6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Case study 1 investigates a scenario surrounding Katie, an 8 year old girl experiencing difficulties in school. She is brought in to the clinic by her parents who indicated that she was forgetful, inattentive, and was making careless mistakes in her school work. An investigation is conducted to understand Katie’s clinical manifestations to obtain an accurate diagnosis and initiate treatment. Overall, the paper review’s Katie’s clinical manifestations to develop three decisions associated with differential diagnosis and a comprehensive treatment plan that encompasses pharmacotherapy and psychotherapy. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

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Decision #1: Differential Diagnosis

Katie’s parents note that they had gotten information from the school that the child has Attention Deficit Hypertensive Disorder (ADHD). The PMHNP thus assessed the patient to confirm or refute the diagnosis. After assessment, it was noted that Katie is inattentive in school, distracted, has poor spelling and reading, and quickly forgets things she has learned in class. While her attention span is short, she only pays attention to things she is interested in. she prefers to play by herself at recess and experiences difficulty interacting with her peers. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Based on these clinical manifestations, the most likely diagnosis for Katie is ADHD. ADHD is a chronic health condition where children experience difficulty controlling their behavior and paying attention. It includes a combination of persistent problems such as difficulty interacting with peers in school, peer performance, and troubled relationships with peers. Katie is displaying all these symptoms. Common signs of ADHD among children are distraction, acting out and inability to control oneself, not paying attention, trouble organizing activities and tasks, forgetting about daily chores and activities learned in class, and trouble making friends. Fidgeting and squirming, coupled with excess talking and interrupting others is also another common of ADHD. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

It is incredibly crucial that children are seen by licensed psychiatric mental health professionals to determine whether displayed behaviors are inappropriate for the child’s age and whether these behaviors are indicative of ADHD. Notably, there is no specific test or diagnosis for attention-deficit hypertensive disorder. Talking to the family physician and school teachers is the best start to eliminate all other conditions. Katie’s parents, caregivers, and the school should be actively engaged in assessing her behaviors and determining how long she has been displaying these behaviors. 6660N PMH Nurse Practitioner Role I:Child And Adolescent. Importantly, it would be essential to find out how her behaviors impact Katie’s daily activities and interactions with her family. Usually, healthcare providers diagnose ADHD following the DSM-5 criteria. Here, children are confirmed positive for ADHD after displaying six or more symptoms linked to inattention, impulsivity, and hyperactivity. Katie meets most of these conditions. One is therefore propelled to confirm a positive diagnosis for ADHD. By making this decision, one was hoping to confirm the diagnosis based on Katie’s manifestations and recommend an effective treatment plan based on psychotherapy and pharmacology. No differences were noted between decision #1 and the results if the decision. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Decision #2: Treatment Plan for Psychotherapy

After a successful diagnosis of ADHD, it is imperative that early treatment be initiated. According to research, medications combined with psychotherapy are the best treatment mechanisms for ADHD. Cognitive behavior therapy should be the type of therapy recommended for Katie. By making this decision, one was hoping to modify her thinking patterns and change negative behavior. Play and talk therapy is highly effective as forms of psychotherapy for children with ADHD. Play therapy offers a platform where children communicate their experiences and feelings through a play while talk therapy utilizes verbal communication between children and therapists to treat mental and emotional disorders. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Behavior therapy for children with ADHD should also include parents training (Sprich et al., 2016). Besides affecting parents and other siblings. Children with ADHD portray behaviors that are considered disruptive to others. Behavior therapy is therefore a treatment alternative that reduce these behaviors for Katie.  For effective treatment, behavior therapy should be initiated immediately after diagnosis. The primary goal of behavior therapy is to strengthen positive behaviors while eliminating unwanted ones. Behavior therapy for ADHD includes behavior interventions in the classroom, behavior therapy with children, and parents training. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Decision #3: Treatment Plan for Psychopharmacology

For most children diagnosed with ADHD, stimulant medications are recommended as safe and effective in relieving ADHD symptoms. These medications assist the children re-focus and better ignore pertinent distractions. They are therefore able to pay more attention and control their behavior. 6660N PMH Nurse Practitioner Role I:Child And Adolescent. While stimulants may be used alone to treat ADHD, it is recommended that they be combined with behavioral therapy. According to research, about 80 percent of children with ADHD who are treated with stimulants significantly improve once the right dosage and medication are determined (Keilow et al., 2018). There are two form of stimulants available; immediate release (short-acting medications) and Extended-release (intermediate-acting and long-acting) medications. The former are taken every four hours and are the cheapest forms of stimulants while the latter are taken once every morning. Non-stimulant drugs can be attempted when stimulant medications do not work or result in severe side effects. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Common stimulant drugs that can be prescribed to Katie include Adderall XR (amphetamine), Concerta (methylphenidate), Evekeo (amphetamine), Focalin XR (methylphenidate), Quillivant XR (methylphenidate), Ritalin (methylphenidate), Strattera (atomoxetine hydrochloride), and Vyvanse (lisdexamfetamine dimesylate). Notably, there is no evidence that specific drug is the best to relieve ADHD symptoms. Inherently, no one drug is more effective than the other. The choice of drug depends on rapid of onset, duration of action, and effectiveness for the specific patient. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

