Attention-deficit or hyperactivity disorder (ADHD) is acknowledged as one of the neurobehavioral sicknesses in children (Brown, Samuel, & Patel, 2018). It manifests early in life with signs of distraction, and hyperactivity-impulsivity components (Arcangelo, Peterson, Wilbur, & Reinhold, 2017; Sulkes, 2017). CDC reports that about 11% of the kids in the United States aged 2-17 years about 6.4 million are diagnosed with ADHD. (Centers for Disease Control and Prevention [CDC], 2018). There are three kinds of ADHD reported by Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5.
They are inattentive, hyperactive/impulsive, or a combination (American Psychiatric Association [APA], 2013; Brown, et al., 2018). A bulk of the study include two groups of treatment for children with ADHD. They are, behavioral interventions and pharmacological treatments. The essay is based on a case study of a youngster diagnosed with ADHD. It is used in evaluating and addressing pharmacological treatments
This is an 8-year Caucasian girl that the parents brought to the clinic to be assessed by psychiatric mental health nurse practitioner (PMHNP).
She was sent because her teacher is of the opinion, she was showing signs of ADHD. Her decision was made based on her administration of the Conner’s’ Teacher Rating Scale-Revised. Which she forwarded a copy of the test results to the client’s parents and PCP. The results of Conner’s’ Teacher Rating Scale-Revised, identified she was vague and easily distracted. Her performance in mathematics, has gone down so has her reading, and spelling. She has the habit of not completing any tasks started especially her school works.
She reports her mind wondering at times to thing she found enjoyable during class. She expresses joy in arts and recreational activities but finds other classes distasteful and feels lost most of the time. Also, when the teacher addresses her by name, she would not remember what the topic was about, as she was daydreaming. She gave a positive report of her relationship with her parents at home and how great they are. they are. She denies being abused or bullied at school.
There three options for this decision. They are to start the patient on Wellbutrin (bupropion), Intuniv (guanfacine), or Ritalin (methylphenidate). The choice is starting her on 10 mg of Ritalin (methylphenidate) PO every morning. Stimulants are usually the first-line of treatment in children with ADHD. It appears to be more effective in children than amphetamine-groups of stimulants (Arcangelo, et al., 2017; Brown, et al., 2018; Stahl, 2014; Sulkes, 2017). Thus, Ritalin (methylphenidate), a stimulant was the drug of choice for the girl. This is because it is known to boost stimulation in the prefrontal cortex by working precisely to elevate norepinephrine and dopamine neurotransmission in the prefrontal cortex (Brown, et al., 2018). Centers for Disease Control and Prevention (CDC) reports that children between 70-80% with ADHD shows less symptoms on fast-acting stimulants (CDC, 2017).
Intuniv (guanfacine) and Wellbutrin (bupropion) will not be good choices as they are non-simulants. This is because they are only used in treating ADHD as second-line and third-line therapy, individually (Arcangelo, 2017; Brown, et al., 2018). It has been proven that the mixture of alpha-agonists to stimulant medications as a monotherapy, stimulant drug is more effective in the treatment of children with ADHD (Arcangelo, et al. 2017). Wellbutrin (bupropion) and Intuniv (guanfacine) are less effective and not approved as first-line drug therapy. They can only be used after stimulant drugs are ineffective or unacceptable due to adverse effects. The patient’s treatment goal is the reduction of her inattentiveness which upsets school work.
At this point choices will embrace the continuance of the same amount of Ritalin, switch to Ritalin LA, or stop Ritalin and begin on Adderall. For the reason that the prior dose lasts for a part of the day, the choice was to change the medication to 20 mg of Ritalin LA every morning. The belief being that Ritalin LA, a longer-acting stimulant would be beneficial all day. Ritalin LA extended-release capsules a longer-acting stimulant copies the effect of two doses with a 50% instant release and a 50% delay release of methylphenidate about 4 hours apart (Pelham, et al., 2014).
It is not usual that with stimulants, side effects can occur. Some of these adverse effects are palpitation increased blood pressure. The patient should be monitored for cardiac disease or risk before the initiation of stimulants. (Brown, et al., 2018). The change from Ritalin to Ritalin LA is anticipated to help with the patient’s heart rate. No significant finding in the change for severe cardiac side effects was found by Food and Drug Administration (FDA) in studying 2.5 million children and young adults for 2.1 years (CDC, 2017 (Brown, et al., 2018). The aim of the treatment
The plan at this point is keeping the patient Ritalin LA dosage, increase Ritalin LA to 30 mg, or get EKG. The decision made was maintaining the patient on her present dosage of Ritalin LA and to review in four weeks. From the outcomes of decision point two, it was reported that the patient’s school work has become better when she changed to Ritalin LA as the effect carries her through the day. Additionally, there is no more report of palpitations and her pulse has remained steady at 92 BPM. This means that the current long-acting preparation of the Ritalin LA dose is effective, and her side effects are known existent. As expected at this point, her symptoms are controlled, with suitable heart rate and there was no reason for EKG currently