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

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.”

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.

MENTAL STATUS EXAM

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

§ 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

Select what you should do:

Decision Point One

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Katie’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication
• At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point Three

Discuss the use of a medication such as Adderall and its evidence for treating ADHD

Guidance to Student
Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.
At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.
In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.
You should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow you to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

 

Instructions

Critically analyze each of the identified organizational challenges you identified in Week 3 and compare them with Capella University’s criteria for an approvable doctoral capstone topic and project and with elements needed for the application of EBP improvement. Then, make a case for focusing on one challenge as the best opportunity for EBP improvement in a potential doctoral capstone project.

Requirements

The assignment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format, length, and supporting evidence.

• Describe the characteristics of a professional doctorate and doctoral capstone project.
  • Compare professional activities and roles for individuals with a DHA or DrPH degree compared to a PhD degree.
  • Delineate the differences and similarities between a DHA or DrPH capstone project and a PhD dissertation.
  • Describe three major characteristics of a doctoral capstone project.
• Critically analyze the potential of evidence-based improvement to mitigate the negative impact of each of the three identified organizational challenges.
  • Describe the appropriateness of applying the EBP process to mitigate the negative impact of the identified challenges.
  • Summarize the quality of available research evidence to support a potential project focused on mitigating the negative impact of the identified challenges.
  • Describe how the EBP process could facilitate improvements that mitigate the negative impact of the challenges in a short period of time.
• Determine the extent to which a project focused on mitigating the negative impact of each of the three organizational challenges meets Capella University criteria for a doctoral capstone project.
  • Outline what a doctoral capstone project is and what it is not, according to Capella University criteria for a doctoral capstone project.
  • Describe how the application of existing knowledge to mitigate the negative impact of the challenges aligns with your program and specialization and contributes to your field.
  • Summarize Capella University criteria that would be met by a doctoral capstone project focused on mitigating the negative impact of the challenges.
• Argue for the potential success and approval of a doctoral capstone project focused on the evidence-based improvement of one challenge the organization is facing.
  • Describe how the evidence-based improvement of one challenge meets professional doctorate, EBP, and university standards and criteria.
• Write concisely and directly, using active voice.
• Apply APA style and formatting to scholarly writing.

Additional Requirements

• Format: Format your paper using APA style. Use the APA Style Paper Template [DOCX]. An APA Style Paper Tutorial [DOCX] is also provided to help you in writing and formatting your paper. Be sure to include:
  • A title page and reference page. An abstract is not required.
  • A running head on all pages.
  • Appropriate section headings.
• Length: Your paper should be 3–4 pages in length, not including the title page and reference page.
• Supporting evidence: Cite at least two current and relevant peer-reviewed studies. Provide in-text citations and references in APA format.

 

Discussions are fundamental to shared learning, so please be sure to participate early and often!

After you have completed the Reading, and without reviewing your classmate’s responses, post your initial response to the following Discussion. Your post should be at least 200-250 words in length and should extend the discussion of the group supported by your course materials and/or other appropriate resources.

After you have submitted your initial post, take time to review your classmates’ responses and to respond specifically and substantially to at least two of them. Refer to the Discussion Rubric in Course Resources for specific grading explanation.

Attention

In this week’s Reading you learned about the topic of divided attention — when you try to pay attention to more than one thing at a time. This is something you do all the time, however the psychological research suggests you may not be as good at this as you think you are.

For this Discussion, describe an example of an everyday situation where you might engage in divided attention. Discuss whether you think it is possible to pay attention to more than one task at a time, using the information from this week’s Reading to support your answer.