It should be noted that stimulants may cause some side effects for Katie. Common side effects of stimulants for ADHD treatment include sleep problems, reduced appetite, weight loss, and social withdrawal. Less common side effects include rebound, tics, and minor growth delay (Brown et al., 2018).  These side effects can be alleviated by changing the medication dosage, adjusting the medication schedule, and attempting non-stimulant drugs. Notably, Stimulants are classified as Schedule II drugs by the US Drug Enforcement Administration. There is thus a potential for abuse for medications in this class. Children using ADHD drugs should be thus closely monitored. No differences were noted between what the expected decision and its outcome. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Ethical considerations will impact the treatment plan for Katie. Her treatment plan consistent with the four principles of ethics. These include autonomy, beneficence, non-maleficence, and justice. Conclusively, the three decisions have focused on a differential diagnosis, treatment plan using psychotherapy and pharmacotherapy. Incorporating both psychotherapy and psychopharmacology in the treatment of mental health disorders is recommended. In the case of Katie, such a treatment plan will help relieve symptoms of ADHD while encouraging behavior change. Care for Katie should be approached with privacy, confidentiality, and consent, to which her parents are responsible. Ethical considerations work to ensure that all patient interests are maintained during treatment. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Practicum Week 3
This week, you examine a case to determine a differential diagnosis and treatment plan that incorporates both psychotherapy and psychopharmacology.
Learning Resources
Required Readings
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

“Neurodevelopmental Disorders”
“Intellectual Disabilities”
“Communication Disorders”
“Disruptive, Impulse-Control, and Conduct Disorders”
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)
Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Review the following medications:

Irritability in autism Attention-deficit/hyperactivity disorder
aripiprazole
risperidone

armodafinil
amphetamine (d)
amphetamine (d,l)
atomoxetine
bupropion
chlorpromazine (hyperactivity)
clonidine
guanfacine
haloperidol (hyperactivity)
lisdexamfetamine
methylphenidate (d)
methylphenidate (d,l)
modafinil
reboxetine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf

Required Media
Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author.

Assignment: Practicum: Decision Tree (Due in Week 4)
For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:

Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis
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: Treatment Plan for Psychotherapy
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 #2 and the results of the Decision. Why were they different?
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources. 6660N PMH Nurse Practitioner Role I:Child And Adolescent.
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 #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 and their families.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

No assignment due this week.

Submit Assignment By Day 7 of Week 4
Making Connections
This week, you examined a case to determine a differential diagnosis and treatment plan, which incorporates both psychotherapy and psychopharmacology.

What is adhd?
CONT: What is ADHD?
This is a chronic condition that makes it difficult for children to pay attention and/or control their behavior.
ADHD includes a combination of persistent problems like the child not able to pay attention, troubled relationships and poor performance in school 6660N PMH Nurse Practitioner Role I:Child And Adolescent.

What are the signs od ADHD?
The child acts out and cannot control himself
The child pays less attention and fails to pay close attention to details
The child has trouble organizing tasks and activities
The child is easily distracted
The child forgets to do daily activities like chores
Child taps his/ her hands or feet
Child has trouble palying or ding an activity quietly

Cont:
Child blurts out answers interrupting the audience
Child interrupts or intrudes on others conversations
Child talks too much, runs around or climb in situations when its not appropriate

What causes adhd?
The cause of ADHD remains unknown but most research suggest that the cause lies in some parts of the brain where parts of the brain are smaller.
Research also suggest ADHD tends to run in families, so there are likely genetic influences
Environmental and social factors such as lead exposure , may increased the risk
Some studies have shown a relationship between alcohol and tobacco use during pregnancy and the risk for ADHD in the baby, so these activities should be avoided while pregant.
How do I find out if my child has adhd?
It is very important that children are seen and examined by a qualified professional to determine whether the behaviors are inappropriate for the child’s age and whether the behavior indicate ADHD.
Talking to a family physician might be a good start to eliminate other conditions
TREATMENT FOR ADHD
CONT: Treatment for adhd
Research shows that medications combined with behavioral treatment are successful in treating ADHD
Medications known as stimulants reduce hyperactivity and improve ability to focus , work and learn
Although medications works well for many children, it can cause undesirable side effects in others making it unacceptable treatment.
Each child’s reacts to treatment different and each child’s personal history must be carefully considered by a professional.
What else can we do?
Have the same routine every day, and post the schedule in the kitchen
Have a place for everything , and have everything in its place

6660N PMH Nurse Practitioner Role I:Child And Adolescent.