A Young Girl With ADHD BACKGROUND In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through. For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features. When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher. To start, consider what assessment tools you might need to evaluate Katie. Child Behavior Check List Conners’ Teacher Rating Scale The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at: http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf). This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, 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. She has difficulty interacting with peers in the classroom and likes to play by herself at recess. When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV. SUBJECTIVE You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during.

1. A Young Girl With ADHD
BACKGROUND
In psychopharmacology you met Katie, an 8-year-old Caucasian
female, who was brought to your office by her mother (age 47)
and father (age 49). You worked through the case by
recommending possible ADHD medications. As you progress in
your PMHNP program, the cases will involve more information
for you to sort through.
For this case, you see Katie and her parents again. The parents
have reported that the medication given to Katie does not seem
to be helping. This has prompted you to reconsider the
diagnosis of ADHD. You will consider other differential
diagnoses and determine what information you need to
accurately assess the DSM-5 criteria to make the diagnosis of
ADHD or another disorder with similar diagnostic features.
When parents bring their child to your office, they may have
read symptoms on the internet or they may have been told by
the school “your child has ADHD”. Your diagnosis will either
confirm or refute that diagnosis.
Katie’s parents reported that their PCP felt that she should be
evaluated by psychiatry to determine a differential diagnosis
and to begin medication, if indicated. The PMHNP makes this
diagnostic decision based on interviews and observations of the
child, her parents, and the assessment of the parents and
teacher.
To start, consider what assessment tools you might need to
evaluate Katie.
Child Behavior Check List
Conners’ Teacher Rating Scale
The parents give the PMHNP a copy of a form titled “Conner’s
Teacher Rating Scale-Revised” (Available at:
http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf).
This scale was filled out by Katie’s teacher and sent home to

2. the parents so that they could share it with their provider.
According to the scoring provided by her teacher, Katie is
inattentive, easily distracted, makes careless mistakes in her
schoolwork, 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. She has difficulty interacting with peers in the classroom
and likes to play by herself at recess.
When interviewing Katie’s parents, you ask about pre- and post-
natal history and you note that Katie is the first born with
parents who were close to 40 years old when she was born. She
had a low 5 minute Apgar score. The parents say that she met
normal developmental milestones and possibly had some
difficulty with sleep during the pre-school years. They notice
that Katie has difficulty socializing with peers, she is quiet at
home and spends a lot of time watching TV.
SUBJECTIVE
You observe Katie in the office and she is not able to sit still
during the interview. She is constantly interrupting both you
and her parents. Katie reports that school is “OK”- her favorite
subjects are “art” and “recess.” She states that she finds some
subjects boring or too difficult, and sometimes hard because she
feels “lost”. She admits that her mind does wander during class.
“Sometimes” Katie reports “I will just be thinking about
something else and not looking at the teacher or other students
in the class.”
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. She offers no other
concerns at this time.
Katie’s parents appear somewhat anxious about their daughter’s
problems. You notice the mother is fidgeting with her rings and
watch while you are talking. The father is tapping his foot.
Other than that, they seem attentive and straight forward in the
interview process.
MENTAL STATUS EXAM

3. 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 neutral. Katie says that she doesn’t hear any ‘voices’
in her head but does admit to having an imaginary friend,
‘Audrey’. No reports of delusional or paranoid thought
processes. Attention and concentration are somewhat limited
based on Katie’s short answers to your questions.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE
SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR
KATIE?
In your write-up of this case, be certain to link specific
symptoms presented in the case to DSM–5 criteria to support
your diagnosis.
299.00 Autism Spectrum Disorder (ASD), mild and co-
occurring; 300.23 Social Anxiety Disorder
315.0 Specific Learning Disorder with Impairment in Reading
and 315.1 Impairment in Mathematics
Diagnosis
314.00 Attention Deficit Hyperactivity Disorder, predominantly
inattentive presentation
A young girl with difficulties in school
Case #1
A young girl with difficulties in school
Decision Point One
314.00 Attention Deficit Hyperactivity Disorder, predominantly
inattentive presentation
RESULTS OF DECISION POINT ONE
· Client returns to clinic in four weeks
· You selected Attention deficit hyperactivity disorder,
predominantly inattentive presentation. Based on this choice,
outline the remainder of the diagnostic evaluation that you will

