Assessing Treatment Outcomes in ADHD

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

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

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.Assessing Treatment Outcomes in ADHD

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.

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Decision #2

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 #3

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.

Conclusion

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.Assessing Treatment Outcomes in ADHD

https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_09/index.html

The case study is about Katie an 8-year-old girl who presented to the office with her parents after the referral by the primary care provider. The teacher has suggested that Katie may have ADHD. The “Conner’s Teacher Rating Scale-Revised” scale filled by the teacher indicated that Katie was inattentive, forgetful, easily distracted, and poor in arithmetic, reading, and spelling. The scale also indicated that Katie’s attention span was short and she was only attentive to things she found interesting. She left her tasks unfinished, did not follow instructions, and did not complete her school work. The subjective data indicates that she finds school work boring and she wanders during class. The MSE indicates that she has achieved all the developmental milestones for her age and her speech is logical, coherent, and clear. She is dressed suitably and well-oriented. She is well mannered throughout the interview and her self-reported mood is euthymic. However, her affect is bright. She denies any hallucinations. No paranoid or delusional thought processes. Her judgment and insight are appropriate for her age. Additionally, based on the clinical interview and Katie’s ability to count backward from 100, her concentration and attention are grossly intact. Katie denies having any homicidal or suicidal thoughts. Based on the MSE, subjective data, and the results from the “Conner’s Teacher Rating Scale-Revised” scale, Katie’s diagnosis was confirmed as attention deficit hyperactivity disorder, predominantly inattentive presentation. This paper will thus discuss the appropriate treatment decisions for Katie and outline the ethical principles used during her treatment.

Decision point One

The available medications for decision point one, are Wellbutrin XL 150 mg; Intuniv extended-release 1 mg at bedtime; and Ritalin chewable tablet 10 mg in the morning. Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI) that is used to treat depression (Fasipe, 2019). Intuniv is a non-stimulant and FDA-approved medication to treat ADHD in the pediatric population (Brown et al., 2019). Ritalin is a stimulant and FDA first-line treatment for ADHD (Karahmadi et al., 2020). Ritalin 10 mg was prescribed for Katie because it is a first-line treatment for ADHD. The mechanism of action of Ritalin is by elevating the level of norepinephrine and dopamine in the brain to improve ADHD symptoms (Briars & Todd, 2016). The medication is also well-tolerated among children. Wellbutrin was no selected because it is not FDA approved to treat ADHD. Intuniv was not chosen since it is not a first-line treatment choice for ADHD.

The treatment goal for prescribing Ritalin is to achieve good response and thus symptom improvement as exhibited by improved concentration and attention. This is due to Ritalin’s effectiveness in the treatment of symptoms of ADHD (Karahmadi et al., 2020). The medication has a good safety profile and minimal side effects and hence it is anticipated that Katie will not have unwanted side effects (Storebø et al., 2018).Assessing Treatment Outcomes in ADHD

The treatment outcome was that the symptoms of ADHD significantly improved as she was able to concentrate and be attentive in the class. Additionally, her school performance improved. This is due to Ritalin’s effectiveness in the treatment of ADHD (Storebø et al., 2018). However, the symptoms of ADHD would resurface in the afternoon and Katie would be inattentive and less concentrated. This is because Ritalin is an immediate-release short-acting medication and therefore the medication’s effects would not last the whole day. Katie also reported a high heart rate, which is a side effect of the medication (Briars & Todd, 2016).

Before prescribing Ritalin for Katie, parents were educated about the medication, including the side effects such as euphoria feeling and possible addiction. This was done to ensure parents made an informed decision when consenting to the medication (Nandra et al., 2020).

Decision Point Two

The available treatment decisions include Katie continuing with the same Ritalin dose, changing to Ritalin LA 20 mg, or discontinuing Ritalin to start Adderall XR mg. Adderall is a stimulant containing both amphetamine and dextroamphetamine and it works by elevating norepinephrine and dopamine in the brain to reduce ADHD symptoms (Castells et al., 2018). The most appropriate decision was changing to Ritalin LA 20 mg. This is because Ritalin LA is a long-lasting agent and hence the medication’s efficacy would last for the whole day (Faraone, 2018). This will enable the client to be attentive and concentrate throughout the day. The decision to maintain the same dose of Ritalin was not chosen because there is a need to prescribe a medication that would enable Kate to be attentive throughout the day. Changing to Adderall was not considered because it is recommended to evaluate the efficacy of the first medication before changing.

The treatment goal for this decision is to ensure Katie remained attentive and concentrated the whole day. This is because Ritalin LA is a long-acting pharmacological agent and hence the effects of Ritalin would last longer (Faraone, 2018). It is also hoped that she would not experience unwanted side effects.

