Running head ATTENTION DEFICIT HYPERACTIVITY DISORDER1A Youn.docx

Running head: ATTENTION DEFICIT HYPERACTIVITY
DISORDER 1
A Young Girl with ADHD
Attention Deficit/Hyperactivity Disorder (ADHD) is a common
psychiatric disorders usually diagnosed in school age children.
It is a neuropsychiatric disorder that affects preschoolers,
children, adolescents and adults all over the world. It is
described by a pattern of reduced persistent attention, and
increased impulsivity or hyperactivity (Sadock, 2015). It is a
kind of behavioral issue that has received substantial awareness
in both classroom and research settings as a result of its likely
adverse effects on academic products and classroom functioning
(Purpura & Lonigan, 2009). The National Institute of Mental
Health (NIMH) approximates that its incidence rate is between
3% and 10%, with ADHD influencing around 2 million children
in the United States (Neuropsychiatric ailment and treatment,
2008). ADHD is usually co-morbid with other psychiatric
disorders including depressive and anxiety disorders, substance
abuse, conduct disorder, and antisocial behaviors
(Neuropsychiatric ailment and treatment, 2008). Children with
untreated ADHD have higher than typical rates of accidents and
injury (NIMH). Pharmacotherapy treatment for ADHD includes
Stimulant and Non stimulant medications. The stimulant
medications includes Methylphenidate, dextroamphetamine and
Focalin (Sadock, 2015). The non-stimulant medications includes
atomoxetine, Clonidine, and Guanfacine (Sadock, 2015). This
paper will examine and addresses treatment options for this 8-
year old Caucasian girl with Attention Deficit/Hyperactivity
Disorder (ADHD) while analyzing ethical and legal implications
regarding her treatment.
Decision #1
My first decision is to start chewable Ritalin (methylphenidate)
IR 10 mg PO every morning.

Reason for selecting this decision
Ritalin is a brand name of methylphenidates, the mainly
common prescribed stimulant medication for attention deficit
hyperactivity disorder (ADHD). Ritalin is a stimulant
categorized to the class of dopamine, norepinephrine reuptake
inhibitor and releaser (DN-RIRe) (Stahl, 2014b). Ritalin is FDA
approved for ADHD in both children and adults (Stahl, 2014b).
It works by boosting dopamine and norepinephrine actions in
particular brain regions which includes the dorsolateral
prefrontal cortex and basal ganglia which may enhance
wakefulness, hyperactivity concentration, attention and
executive function (Stahl, 2014b). Ritalin has an established
long-term efficacy as a first-line treatment for attention deficit
hyperactivity disorder (ADHD) (Stahl, 2014b). In the class of
stimulant drugs, Ritalin is the best known for the treatment of
ADHD for more than 60 years (The Western journal of
medicine, 2000). Stimulant medications such as Ritalin have
been prescribed for decades for the treatment of ADHD and
their recognition as cognition enhancers has recently risen
among the healthy as well to boost mental performance (Fisher,
2008). Stimulant medications used to treat ADHD, like Ritalin,
has been widely and lengthily studied and found to be safe.
With over 6,000 patients treated in more than 200 clinical trials,
methylphenidate is one of the best studied drugs in children and
adolescents (Vitiello 2001).
According to research, Ritalin are more tolerated, acts quickly
and have fewer side effects in most people than other
medications (Haggerty, 2018). Psychostimulants, most
commonly methylphenidates are mostly safe and well tolerated
(Clancy et. al, 2011). Stimulants are the major treatment for
ADHD and have been proven to be the most effective treatment
with 80 percent response rate (Kolar et al., 2008). About 90
percent of cases, stimulant medication facilitates children to
think before they act, improve their approach to schoolwork to
get more focused and organized, get along better with others
and break fewer rules; they often seem happier too (American