4. conduct on this child and their parents. Be sure to include
standardized assessment instruments that you would administer
Decision Point Two
Begin Strattera 25 mg orally daily
RESULTS OF DECISION POINT TWO
· Client returns to clinic in four weeks
· Katie’s parents seem absolutely delighted upon their return
stating that Katie is paying more attention in school, but note
that there is still room for improvement
· They are somewhat concerned however about some sedation
that she experiences following the medication. They report that
Katie has been becoming more uncooperative with medications
as she feels ‘sleepy’ after taking them
· Her parents are also concerned about her decrease in appetite
since starting the medication
Decision Point Three
Discontinue Strattera and begin Adderall XR 10 mg orally daily
Guidance to Student
In response to the first choice, although decreased appetite is a
side effect of Strattera, it does not address the parents’ concerns
about Katie’s sedation, which can occur with Strattera use. It
may help with residual inattention symptoms, however, if the
medication is creating such negative side effects, compliance
may become an issue.
CBT has some evidence of efficacy in treating ADHD
symptoms, however, augmenting the medication is not going to
effectively address the concerns that Katie’s parents have raised
regarding side effects.
Discontinuing Strattera and beginning Adderall XR would be
the most appropriate strategy in this case as changing agents
may alleviate the unfavorable side effects, and may treat
symptoms more effectively.

5. The Assignment:
Examine Case 1. You will be asked to make three decisions
concerning the diagnosis and treatment for this client. Be sure
to consider co-morbid physical as well as mental factors that
might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
· Decision #1: Differential Diagnosis
· 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: Treatment Plan for Psychotherapy
· 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: Treatment Plan for Psychopharmacology
· 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 and their

6. families.
1
MIE 124
Numerical Integration
I – Overview
1 – Intro
want to know the integral of that function.
o Measure forces along a wind turbine blade, and want to
compute the bending moment on the root.
o Measure the flow velocity at many points in a river, and want
to calculate the total volume or mass flow
rate.
o Measure the heat addition and heat loss to a building over
time, and want to calculate the total heat flux.

7. 2 – Math refresher
nction f(x), and we want to determine the
integral of that function between limits a and b.
( ) ( ) ( )
b
b
between limits a and b.
Integration is related to summation, that’s why the integral
sign is a fancy S.
2
1
1
bb n

8. n
a a
x
x dx
n
imes we have function where we can’t determine
the integral.
2 – Numerical Integration intro
analytically.
nvert the continuous function to discrete
values of the function at a number of points.
weighting system to estimate the integral.

9. 3 – Graphical method
ternative is a graphical method.
3
II – Trapezoid Method
1 – Graphically
Probably many of you are familiar with the trapezoid
method.
-line
segments, then sum the area in the resulting
trapezoids.
2 – Mathematically

10. 4
( ) ( )
( )
2
f a f b
I b a
points (x1, x2, …, xn+1), and n equal segments.
-a)/n.
Take 2 minutes, apply the trapezoid rule for each segment,
and group terms. Try to determine an expression
that uses a summation over an arbitrary number of segments.
1 1
2
( ) 2 ( ) ( )
2

11. n
i n
i
h
-n, but
since first index in Matlab is 1, this is easier.
3 – Error analysis
ng the trapezoid
rule.
solution.
is big enough?

12. I as n increases (just like root finding).
4 – Example and Numerical solution
falling object as a function of time:
c
between t1=0 s and tf=50 s.
Now take 5 minutes and write pseudocode to integrate v(t)
numerically to find D, using n=16.
D.
entering the equation every time.
between a and b.
5 – Example and effect of discretization

13. increasing by factors of 2).
5
Note, using a loop to store values of integral for each value
of n.
You will do something similar for your homework except
using Simpson’s method
III – Simpson’s Method
get a
better estimate of I, use a higher order method.
1 – Graphically
sum the area.