The treatment outcome for this decision is that Katie maintained concentration and attention the whole day. This is due to the increased efficacy of long-acting Ritalin, which led to better response (Faraone, 2018). Katie also tolerated the prescribed medication as the pulse rate had stabilized and she did not report any other side effects.

When choosing Ritalin LA, beneficence and non-maleficence were applied. This involved analyzing the risks and benefits associated with all available medications and selecting the medication with minimal risks and most benefits (best treatment outcome) (Kerry et al., 2018). The parents were also educated about Ritalin LA, meaning informed consent was obtained before changing to Ritalin LA (Nandra et al., 2020).Assessing Treatment Outcomes in ADHD

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Decision Point Three

The available treatment choices include maintaining the Ritalin LA, increasing Ritalin LA to 30 mg, or obtaining Katie’s EKG based on the current heart rate. For this decision point, the appropriate decision was to maintain the dose of Ritalin LA and have Katie reevaluated after 4 weeks. The rationale for selecting this decision is because Katie is manifesting a satisfactory response to the dose as she is maintaining attention and concentrating the whole day. The long-lasting Ritalin led to higher effectiveness and thus increased symptom improvement. Moreover, with Ritalin LA, Katie did not experience any unwanted side effects, showing she was tolerating the dose and the medication. Therefore, maintaining Ritalin LA 20 mg expects that Katie will continue to show a good response without experiencing any side effects. The decision to increase Ritalin LA to 30 mg was not chosen because Katie is already showing satisfactory response to Ritalin LA 20 mg and tolerating the dose. Increasing the dose could lead to unwanted side effects. The decision to obtain Katie’s EKG was not chosen because her heart rate is already stable and thus there is no clinical reason to perform EKG.

By selecting the decision to maintain Ritalin LA 20 mg, the treatment goal is to ensure that Katie continues to show good response and finally have full symptom remission. This is due to Ritalin’s effectiveness in treating ADHD symptoms (Faraone, 2018). It is also hoped Katie would continue tolerating Ritalin LA 20 mg.

The decision to maintain Ritalin LA 20 mg, applied beneficence, and non-maleficence ethical principles. This is because maintaining Ritalin LA 20 mg was the decision with the best treatment outcomes for Katie and with minimal risks because she is not having any side effects with Ritalin LA 20 mg (Kerry et al., 2018).

Conclusion

Katie’s diagnosis was ADHD, predominantly inattentive presentation as per the subjective data, MSE, and the results from the Conner’s Teacher Rating Scale-Revised scale. At first, Ritalin 10 mg is the medication prescribed for Katie; Ritalin is a first-line treatment option for ADHD. With Ritalin 10 mg, Katie would concentrate and become attentive in the morning hours, but in the afternoon, she would be inattentive and the concentration would reduce. For the second decision, it was decided to have the Ritalin 10 mg changed to Ritalin LA 20 mg. This decision was selected to ensure that Katie was able to maintain attention and concentration throughout the day due to the long-lasting effects of Ritalin LA 20 mg. After taking Ritalin LA 20 mg, Katie was able to concentrate and be attentive throughout the day and also tolerated the dose well. Therefore, the third decision was to maintain Ritalin LA 20 mg, as Katie is showing satisfactory response without any side effects. Before prescribing the medications, informed consent was obtained from Katie’s parents. Moreover, both non-maleficence and beneficence were applied when choosing each medication for Katie. The ethics ensured that Katie’s parents had adequate information about the medications before consenting to treatment and the medications likely to bring the best outcomes for Katie were prescribed. Assessing Treatment Outcomes in ADHD

References

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02

Briars L & Todd T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. J Pediatr Pharmacol Ther, 21(3), 192–206

Castells, X., Blanco-Silvente, L., & Cunill, R. (2018). Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 8(8), CD007813. https://doi.org/10.1002/14651858.CD007813.pub3

Faraone, S. V. (2018). The pharmacology of amphetamine and methylphenidate: relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neuroscience & Biobehavioral Reviews, 87, 255-270.

Fasipe O. J. (2019). The emergence of new antidepressants for clinical use: Agomelatine paradox versus other novel agents. IBRO reports 6, 95–110. https://doi.org/10.1016/j.ibror.2019.01.001

Karahmadi, M., Saadatmand, S., & Tarahi, M. J. (2020). Investigation of Efficacy of Short-Acting Methylphenidate (Ritalin) and Long-Acting (Matoride) on Symptoms of Attention Deficit Hyperactivity Disorder in Children Aged 6-18 Years: A Single-Blind, Randomized Clinical Trial. Advanced biomedical research, 9, 18. https://doi.org/10.4103/abr.abr_9_20

Kerry, R. G., Patra, J. K., Gouda, S., Park, Y., Shin, H. S., & Das, G. (2018). Benefaction of probiotics for human health: A review. Journal of food and drug analysis, 26(3), 927-939.

Assessing Treatment Outcomes in ADHD