Psychological Association, 2018). At the initial stage, the
patient should not be placed on high amount of prescriptions of
an oral dosage. The client is initiated at a less dosage, which
reduces the chance of side effects. This will also give the
provider the chance to keep assessing her response to it, and
decide if the dosage should be increased, decreased or switched
to another drug completely either because of side effects or for
not having any therapeutic effect on the patient. Wellbutrin on
the other hand was not selected due to numerous reasons.
Wellbutrin has not been approved by the FDA for the treatment
of ADHD. Wellbutrin including other antidepressants have been
linked to suicidal ideation in children and adolescents and their
Safety and efficacy have not been established (Stahl, 2014b).
There is not enough scientific studies to back up Wellbutrin’s
effectiveness and safety in treating ADHD (Low, 2018).
Intuniv belong to the nonstimulant medication types for ADHD.
It’s an antihypertensive and centrally acting alpha 2A agonist
(Stahl, 2014b). It has also not been approved by the FDA for the
treatment of ADHD. The basic standard for treating ADHD is
the use of a psychostimulant as the first line agent. Intuniv is a
nonstimulant, and an option for ADHD patients who cannot take
stimulants (Neuropsychiatric disease and treatment, 2008).
Nonstimulants do not work as quickly as stimulants, but may be
used when psychostimulant medications have been ineffective,
unacceptable side effects have resulted, or the individual or
child’s parents prefer a nonstimulant for other reasons. They do
not appear to be as effective in improving symptoms of
inattention (Low, 2018). Non-stimulants can be very effective
for some kids with ADHD, but for most don’t have the same
rate of success as stimulants, which work well in about 70 to 80
percent of cases (Rosen & Braaten, n.d.). Intuniv can cause an
individual to be excessively sedated and sluggish throughout the
day. There has also been reports of mania and aggressive
behavior in ADHD patients taking Intuniv. Intuniv can cause
changes in the blood pressure. It may lower the blood pressure
about 30 to 60 minutes after first dose is taken and the highest

reduction is seen after 2 to 4 hours of use (Stahl, 2014b).
Expected outcome
For the treatment of ADHD, the overall goal is to see reduction
of symptoms of inattentiveness, motor hyperactivity, and/or
impulsiveness that disrupt social, school, and/or occupational
functioning (Stahl, 2014b). Starting her on Ritalin will help
determine patient’s response to the medication and taking it in
the morning is to help improve her attention and concentration
while in class. With this decision, it is expected to see
improvement in my client’s symptoms even with the first dosing
but maximum therapeutics mat take several weeks (Stahl,
2014b). She was prescribed an Immediate Release (IR) of
Ritalin which makes the drug a quick acting. Before her next
appointment in four weeks, there will be noticeable
improvement in her behavior. It is also expected that while in
class, her attentiveness will improved. She will not be easily
distracted, and not forget things she already learned. It is also
expected to see an improvement in her performance in
arithmetic, ability to spell and read (Pelham, et al., 1999). Not
only any attention to what she is interested in, but the patient is
also expected to have an extended time span of concentration to
everything. IR chewable tablets offer a child-friendly
alternative for patients or parents who are not satisfied with the
available formulation options, especially those individuals who
cannot or will not swallow tablets or capsules, and could
improve treatment compliance. (Wigal, et. al, 2017). It is
expected that she will have no side effects and tolerate this
chewable form better than the others.
Difference between the expected outcome and the initial short-
term outcome
As expected, during the 4 weeks follow up appointment, the
client’s teacher reported her symptoms got considerably better
in the morning, which has led to an improvement in her overall
academic performance (Laureate Education, 2016d). But by

noon, she is gazing off into space and daydreaming (Laureate
Education, 2016d). The client also gave reports about her heart
feeling funny (Laureate Education, 2016d). On assessment, her
pulse was 130bpm (Laureate Education, 2016d). One of the side
effects of Ritalin is an increases in norepinephrine peripherally
which can cause autonomic side effects such as, tachycardia,
hypertension, tremor and cardiac arrhythmias (Stahl, 2014b).
There was a close relationship between the client’s actual
results and the expected results. The client had an improvement
in her symptoms, however the improvements does not last long.
Side effects was also reported. The result of using Ritalin
shows distinctively how it is effective in the morning, which
signifies that the provider will have to decide on how to address
the afternoon behavioral issues with the medication and the
tachycardia.
Decision #2
From other list of drugs available in the decision tree, I choose
to change to Ritalin LA 20 mg orally every morning.
Since it was reported that though the IR formula of Ritalin was
effective, but it dissipates before the school day finishes
resulting her to stare into space, daydream. Also causing the
side effects, tachycardia. It is important at this point for a
provider to do something about the results and side effects of
the medication. As a result of the tachycardia and the client
having a decrease in attention during the afternoon it would be
recommended to switch the formula of the same medication to a
long acting one (Drugs.com, 2018). The encounter with
stimulant drugs is how they deliver an effective dose over a
required period of time. When Ritalin was first used to treat
ADHD in 1961, it lasted three or four hours. But technology has
been created to make the medication release gradually, peaking
at the desired time (Ehmke, 2018). Ritalin IR is quickly
absorbed, with its action initiating within 30 minutes of use,
lasting only for about two to four hours before it gets is
(Durand-Rivera, et. al, 2015). Sustained release Ritalin LA has