14. 2 – Mathematically
a single segment:
( ) 4 f((a b) / 2) ( )
( )
6
f a f b
I b a
xn+1), n equal segments, and h=(b-a)/n.
1
1 1
2,4,6 3,5,7
( ) 4 ( ) 2 ( ) ( )
3
n n
i i n
i i
h
I f x f x f x f x

15. segment if odd).
-n, but since first index in Matlab is 1,
this is easier.
3 – Error analysis
xpression for the error when using the Simpsons.
6
ions,
Simpsons rule is a “second order” solution but

16. “third order” accurate.
4 – Example and Numerical solution
c
Won’t show you Simpsons code, almost identical to
trapezoid code. You will implement for your
homework.
5 – In class exercise on separate document
Homework 7

17. A contractor in Flavortown is renovating a room in a house. His
client is interested in
lowering his heating bill during the winter. The room has four
walls and a roof, and one window
facing the front yard of the house. The contractor, Mr. Fieri, has
already effectively insulated the
walls so that no heat is lost through them.
You have been asked to aid him in designing the window for the
room, which is 1 meter
by 0.5 meters. The contractor has three different types of glass
to choose from, each with a
different thermal conductivity constant. They also are all
available in a wide range of
thicknesses. The previous window allowed 0.5 kWh of heat to
escape per hour, i.e. 500 W is the
heat loss rate. The room is heated by a space heater running 24
hours a day to keep the room
at a constant 25 degrees Celsius. The space heater’s thermal
efficiency is 0.8, meaning that
80% of the energy consumed by the heater is turned into heat.
In Flavortown, the cost of
electricity is $0.10 per kilowatt-hour. Here are the
specifications of each type of glass:
Type Thermal Conductivity, (k), (W/m/K) Price
Glass 1 .78 $28.70 + $12 per mm
Glass 2 .8 $30 + $11 per mm
Glass 3 .82 $30 + $8 per mm

18. Mr. Ramsay, the client, seems to be on the fence about the
renovation. After losing a
batch of his delicious lamb sauce he is in an especially bad
mood and doesn’t want to spend
more money on a new window. The contractor wants to show
him how beneficial the renovation
will be. In your code, you will need to calculate the amount of
time it will take for Mr. Ramsay to
see a return on his investment and his daily savings.
Your function and script will help Mr. Fieri determine the
specifications of the glass, as
well as display Mr. Ramsay’s cost savings in order to convince
him to go through with the job.
The Function:
-Inputs: [Glass Type],[Outside Temperature], [Desired Heat
Loss]
-Outputs: [Heat Flux],[Desired Thickness],[Cost of
Pane],[Time until Investment is
Covered],[Cost Savings per Day]
1. Your function will have three inputs, outside temperature
(T_O) in units of Celsius, glass
type (Type) a scalar that can be 1, 2, or 3, and desired heat loss
(DHL) in Watts.
2. Since glass type is an input to your function, you will need to
include an if/else statement
to determine the glass parameters. For example, if the glass type
is 1, the thermal
conductivity used in your calculations will have to be 0.78, etc.
3. After defining the thermal conductivity and costs of the glass
based on the type, you will

19. then initialize the rest of your constants: Previous allowed heat
loss, Indoor
Temperature, the Area of your window, and the Efficiency of
the space heater.
4. In order to calculate the desired window pane thickness you
will need to use a series of
formulas. Heat Flux quantifies the heat diffusion through a
certain material. The unit for
Heat Flux is W/m2, the number of joules per second of thermal
energy passing through
one square meter of a material. The Heat Flux formula, is
defined as:
Heat Flux (q) = -k*(ΔT/Δx)
Where k is the thermal conductivity, ΔT is the difference
between the outdoor and indoor
temperature in Celsius or Kelvin, and Δx is the thickness of the
window pane in meters.
5. The next formula you will need is the formula for heat loss in
Watts, in which you will use
the calculated value for heat flux and the input desired heat
loss. Since you already
know the desired heat loss, you will be solving for the desired
thickness of the glass after
performing the substitution. The formula for heat loss per hour
is:

