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 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with  Decision #1 and the results of the decision. Why were they different? · Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? · Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with  o 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. Note: Support your rationale with a minimum of three academic resources no more than five years old in APA Format 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 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 in.

1. 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
o Which decision did you select?
o Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
o Explain any difference between what you expected to achieve
with

2. Decision #1 and the results of the decision. Why were they
different?
·
Decision #2
o Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
o Explain any difference between what you expected to achieve
with Decision #2 and the results of the decision. Why were they
different?
·
Decision #3
o Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
o Explain any difference between what you expected to achieve

3. with
o 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.
Note: Support your rationale with a minimum of three academic
resources no more than five years old in APA Format
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 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,

4. 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

5. 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
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

6. Decision Point #Two:
Select what the PMHNP should do next:
Educate the parents that Bupropion sometimes causes suicidal
ideation in children and that this is normal, and restart 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:
Select what the PMHNP should do next:
Refer the parents to a pediatric psychologist who can use
behavioral therapy to treat Katie’s ADHD

7. 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.
The PMHNP should attempt to repair the rupture in the
therapeutic alliance (the parents now believe that medications

8. 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 the PMHNP to initiate Adderall as it has a very good
track record in terms of its efficacy in treating ADHD.