an early peak and an 8 hours duration of action (Stahl, 2014b).
Ritalin LA also has beads, but they’re 50-50, which means half
the beads are going to be released immediately, to peak in the
morning, the other half in the afternoon, for a total of six to
eight hours. So as to have much more of a two-equal-phases
effect on focus and attention (Ehmke, 2018). An observational
study had an objective to evaluate effectiveness of Ritalin LA in
children with ADHD and It demonstrated improvements in
ADHD symptoms, confirmed overall good tolerability and
safety, and revealed a longer perceived effect particularly after
switching from immediate release formulations (Haertling et. al,
2014).
When there’s a side effects encountered such as the tachycardia,
it is recommended to switch to another formulation of d,l-
methylphenidate (Stahl, 2014b). Continuing the same formula
and waiting to re-evaluate in 4 weeks will not be appropriate for
the client. It means she will still be having a high heart rate and
her symptoms will still not be controlled throughout her school
day. It is also not recommended to switch to another agent at
this time since there’s an improvement in symptoms. Since
positive results were observed, improving the dosage rather than
changing the drug could help. The provider just needs to select
a better formula and dosage for further enhancement in
symptoms. Also the dosage suggested in the case study is not
recommended to be prescribed as an initial dose. For an
extended-release form of Adderall, it is recommended to start
with 10 mg/day in the morning, and can be increased on weekly
basis by 5 to 10 mg, with a maximum dose generally of 30
mg/day (Stahl, 2014b). As a result of tachycardia and the client
having a decrease in attentiveness in the afternoon, it would be
advised to change the medication to a long acting formula
(Drugs.com, 2018). prescribing Ritalin LA 20mg a day is an
appropriate dose for clients who were previously taking using
Ritalin 10mg daily and can be titrated up by 10mg weekly to the
maximum dose of 60mg daily depending on response
(Drugs.com, 2016). Ritalin LA 20mg would be the appropriate

drug for symptoms like inattentiveness and concentration
deficits (Denise et al. 2016).
Expected outcome
In four weeks, client is expected to return to the clinic with
reduction in tachycardia and an improvement in her attention
span throughout the day. It is also expected that her symptoms
of staring into space, and daydreaming will improve. Overall
improvement in her academic performance is also anticipated.
Her increase heart rate is likewise expected to reduce to a
normal range of 70-110 beats per minute for her age range
(Medlineplus.gov, 2017).
Difference between the expected outcome and the initial short-
term outcome
Patient returned in four weeks with reports that the switch to
the LA preparation is lasting her throughout the school day
(Laureate Education, 2016d). This brought along an improved
academic performance. No reports of her staring into space and
daydreaming unlike when she was on the Ritalin IR.
Additionally her previous reports of her heart feeling funny has
stopped. On assessment during this visit, her previously pulse of
130 had diminished to 92 beats per minute, which is a normal
range for her age. It is evident that her response in four weeks
after her medication was changed was significantly positive; it
keeps her functioning normally throughout a school day, unlike
formerly where it could only be noticed in the morning. There
was a connection between the expected results and actual result
for this client.
Decision #3
As my final decision, I chose to continue on the current dose of
Ritalin LA 20mg and re-evaluate her in four weeks.
Given that the client has shown continuous improvement with
treatment, no alteration in her dose was necessary. There is no
purpose to alter her medication or increase the dosage at this
time. She is currently responding to the new Ritalin LA formula
and dosage with no side effects. A change is always done when

