Attention Deficit Hyperactivity Disorder Essay

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.Attention Deficit Hyperactivity Disorder Essay

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Attention Deficit Hyperactivity Disorder
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 you 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.Attention Deficit Hyperactivity Disorder Essay
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.Attention Deficit Hyperactivity Disorder Essay
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decision Point One
Begin Wellbutrin (bupropion) XL 150 mg orally daily
Begin Intuniv extended release 1 mg orally at BEDTIME
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
Results OF DECISION POINT ONE
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

• 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 performance. However, by the afternoon, Katie is “staring off 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 find that Katie’s heart is beating about 130 beats per minute
Decision Point Two
Continue same dose of Ritalin and re-evaluate in 4 weeks
Change to Ritalin LA 20 mg orally daily in the MORNING
Discontinue Ritalin and begin Adderall XR 15 mg orally daily
Decision Point Two

Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO
o Client returns to clinic in four weeks
o Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
o Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Decision Point Three

Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student
At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects 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 effective 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.Attention Deficit Hyperactivity Disorder Essay

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In the first e ssay, w e u se s tochastic d ominance t echniques t o u nderstand how
the reporting of behavioral problems as well as ADHD prevalence has changed between
2000 and 2004. This time period coincides with changes in national educational policy
which we hypothesize may have influenced t he r eporting o f behavioral p roblems i n children and a change in ADHD prevalence. We use stochastic dominance techniques and
find t hat t he d istribution o f behavioral p roblems i n 2 004 fi rst-order st ochastically dominates that of 2000. We then use decomposition techniques to study the primary drivers
of changes in mother reported behavioral problems. We find e vidence t hat c hanges in
the educational policy between 2000 to 2004 led mothers of elementary school children
to alter their reporting of child hyperactivity.
In the second essay, we explore whether the introduction of school accountability policies can account for changes in ADHD diagnosis. We exploit differences across
states and time in the introduction of school accountability laws to estimates differences in mean ADHD diagnosis. The results from our analysis suggest that one policy,Attention Deficit Hyperactivity Disorder Essay
state-level rewards given to high-performing schools, leads to approximates a 3 percentage point increase in the probability of an ADHD diagnosis among children. We find
that the children most impacted by the policy are those whose mothers’ reported zero
behavioral problems in the pre-policy period, perhaps indicating that prior to the policy these mothers did not believe that their child had behavioral problems.
In the third and final e ssay, I s tudy t he i mpact o f c hild A DHD o n p arental labor market and relationship dissolution outcomes. As unobserved characteristics may
simultaneously impact the likelihood of having a child diagnosed with ADHD and outcomes of the parent, results using OLS estimation are likely biased. I mitigate issues
of endogeneity using an instrumental variables framework where I utilize state-level
educational policy as an instrument for child ADHD diagnosis. To be a valid instruii
ment, the educational policy should be correlated with child ADHD, while exogenous to
parental outcomes. While in several specifications, I find negative effects of child ADHD
on parental outcomes using OLS, interestingly, IV estimates all lead to a switching of
sign and are largely insignificant. Findings indicate that parental labor market and
marital status outcomes are not impacted by child ADHD
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DEDICATION
To my parents, who have always supported me and encouraged me to continue
in my education. Thank you for always being there, stressing to me the importance
of education, and pushing me to pursue a Ph.D. To my wife Tara, thanks for listening
during the times of stress, helping me through all of these years of graduate school, and
being a pillar of support in all aspects of my life.
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ACKNOWLEDGMENTS
A tremendous amount of this dissertation is due to the guidance and support
of Dr. Susan Chen. She is a great adviser who taught me how to think about an economic problem, enhanced my ability to work with data, and guided me through the
intense process that is the academic job market, all the while encouraging me to be an
excellent teacher to my students. I have enjoyed working with you as a graduate student, and I hope to maintain this relationship as I transition and become an assistance
professor.Attention Deficit Hyperactivity Disorder Essay
I am also thankful for the help of other members of my committee, Dr. Daniel
Henderson, Dr. Amanda Ross, Dr. Peter Brummund, and Dr. Matthew Jarrett, and
the many other University of Alabama faculty members that gave me guidance over the
past several years. I am grateful to all those that gave me comments on my research
and job market materials. Additionally, I would like to thank Dr. William Walsh for
giving me endless amounts of support with teaching, Attention Deficit Hyperactivity Disorder Essay