20. ΔQ/Δt = q * A
Where q is heat flux and A is the area of your window pane in
m^2.
6. Derive the final formula needed for solving for desired
thickness, in meters, on a piece of
paper. Next implement the formula into your function. Once you
have obtained the
necessary glass thickness (Δx) you can substitute this value
back into the Heat Flux
formula to find the heat flux of the window pane (which is
another one of your outputs).
7. You will then have to calculate the cost of the window pane
and output it, noting that the
cost depends on the thickness in millimeters.
8. After this, you will calculate the number of days that it will
take for Mr. Ramsay to recoup
his investment. Given that the cost of the renovation is $500
plus the cost of the window,
you must first find the difference in the amount of energy that
the space heater
consumes before and after the renovation. Keep in mind that the
heat loss through the
window per hour is equal to the amount of energy that needs to
be outputted by the
space heater to keep the temperature of the room constant. Find
this required energy
output per hour before and after the renovation, then divide both
values by the thermal
efficiency (.8) of the heater to determine the energy input.
Using this information and the

21. cost of energy you can calculate how many days it will take to
recoup the investment
and how much money will be saved per day.
The Script:
1. First you will have to initialize a vector of Outside
Temperature values starting at -15
degrees Celsius to 15 degrees Celsius in increments of 0.5. Set
the desired heat loss to
250 Watts.
2. Using two nested for loops, you will then run your function
for each outside temperature
value and each glass type, storing each output in different
matrices, with each column
representing a different glass type, and each row a different
outside temperature. When
you call your function, instead of having a variable for the
outputs Investment Recovery
Time and Cost Saved per Day set these to both to “~” for now.
3. Now you must analyze the data. On one graph, plot the
thicknesses of each glass type
versus the Outdoor temperature vector. The line for Glass 1
should be a blue solid line.
The line for Glass 2 should be a red solid line. The line for
Glass 3 should be a green
solid line. Comment on the nature of the relationship between
required thickness and
outside temperature.

22. 4. On a new figure, plot the costs of each glass type versus the
Outside Temperatures. The
lines should have the same specifications as the previous graph.
Does the outdoor
temperature have an effect on which glass type is the most cost
efficient? Which panes
are the most cost efficient depending on the temperature? At
approximately which point
does the most efficient glass type change? If the average
outdoor temperature in
Flavortown in the winter is 0 degrees Celsius, which type of
glass should the contractor
use? Use a comment in your script to discuss the results.
5. For the second part of your script you will create a vector,
DHL, of desired heat loss
values ranging from 100 W to 300 W in increments of 5 W. Set
your Outdoor
Temperature to 0 degrees Celsius. Set your glass type to the
optimal glass type at 0
degrees Celsius. Use a for loop to run your function for the
values of DHL using a for
loop. Set the outputs Heat Flux, Desired Thickness, and Cost of
Pane to “~”. Call your
remaining outputted results vectors Investment_Time and
Daily_Savings.
6. Now plot your Investment_Time vector versus DHL on one
graph, with a simple blue
line. Then plot your Daily_Savings vector versus DHL with a
red line. At about what
Desired Heat Loss value is Mr. Ramsay’s investment
recuperation time one year (365
days)? At this DHL, about how much money does Mr. Ramsay
save per day? (If you’re
having trouble reading the graph, look through the values in

23. your DHL, Daily_Savings,
and Investment_Time vectors).
DON’T FORGET TO LABEL YOUR AXES AND GIVE TITLES
TO YOUR GRAPHS