Prescribing for Children and Adolescents with ADHD Assignment

Attention-Deficit Hyperactivity disorder (ADHD) is a mental disorder that mainly occurs during childhood and involves inattention, impulsivity, and hyperactivity. Children with this condition experience difficulty learning and focusing in class, resulting in poor performance at school. 60- 100 % of the children with ADHD present with various comorbid disorders that are also present during adulthood (Gnanavel et al., 2019). There are various treatment options for individuals with ADHD; therefore, it is the role of the advanced nurse practitioner to identify the best therapy for the patients. This paper seeks to elaborate on the benefits and risks of treatment options, including FDA-approved drugs and off-label drugs, in addition to non-pharmacological interventions and the clinical practices for ADHD. Prescribing for Children and Adolescents with ADHD Assignment

FDA Approved Drug

Combining both pharmacological and non-pharmacological interventions is most effective for ADHD. According to Cortese (2020), FDA has approved various stimulants and non-stimulants as the best treatment option. The first line of treatment for ADHD is stimulants, and there are various types of stimulants, including amphetamines and methylphenidate. I will recommend Ritalin, also known as methylphenidate, which increases the levels of norepinephrine and dopamine in the extracellular synaptic (Cortese, 2020). The most common side effects of the drug include; insomnia, tremor, hyperactivity, restlessness, hypertension, anorexia, tachycardia, palpitations, and seizure.

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Stimulants have various benefits and risks, so it is necessary to identify them before prescribing the medications. The major risks of stimulants are potential abuse, especially among adolescents, and sudden death among children and adolescents with cardiac abnormalities or heart problems (Cortese, 2020). The stimulants have various benefits, including; helping the child focus, improving self-esteem, decreasing disruptive behaviors, improving relationships with friends and families, and decreasing levels of dependence.

Off Label Drug

Some f the off-label drugs are used in treating ADHD, and I would recommend Wellbutrin, which is in the class of atypical antidepressants. It works by decreasing the neuronal reuptake of dopamine and norepinephrine in the central nervous system. It is commonly used to treat depression, smoking cessation, nicotine addiction, and other conditions such as seasonal affective disorder (Skånland & Cieślar-Pobuda, 2019). It is also considered an effective medication for treating ADHD. The common side effects of the medication include; hypertension, weight loss, headache, dizziness, and sweating. The major risk that comes with the use of the medication is an increased risk of suicidal thinking and behavior. Prescribing for Children and Adolescents with ADHD Assignment

Non-pharmacological Intervention

There are various non-pharmacological interventions used in the treatment of ADHD. They include; behavioral therapy, exercise, diet, and psychoeducation. They play a role in reducing hyperactivity, improving attention, and controlling impulsive behavior. The essential non-pharmacological intervention is the therapy of parent training in behavior management (Shrestha et al., 2020). It plays a role in enhancing their understanding of the disorder’s behavioral symptoms and adapting reinforcement methods that will play a role in modifying the behavior and emotions of children with ADHD.

Clinical Practice Guidelines

Various guidelines are applicable during the treatment of ADHD. They include; comprehensive assessment, diagnosis, and evaluation. It is vital to assess all children before 18 years for ADHD. Various treatment options vary depending on the patient’s age and mainly include pharmacological treatments and evidence-based behavioral and educational interventions (Barbaresi et al., 2020). The health care provider should prescribe a dose with fewer side effects and the most benefits. Diagnosis of ADHD is mainly made based on the DSM V guidelines.

Conclusion

To sum up, attention deficit disorder is a neurodevelopmental disorder that is common in childhood. Children with this condition experience difficulty in controlling impulsive behaviors and paying attention. The most common treatment options for ADHD include; FDA-approved drugs, off-label medications, and non-pharmacological interventions. Various clinical practice guidelines play a role in assessing, diagnosing, and treating ADHD. Prescribing for Children and Adolescents with ADHD Assignment

References

Barbaresi, W. J., Campbell, L., Diekroger, E. A., Froehlich, T. E., Liu, Y. H., O’Malley, E., Pelham, W. E. J., Power, T. J., Zinner, S. H., & Chan, E. (2020). Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. Journal of Developmental & Behavioral Pediatrics, 41, S35. https://doi.org/10.1097/DBP.0000000000000770

Cortese, S. (2020). Pharmacologic Treatment of Attention Deficit–Hyperactivity Disorder. New England Journal of Medicine, 383(11), 1050–1056. https://doi.org/10.1056/nejmra1917069

Gnanavel, S., Sharma, P., Kaushal, P., & Hussain, S. (2019). Attention deficit hyperactivity disorder and comorbidity: A review of literature. World Journal of Clinical Cases, 7(17), 2420–2426. https://doi.org/10.12998/wjcc.v7.i17.2420

Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Translational Pediatrics, 9(S1), S114–S124. https://doi.org/10.21037/tp.2019.10.01

Skånland, S. S., & Cieślar-Pobuda, A. (2019). Off-label uses of drugs for depression. European Journal of Pharmacology, 865, 172732. https://doi.org/10.1016/j.ejphar.2019.172732

Name: NRNP_6665_Week3_Assignment1_Rubric
● Grid View
● List View Prescribing for Children and Adolescents with ADHD Assignment

Excellent Good Fair Poor
In 1–2 pages, address the following:

• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents. 23 (23%) – 25 (25%)
The response accurately and concisely explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 20 (20%) – 22 (22%)
The response accurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 18 (18%) – 19 (19%)
The response somewhat vaguely or inaccurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 0 (0%) – 17 (17%)
The response vaguely or inaccurately explains interventions that would be appropriate for treating the assigned disorder in children and adolescents. Interventions may not represent the three types of interventions required, or response may be missing.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug? 23 (23%) – 25 (25%)
The response accurately and concisely explains the risk assessment you would use to inform your treatment decision making. A concise and accurate explanation of the risks and benefits of each pharmacological intervention is provided. 20 (20%) – 22 (22%)
The response accurately explains the risk assessment you would use to inform your treatment decision making. An adequate explanation of the risks and benefits of each pharmacological intervention is provided. 18 (18%) – 19 (19%)
The response somewhat vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The explanation of the risks and benefits of each pharmacological intervention is somewhat vague or inaccurate. 0 (0%) – 17 (17%) Prescribing for Children and Adolescents with ADHD Assignment
The response vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The risks and benefits of each pharmacological intervention is vague or inaccurate. Or, the response is missing.
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration. 23 (23%) – 25 (25%)
The response accurately and concisely uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 20 (20%) – 22 (22%)
The response accurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 18 (18%) – 19 (19%)
The response somewhat vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 0 (0%) – 17 (17%)
The response vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. Or, the response is missing.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Be sure they are current (no more than 5 years old). Attach the PDFs of your sources. 9 (9%) – 10 (10%)
The response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. The resources reflect the latest clinical guidelines and provide strong justification for decision making. 8 (8%) – 8 (8%)
The response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. 7 (7%) – 7 (7%)
Three evidence-based resources are provided to support the intervention recommendations, but they may only provide vague or weak justification. 0 (0%) – 6 (6%)
Two or fewer resources are provided to support the intervention recommendations. The resources may not be current or evidence based.
Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Prescribing for Children and Adolescents with ADHD Assignment

Purpose, introduction, and conclusion of the assignment are vague or off topic. 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English Writing Standards:

Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors 4 (4%) – 4 (4%)
Contains one or two grammar, spelling, and punctuation errors 3.5 (3.5%) – 3.5 (3.5%)
Contains several (three or four) grammar, spelling, and punctuation errors 0 (0%) – 3 (3%)
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors 4 (4%) – 4 (4%)
Contains one or two APA format errors 3.5 (3.5%) – 3.5 (3.5%)
Contains several (three or four) APA format errors 0 (0%) – 3 (3%)
Contains many (five or more) APA format errors

Total Points: 100
Name: NRNP_6665_Week3_Assignment1_Rubric

Assignment 1: Prescribing for Children and Adolescents
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug? Prescribing for Children and Adolescents with ADHD Assignment
For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
Reference:
Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html

To Prepare
Your Instructor will assign a specific disorder for you to research for this Assignment. **(Assigned- Attention Deficit Hyperactivity Disorder (ADHD)**
Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
The Assignment (1–2 pages)
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources. Prescribing for Children and Adolescents with ADHD Assignment

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Learning Resources
Required Readings (click to expand/reduce)
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
Chapter 14, “Psychosocial Interventions”
Chapter 15, “Psychotherapeutic Interventions”
Chapter 16, “Psychopharmacological Interventions”
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
Chapter 43, “Pharmacological, Medically-Led and Related Treatments”
Walden University. (n.d.). Developing SMART goals. https://academicguides.waldenu.edu/ld.php?content_id=51901492

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
Chapter 5, “Psychopharmacology”
Required Media (click to expand/reduce)
CriticalThinkRx. (2019, June 9). Module 5: Specific drug classes: Focus on adverse effects [Video]. YouTube. https://youtu.be/Gbq6RnOsGKQ
CriticalThinkRx. (2019, June 9). Module 2: Use of psychotropics with youth_prevalence and concerns [Video]. YouTube. https://youtu.be/NRef-g4Ding Prescribing for Children and Adolescents with ADHD Assignment