RESPONSE 1: MEGAN  

Hello class,

   Between work, school, kids, and life overall, I feel as if my senses are overloaded with excess amounts of stimuli. I have a difficult time concentrating, and performing well at my tasks at hand. For example, mornings consist of getting myself ready, in addition to my two children. Often, I’m trying to multitask by packing lunches, making breakfast, feeding the animals, and answering messages or emails off my phone. I learned from our unit reading, research does not support multitasking; typically performing one task at a time is a more effective and accurate way to focus one’s attention. (Matlin, M. W., Farmer, T. A. (2016). Which leads me to mention selective-attention, this is when a person pays attention to certain kinds of information, while ignoring other ongoing information. As my son is talking to me about Minecraft mods and creepers, my daughter is adding to the conversation by telling me about a bizarre dream she had! I navigate and decipher what’s most important, respond and act accordingly, all while continuing our morning routine. I find myself facing divided attention tasks frequently, and try to respond appropriately to each message. Although my attention is not capable of handling these challenging tasks. I try to remember the importance of tackling life one day, and one task at a time. As a single, working mother I feel the weight of responsibility. Like many other parents, we are pulled in 500 directions and attempt to concur the world. We must remember to take it slow, and focus on what’s most important.

Reference

Matlin, M. W., Farmer, T. A. (2016). Cognition, 9th Edition. [Purdue University Global Bookshelf]. Retrieved from https://purdueuniversityglobal.vitalsource.com/#/books/9781119177678/

RESPONSE 2 MARCUS: 

Social media is slowing killing face-to-face interactions which limits our ability to truly gauge how our attention is divided outside of the emoticons, and hashtags. As a child I often traveled up and down the street to see how everyone was doing. These interactions helped to truly understand my neighbors and their lives. My children now spend more time on a tablet than they interact with the real world. Facebook has officially replaced individual interactions as many often find it easier to discuss how they feel through a QWERTY keyboard than a one, on one interaction, social media is holding our collective attention spans hostage.

“The concept of attention is traditionally closely linked to the resource theory and its central premise that an organism possesses limited capacity and has to select from the multitude of available sensory input” (Broadbent, 1958). Although we may think we are offering our undivided attention to someone, this message may not be conveyed to them based on the senses we have offered to the conversation. My current positions requires a large amount of coordination which for the most part is accomplished through text, emails, and phone calls. I often find myself speaking to someone but focusing on the dings, and pings of these various communication mediums.

According to our text “when people are multitasking, they strain the limits of attention, as well as the limits of their working memory and long term memory” (Matlin & Farmer, 2016). If an individual has to strain or push their senses to the limit to share their attention with another while working on a project with other senses, they are not exclusively focusing on the individual interaction. Can a person effectively multitask? I believe the answer is a resounding yes as I often accomplish several task at once. The problem is only visible when I think back about the true nature of interaction or the quality of the product produce which is most likely of lesser quality than if I focused on one thing or a single conversation at once.

Broadbent DE. Perception and Communication. London: Plenum Press; 1958.

Matlin, M.W., & Farmer, T.A. (2016). Cognition.

Choice Theory- Is to choose to engage in delinquent and criminal behavior after weighing the consequences and benefits of their actions

Classical Criminology
People have free will to choose criminal or conventional behaviors, people choose to commit crime for reasons of greed or personal need, and crime can be controlled only by the fear of criminal sanctions.

1.      In 1764, criminologist Cesare Beccaria wrote An Essay on Crimes and Punishments, which set forth classical criminological theory. He argued that the only justified rationale for laws and punishments was the principle of utility.

2.      Beccaria believed the basis of society, as well as the origin of punishments and the right to punish, is the social contract. The only legitimate purpose of punishment is special deterrence and general deterrence.

3.       Beccaria believed the best way to prevent and deter crime was to: • Enact laws that are clear, simple, and unbiased, and that reflect the consensus of the population. • Educate the public. • Eliminate corruption from the administration of justice. • Reward virtue.

4.      Real-world drawbacks of Beccaria’s theory are: • Not all offenders are alike, juveniles are treated the same as adults. • Similar crimes are not always as similar as they might appear,first-time offenders are treated the same as repeat offenders. 

I don’t pay for cover pages 

1 APA style page

12 pt font

I gave a breakdown of what the teacher is looking for