Treating ADHD in Children

1 Treating ADHD Background Psychological health disorders are rare occurrences in children. However, neurodevelopmental and behavioral disorders are common in this group. Attention deficit hyperactivity disorder, for instance, is a common health issue in children. This disorder is linked to abnormalities in the brain. It disrupts a child’s normal learning process and social interactions between the child and her peers (Wender & Tomb, 2017). Children with ADHD do not behave like other children. They experience difficulties focusing, organizing, and controlling impulses (Hinshaw & Ellison, 2016). They cannot actively participate in social activities for extended periods. Scientists have also revealed that ADHD children battle an overwhelming impulse to engage in activities that might lead to physical harm (Hinshaw & Ellison, 2016). Children comprise the largest group in which ADHD symptoms are noticed. These symptoms might also be detected in adolescents and adults.

Diagnosing ADHD in some children and adults might be problematic since some symptoms mimic other neurodevelopmental disorders. These symptoms might also resemble normal developmental changes that occur during adolescence. In some cases, ADHD symptoms are detected in adults who never experienced similar problems during childhood (Hinshaw & Ellison, 2016). Many children often overlook hyperactive symptoms, leading to late diagnosis (Wender & Tomb, 2017). In adults, ADHD symptoms are confused with mental conditions such as bipolar. These mistakes lead to late diagnosis, inappropriate treatment, and poor management.

Clinicians incorporate therapy and medications in ADHD treatment plans to elevate chances of recovery and improve care quality. This discussion illuminates an ADHD treatment plan for an 8-year-old child.

2 Case Summary The child was presented to the facility by her parents after being referred by the primary care practitioner. The primary provider suggested that the child needs further psychiatric evaluation since her symptoms resembled ADHD. The teacher had disclosed that the child’s concentration level matches that of other children when engaged in pleasing tasks. The Conner’s Teacher Rating Scale-Revised, presented by the parents to the clinic, indicates that the child loses concentration quickly besides being inattentive. The report also pointed out that the child has significant reading, spelling, and arithmetic challenges. Importantly, the report revealed that the child has memory problems and cannot recall simple instructions. The child rarely finished academic tasks, including homework. She does not show interest in social activities like other children. Although the child’s speech is clear, she does not follow instructions. Her mind wanders off frequently, especially during class time. Due to these difficulties, the PMHNP diagnosed her with ADHD, predominantly inattentive presentation.

Decision Point 1 Selection: Begin Wellbutrin (bupropion) XL 150 mg orally daily Justification: although Wellbutrin is not FDA approved for ADHD, doctors still use it as an offlabel medication for this condition. This medication improves concentration and alleviates other ADHD symptoms. A meta-analysis by Gray et al. (2020) revealed that this mediation effectively treats ADHD in both children and adults. Hile (2020) noted that it also helps eradicate psychological symptoms such as anxiety and depression in ADHD patients. Wellbutrin achieves the targeted neurological impact by improving neurotransmitters dopamine and norepinephrine concentration in the brain. An increase in Norepinephrine concentration in the frontal cortex

3 inactivates dopamine reuptake, subsequently elevating dopamine neurotransmission in this region.

Rejection alternatives: The PMHNP did not prescribe Intuniv ER at bedtime since it predisposes patients to gastrointestinal symptoms like vomiting and pain. This medication also causes drowsiness and fatigue, greatly affecting the child’s concentration in class. The nurse did not consider Ritalin as a viable treatment option at this point despite being an effective agent for ADHD since, as highlighted by Bouziane et al. (2019), it increases the risk for addiction and abuse among patients.

Expected outcome: The nurse aimed to increase the child’s concentration span, memory, and interest in social and academic activities. The nurse believed that this plan would help improve the child’s academic performance.

Results: The treatment plan developed by the nurse had not attained the expected outcomes.

Instead, Katie’s parents had stopped giving her the medications two weeks into the prescription since she reported self-injury ideations. Her parents were scared and decided to stop the medications.

Decision Point II Selection: Educate the parents that Wellbutrin sometimes leads to suicidal ideation in children and that this is normal, and re-start the drug at the previous dose Justification: antidepressant medications, including Wellbutrin, increase the risk of suicidal ideation and self-injury in children and adolescents. The nurse did not increase the dosage to ensure the risk of self-injury was not elevated. Although bupropion was used to treat ADHD in

4 this scenario, it is still an antidepressant. Therefore, it is crucial to inform the parent of the side effects associated with this medication.

Rejection alternatives The nurse did not replace Strattera with Wellbutrin since it takes several weeks to achieve the intended therapeutic outcome. Strattera is also associated with the risk of severe allergic reactions, increased heart rate, blood pressure, and abdominal problems. These side effects would further affect the child’s productivity and compliance with treatment.

