The Diagnosis and Treatment of ADHD

1 The Diagnosis and Treatment of ADHD Katie, an 8-year-old female is brought in by her parents with complains that her prescribed medications were not effective. She had been diagnosed with ADHD based on her symptoms and the description of her behavior by her teacher. She had been described as inattentive, easily distracted, forgets easily and performs poorly in arithmetic, spelling and reading. She reports feeling lost and her mind wandering off in class. She finds her subjects boring or too complicated but likes recess and art classes. She is not delusional or paranoid. Her parents stated that she met all her developmental milestones as required.

Decision 1 The patient is diagnosed with attention hyper deficit disorder (ADHD). The patient’s symptoms is consistent with that of ADHD. According to the DSM IV diagnostic criteria, ADHD presents with difficulty with sustaining attention, not paying attention to details, wandering mind, not following through with instructions or tasks, forgetfulness, avoiding tasks that require prolonged concentration and losing things required for a task (American Psychiatric Association, 2000). These symptoms are consistent with that of Katie.

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2 The differential diagnosis considered included sleep disorder, autism spectrum disorder and bipolar disorder. Lack of sleep in children with sleep disorders may cause them to have trouble concentrating, learning and following instructions while awake. Autism affects social interactions, behavior and learning among others. Bipolar disorder affects mood and could have similar symptoms as ADHD in a manic state. Decision 1 determines the diagnosis of the patient as ADHD based on the DSM IV diagnostic criteria. This decision will guide the treatment and management of the patient.

Decision 2 The patient is placed on Wellbutrin 150mg to help with her symptoms. Wellbutrin is an antidepressant that works by enhancing the action of dopamine and norepinephrine in the brain (Hile, 2019). It can be prescribed in ADHD to improve concentration and focus. However, it has not been approved by the FDA for use in ADHD. The decision to use Wellbutrin was to help manage the patient’s symptoms. However, the client started having morbid thoughts. Having suicidal ideations is one of the side effects of using Wellbutrin (Hile, 2019). As an alternative, the patient is placed on Strattera 25mg daily.

Strattera is an elective norepinephrine reuptake inhibitor used to treat ADHD in children by reducing hyperactivity and improving focus (Bélanger et al., 2018).

The decision to replace Wellbutrin with Strattera was made to stop the suicidal ideations associated with the use of Wellbutrin. Strattera is also a better option as it has been approved for use to treat ADHD in children. Strattera was able to manage ADHD symptoms effectively. She became more attentive with the use of Strattera. However, the patient’s parent were concerned with the sedative effects of the medication and loss of appetite, causing her to lose weight.

Decision 3

3 The third decision was to discontinue Strattera and begin Adderall 10 mg daily. This decision was made to avoid the undesired effects caused by Strattera. The patient had experienced a loss of appetite and sedation, which could affect drug adherence. Augmenting Strattera with CBT would have effectively addressed the symptoms of ADHD but did not help in reducing its side effects. With continued use of Strattera, its side effects are expected to persist.

Adderall acts on dopamine and norepinephrine neurotransmitters. It is used in the treatment of ADHD to improve attention span and control hyperactivity and impulsive behavior (Limandri, 2020). Using Adderall will help manage patient symptoms as well as reduce the negative side effects of medications.

Ethical considerations The patient in this scenario is a minor. Providing care to minors presents various ethical issues, especially with consent to treatment. In this case, the patient is accompanied by both parents, who are in a position to make decisions on her behalf. Parents and/or guardians are required to provide consent in the case of minors. They should be provided with adequate information on their daughter’s diagnosis and treatment options to ensure they understand the options available. The parents should also be informed of the side effects associated with the medications prescribed and their use in children (Bélanger et al., 2018) Other than obtaining informed treatment consent from the parents, it is also important for the care provider to employ the ethical principles of beneficence and non-maleficence.

Beneficence ensures that the best interests of the patient are prioritized when designing the treatment plan. Non-maleficence commits the care provider not to inflict any harm on the patient.

These two ethical principles are crucial in deciding the best medications for the patient. Being a minor with ADHD, there are limited approved drugs that could be used in treatment. The care

4 provider should strive to achieve the best clinical outcomes with fewer side effects. This calls for the use of the safest and most effective treatment (Sayal et al., 2018).

5 References American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed).

Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity. Paediatrics & child health, 23(7), 447–453. https://doi.org/10.1093/pch/pxy109.

Hile, A. L. (2019). Bupropion for the Treatment of ADHD. Lynchburg Journal of Medical Science, 2(1), 15.

Limandri, B. J. (2020). Pharmacotherapy with Attention-Deficit Disorder. Journal of Psychosocial Nursing and Mental Health Services, 58(5), 7-14.

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186.