Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people 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 nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

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Attention De�cit Hyperactivity Disorder
A Young Girl With ADHD

BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your o�ce 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 �lled 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

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lacks interest in school work and is easily distracted. Katie is also noted to start things but

never �nish them, and seldom follows through on instructions and fails to �nish 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 de�ant 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 �nds 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 �ne. She reports that she loves her parents and

that they are very good and kind to her. Denies any abuse, denies bullying at school.

O�ers 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 dre

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Attention De�cit Hyperactivity Disorder
A Young Girl With ADHD

Decision Point One

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in

the MORNING

RESULTS OF DECISION POINT ONE
� Client returns to clinic in four weeks

� Katie’s parents report that they spoke with Katie’s teacher who
notices that her symptoms are much better in the morning,
which has resulted in improvement in her overall academic

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performance. However, by the afternoon, Katie is “staring o�
into space” and “daydreaming” again

� Katie’s parents are very concerned, however, because Katie
reported that her “heart felt funny.” You obtain a pulse rate
and �nd that Katie’s heart is beating about 130 beats per
minute

Decision Point Two

Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO
� Client returns to clinic in four weeks

� Katie’s academic performance is still improved, and the
switch to the LA preparation is lasting Katie throughout the
school day

� Katie’s reports of her heart feeling “funny” have gone away.
Pulse was 92 during today’s o�ce visit

Decision Point Three

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

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Guidance to Student

At this point, Katie’s symptoms are well controlled (her attention is

sustained throughout the school day) and her side e�ects have

gone away following change to a long-acting preparation. There is

no indication at this point that the dose should be increased as it is

always advisable to use the lowest e�ective dose of stimulant

medication. Katie’s heart rate is appropriate for an 8 year old girl

and an EKG would not be indicated based on her heart rate.

Start Over (index.html)

Assignment: Assessing and Treating Patients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people 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 nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.

Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.

The Assignment: 5 pages

Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

Which decision did you select?

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and pati