the prescribed dosage does not have a positive impact on the
patient. In the situation when a prescribed dose does not
produce a therapeutic effect in a client, the medication itself or
dosage can be modified or altered. It can either be increased,
reduced, stopped or switched to another drug. However, in this
case, the client has reached an optimal clinical effect so there
was no reason to change the medication. Stahl (2014b)
recommended to continue treatment until all symptoms are
under control or improvement is stable and then continue
treatment until further notice as long as there’s a constant
improvement. It is also suggested to reevaluate the client for the
need for treatment periodically (Stahl, 2014b).
Expected outcome
It is expected that during her next four weeks appointment, the
client, including her parent and teacher will report much further
improvement. It is also expected that she will also continue to
tolerate it with no side effects.
The difference in expected results and the real results.
There is also no need to obtain an EKG for this client since her
heart rate is appropriate for her age. Ritalin LA 20 mg has
demonstrated positive effect in resolving the client’s symptoms.
She has continued to show over-all improvement in her
symptoms and hence there is no reason to alter the dosage or
switch to another medication (Coffey 2016). Maintaining the
same formula and dosage under required prescription from the
health professional is a better choice. She should also
constantly be evaluated for side effects. Since Ritalin could
temporarily slow normal growth in children, her weight and
height should be constantly monitored (Stahl 2014b). Her heart
rate and blood pressure should likewise be monitored regularly
(Stahl 2014b). The client’s parent should also be advised to
avoid dosing late in the day because of the risk of insomnia
(Stahl, 2014b).
Ethical considerations.
It is ethical for a provider to prescribe the most suitable dose of

drug and monitor the efficacy or potential side effects of the
drug on clients. There’s a contend that by not allowing parents
or guardians of the children to use these medications when
diagnosed with attention deficit hyperactivity disorder(ADHD),
the psychiatric and medical communities would be in violation
of the principle of autonomy(Meppelink et. al., 2016). Justice
too would be abused since the greater part of the burden of
managing every one of the symptoms caused by this issue would
descend on those with ADHD and relatively on their families
(Meppelink et. al., 2016). There has been some debate over the
utilization of stimulant medications and unethical practices
involving children. A few people have utilized stimulants as a
type of social control, attempting to wipe out socially
inadmissible behaviors by controlling the child’s guardian into
having stimulants recommended (Johns, 1994).It is vital that the
child’s guardian completely comprehends the symptoms and
appropriate utilization of stimulant prescriptions (Huss et. al.,
2017).
Conclusion
Medications for ADHD can be very helpful in reducing
impulsiveness and hyperactivity and increasing focus and
attention (Low, 2018). The goal of every prescriber is to always
obtain an optimal effect while reducing the risk to the client
(Huss et al., 2017). There is no specific treatment that is right
for every client in every situation, hence, in order to boost
treatment it is vital to for providers to listen to the client and
utilize a tailored approach to treatment (Coghill et al., 2013).

References
Abassi, L. (2015). Chewable Ritalin for the Kiddies. Retrieved
from https://www.acsh.org/news/2015/12/14/chewable-ritalin-
for-the-kiddies
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th Ed.). Washington,
DC: Author.
Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011).
Attention deficit hyperactivity disorder: Effectiveness of
treatment in at-risk preschoolers; long-term effectiveness in all
ages; and variability in prevalence, diagnosis, and treatment.
Table B. KQ2: Long-term(>1 year) effectiveness of
interventions for ADHD in people 6 years and older.
Coffey, C. (2016). Pediatric neuropsychiatry. Philadelphia, Pa:
Lippincott Williams & Wilkinsg
Coghill, D., Banaschewski, T., Zuddas, A., Pelaz, A., Gagliano,
A., & Doepfner, M. (2013). Long-acting methylphenidate
formulations in the treatment of attention-deficit/hyperactivity
disorder: a systematic review of head-to-head studies. BMC
Psychiatry, 13(1). doi:10.1186/1471-244x-13-237
Denise, F. & Cheryl, T. (2016). Resource manual for nursing
research: generating and assessing evidence for nursing
practice. Philadelphia
Durand-Rivera, A., Alatorre-Miguel, E., Zambrano-Sánchez, E.,
& Reyes-Legorreta, C. (2015). Methylphenidate Efficacy:
Immediate versus Extended Release at Short Term in Mexican
Children with ADHD Assessed by Conners Scale and EEG.
Neurology Research International, 2015, 1-9.
doi:10.1155/2015/207801
Ehmke, R. (2018). The Facts on ADHD Medications. Retrieved
from https://childmind.org/article/the-facts-on-adhd-
medications/
Fisher, M. (2008). Study uncovers how Ritalin works in brain to
boost cognition, focus attention. Retrieved from
https://news.wisc.edu/study-uncovers-how-ritalin-works-in-