The PMHNP did not consider replacing Wellbutrin with Adderall ER since the latter might expose the child to worsening psychotic or manic symptoms, as highlighted by Gupta (2021).

Other adverse effects of Adderall that influence compliance and affect productivity are decreased appetite, insomnia, seizures, and nausea (Gupta, 2021).

Expected outcome: At this point, the PMHNP aimed to alleviate ADHD symptoms and protect the child from suicidal ideations. The plan also purposed to help the child attain better academic results and engage in social and daily life activities.

Results The plan did not attain the targeted results since the parents reported that the child was still experiencing suicidal ideations after four weeks of treatment. Her parents had once again stopped giving her the medications. The parents are disappointed with their daughter’s treatment and want to try other interventions.

Decision Point III Selection: Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD

5 Justification: The parents were distressed at this point by the notion that their child was contemplating self-harm and suicide. The parents are hesitant about more medications. They believe that medications are not attaining the intended results. Therefore, the best intervention is to refer them to a skilled behavioral therapist or a pediatric psychologist. Using behavioral therapy could increase the chances of better outcomes (Anastopoulos et al., 2020). However, behavioral therapy is combined with medications for maximum results.

Rejection alternatives: Educating the parents on Adderall use in treating ADHD was not an option since they were determined to ensure their child was not given more medications.

Although the pathophysiology of ADHD indicates that symptoms may resolve with increasing age, this is not a solution for the child. The child needs assistance to overcome the disruptive symptoms and improve academic performance. Behavioral therapy is the only intervention suitable for the child since her parents have rejected medications.

Expected outcome:- The therapist aimed to restore the therapeutic alliance with the parents and eradicate ADHD symptoms in the child.

Results: Behavioral therapy helped improve the child’s behavior. The parents noted that her selfesteem and self-control had improved significantly following behavioral therapy. As asserted by Anastopoulos et al. (2020), behavioral therapy helps ADHD children change their response to situations.

Ethical Considerations ADHD is a complex neurodevelopmental condition affecting children. Therefore, clinicians need to uphold bioethics while treating this condition. The child should be respected despite being unable to concentrate and perform well academically. In line with autonomy, the clinician should encourage the parents’ active participation in the treatment plan (Gopalan & IGI

6 Global, 2021). The nurse should educate the parents on all ADHD issues, including medication and prognosis. Parents should be given a list of available ADHD interventions to help them make an informed choice. Notably, the nurse should initiate treatments that are beneficial to the child.

The nurse should discontinue all treatments that generate side effects (Brunoni, Nitsche, & Loo, 2016). Medication reconciliation could help the nurse adjust medications accordingly to avoid intolerable side effects.

Conclusion Neurodevelopmental disorders have a disruptive impact on children. ADHD, for instance, affects a child's concentration, ability to interact with peers, and perform academic tasks. ADHD symptoms include decreased concentration, difficulty reading and performing other academic tasks, excessive thinking, and hyperactivity. Clinicians use medications and behavioral therapy to treat ADHD. These medications are adjusted regularly depending on the child’s response to treatment.

7 References Anastopoulos, A. D., King, K. A., Besecker, L. H., O’Rourke, S. R., Bray, A. C., & Supple, A. J. (2020). Cognitive-behavioral therapy for college students with ADHD. Journal of Attention Disorders, 24(6), 863-874. https://doi.org/10.1177/1087054717749932 Bouziane, C., Filatova, O. G., Schrantee, A., Caan, M. W., Vos, F. M., & Reneman, L. (2019).

White matter by diffusion MRI following methylphenidate treatment: a randomized control trial in males with attention-deficit/hyperactivity disorder. Radiology, 293(1), 186-192. https://doi.org/10.1148/radiol.2019182528 Brunoni, A., Nitsche, M., & Loo, C. (2016). Transcranial direct current stimulation in neuropsychiatric disorders: Clinical principles and management. Springer.

Gopalan, R. T., & IGI Global,. (2021). New developments in diagnosing, assessing, and treating ADHD. IGI Global.

Gray, B., Hurtado, C., Hudson, J., Coulter, L., & Gray, D. (2020). Is bupropion monotherapy efficacious for ADHD in adults?. Evidence-Based Practice, 23(10), 39. http://doi:10.1097/EBP.0000000000000794 Gupta, M. (2021). Rare side effects of stimulants: Raynaud’s phenomenon. The primary care companion for CNS disorders, 23(5), 36908. https://doi.org/10.4088/pcc.20l02857 Hile, A. L. (2020). Bupropion for the treatment of ADHD. Lynchburg Journal of Medical Science, 2(1), 15.

Hinshaw, S. P., & Ellison, K. (2016). ADHD. Oxford University Press Wender, P. H., & Tomb, D. A. (2017). ADHD: A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults. Oxford University Press.