brain-to-boost-cognition-focus-attention/
Haertling, F., Mueller, B., & Bilke-Hentsch, O. (2014).
Effectiveness and safety of a long-acting, once-daily, two-phase
release formulation of methylphenidate (Ritalin ® LA) in school
children under daily practice conditions. Attention deficit and
hyperactivity disorders, 7(2), 157-64.
Huss, M., Duhan, P., Gandhi, P., Chen, C., Spannhuth, C., &
Kumar, V. (2017). Methylphenidate dose optimization for
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Johns, G. (1994). Treatment with Stimulant Medication as an
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Disorder/Attention Deficit Hyperactivity Disorder. National
Student Speech Language Hearing Association, 21, 45-49.
Laureate Education (2016d). Case study: A young Caucasian
girl with ADHD [Interactive media file]. Baltimore, MD:
Author
Low, K. (2018). Medications to Treat ADHD in Children and
Adults. Retrieved from https://www.verywellmind.com/adhd-
medication-20882
Meppelink, R., de Bruin, E. I., & Bögels, S. M. (2016).
Meditation or Medication? Mindfulness training versus
medication in the treatment of childhood ADHD: a randomized
controlled trial. BMC psychiatry, 16, 267. doi:10.1186/s12888-
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Methylphenidate Chewable Tablets - FDA prescribing
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tablets.html
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Stimulant and Non-Stimulant ADHD Medication: What You
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Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
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Understanding the Ritalin debate. (2018). Retrieved from
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Sarkis, E. H., & Kindling, R. L. (2016). Atomoxetine Increased
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Running head: ATTENTION DEFICIT
HYPERACTIVITY DISORDER
1

psychiatric disorders usually
diagnosed in school age children. It is a neuropsychiatric
disorder that affects preschoolers,
described by
a pattern of reduced persistent
attention, and increased impulsivity or hyperactivity (Sadock,
2015). It is a kind of behavioral
issue that has received substantial awareness in both classroom
and research settings as a result of
its likely adverse effect
s on academic products and classroom functioning (Purpura &
Lonigan,
2009). The National Institute of Mental Health (NIMH)
approximates that its incidence rate is
between 3% and 10%, with ADHD influencing around 2 million
children in the United States
(Neu
ropsychiatric ailment and treatment, 2008). ADHD is usually co
-
morbid with other
psychiatric disorders including depressive and anxiety
disorders, substance abuse, conduct
disorder, and antisocial behaviors (Neuropsychiatric ailment
and treatment, 2008). C
hildren with
injury (NIMH). Pharmacotherapy
treatment for ADHD includes Stimulant and Non stimulant
medications. The stimulant

Focali
n (Sadock, 2015). The non
-
stimulant medications includes atomoxetine, Clonidine, and
Guanfacine (Sadock, 2015).
This
paper will examine and address
es treatment options for this 8
-
year old
Caucasian girl
with
Attention Deficit/Hyperactivity Disorder (ADHD)
while analyzing ethical and legal implications
Decision #1
IR
10 mg PO every morning.
Ritalin is a brand name of methylphenidates,
the mainly common prescribed stimulant medication
for attention deficit
hyperactivity
disorder (ADHD). Ritalin is a stimulant categorized to the class

of dopamine, norepinephrine reuptake inhibitor and releaser
(DN
-
RIRe) (Stahl, 2014b). Ritalin is
FDA approved for ADHD in both children and adults (Stahl,
2014b). It works by boosting
dopami
ne and norepinephrine actions in particular brain regions which
includes the dorsolateral
wakefulness, hyperactivity concentration,
attention and executive function (Stahl, 2014b).
Ritalin has an establ
ished long
-
term efficacy as a
Running head: ATTENTION DEFICIT HYPERACTIVITY
DISORDER 1
psychiatric disorders usually
diagnosed in school age children. It is a neuropsychiatric
disorder that affects preschoolers,
described by a pattern of reduced persistent
attention, and increased impulsivity or hyperactivity (Sadock,
2015). It is a kind of behavioral
issue that has received substantial awareness in both classroom
and research settings as a result of
its likely adverse effects on academic products and classroom
functioning (Purpura & Lonigan,
2009). The National Institute of Mental Health (NIMH)
approximates that its incidence rate is
between 3% and 10%, with ADHD influencing around 2 million

children in the United States
(Neuropsychiatric ailment and treatment, 2008). ADHD is
usually co-morbid with other
psychiatric disorders including depressive and anxiety
disorders, substance abuse, conduct
disorder, and antisocial behaviors (Neuropsychiatric ailment
and treatment, 2008). Children with
injury (NIMH). Pharmacotherapy
treatment for ADHD includes Stimulant and Non stimulant
medications. The stimulant
Focalin (Sadock, 2015). The non-
stimulant medications includes atomoxetine, Clonidine, and
Guanfacine (Sadock, 2015). This
paper will examine and addresses treatment options for this 8-
year old Caucasian girl with
Attention Deficit/Hyperactivity Disorder (ADHD) while
analyzing ethical and legal implications
Decision #1
IR 10 mg PO every morning.
Ritalin is a brand name of methylphenidates, the mainly
common prescribed stimulant medication
for attention deficit hyperactivity disorder (ADHD). Ritalin is a
stimulant categorized to the class
of dopamine, norepinephrine reuptake inhibitor and releaser
(DN-RIRe) (Stahl, 2014b). Ritalin is
FDA approved for ADHD in both children and adults (Stahl,
2014b). It works by boosting
dopamine and norepinephrine actions in particular brain regions
which includes the dorsolateral
wakefulness, hyperactivity concentration,

attention and executive function (Stahl, 2014b). Ritalin has an
established long-term efficacy as a
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
Learning Resources
Note: To access this week’s required library resources, please
click on the link to the Course Readings List, found in
the Course Materials section of your Syllabus.
Required Readings
Note: Review all materials from the Discussion.
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.

Note: Retrieved from Walden Library databases.
Required Media
girl with ADHD [Interactive media file]. Baltimore, MD:
Author
Note: This case study will serve as the foundation for this
week’s Assignment.
To prepare for this Assignment:
This case study will serve as the foundation for this week’s
Assignment.
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
Learning Resources.

different?
Decision #3
Learning Resources.
different?
Also include how ethical considerations might impact your
treatment plan and communication with clients.
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 the PMHNP 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.
ADHD, but males and females
may also have vastly different clinical presentations. They may
also respond to medication
may cause chil
dren to experience
stomach pain, while others can be highly addictive for adults. In
your role, as a psychiatric
assessments and weigh the risks and
benefits of medication therapies for clients acr
oss the lifespan. For this Assignment, you consider
how you might assess and treat clients presenting with ADHD.
Learning Objectives
Students will:
Analyze factor
s that influence pharmacokinetic and pharmacodynamic
processes in clients
requiring therapy for ADHD

Learning Resources
Note:
To access this week’s required library resources, please click on
the link to the Course
Readings List, found in the
Course Materials
section of your Syllabus.
Required Readings
Note:
Review all materials from the Discussion.
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.
Note:
Retrieved from Wal
den Library databases.
Required Media

Laureate Education (2
016d).
Case study: A young Caucasian girl with ADHD
[Interactive media
file]. Baltimore, MD: Author
Note:
Assignment.
This case study will serve as the foundation
for this week’s Assignment.
ADHD, but males and females
may also have vastly different clinical presentations. They may
also respond to medication
may cause children to experience
stomach pain, while others can be highly addictive for adults. In
your role, as a psychiatric
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:

Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients
requiring therapy for ADHD
Learning Resources
Note: To access this week’s required library resources, please
click on the link to the Course
Readings List, found in the Course Materials section of your
Syllabus.
Required Readings
Note: Review all materials from the Discussion.
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.
Note: Retrieved from Walden Library databases.
Required Media
girl with ADHD [Interactive media
file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this
week’s Assignment.
Assignment.

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