Week 9: Therapy for Clients with ADHD

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Week 9: Therapy for Clients with ADHD

Week 9: Therapy for Clients with ADHD

Tyler, a 9-year-old third grader, had always
been an energetic child with a short attention span. For years, his
mother attributed his behaviors to him being “all boy” and assumed it
would improve as he grew older. Instead, daily tasks like chores and
homework became increasingly overwhelming for Tyler, resulting in
disruptive behaviors at home and school. After being evaluated by his
healthcare provider, Tyler was diagnosed with and treated for attention
deficit hyperactivity disorder (ADHD).

ADHD
is a prevalent disorder for clients across the lifespan, as more than 6
million children (CDC, 2016) and 8 million adults (ADAA, 2016) have been
diagnosed with the disorder. Like Tyler, individuals of all ages find
that symptoms of ADHD can make life challenging. However, when properly
diagnosed and treated, clients often respond well to therapies and have
positive health outcomes.

This week, as you
study ADHD therapies, you examine the assessment and treatment of
clients with ADHD. You also explore ethical and legal implications of
these therapies.


Discussion: Presentations of ADHD

Although ADHD is often associated with children,
this disorder is diagnosed in clients across the lifespan. While many
individuals are properly diagnosed and treated during childhood, some
individuals who have ADHD only present with subsyndromal evidence of the
disorder. These individuals are often undiagnosed until they reach
adulthood and struggle to cope with competing demands of running a
household, caring for children, and maintaining employment. For this
Discussion, you consider how you might assess and treat individuals
presenting with ADHD.

Learning Objectives

Students will:
  • Assess client factors and history to develop personalized therapy plans for clients with ADHD
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
  • Evaluate efficacy of treatment plans
  • Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

  • Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

  • Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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.

Review the following medications:

For ADHD

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

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Optional Resources

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. doi:10.2165/11599630-000000000-00000

Psychiatric Times. (2016). A 5-question quiz on ADHD. Retrieved from http://www.psychiatrictimes.com/adhd/5-question-quiz-adhd?GUID=AA46068B-C6FF-4020-8933-087041A0B140&rememberme=1&ts=22072016

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty

Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter

Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder

  • Review this week’s Learning Resources and reflect on the insights they provide.
  • Go to the Stahl Online website and examine the case study you were assigned.
  • Take the pretest for the case study.
  • Review the patient intake documentation, psychiatric history,
    patient file, medication history, etc. As you progress through each
    section, formulate a list of questions that you might ask the patient if
    he or she were in your office.
  • Based on the patient’s case history, consider other people in his
    or her life that you would need to speak to or get feedback from (i.e.,
    family members, teachers, nursing home aides, etc.).
  • Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
  • Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
  • Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
  • Review the posttest for the case study.

Note: For this Discussion, you are required to complete
your initial post before you will be able to view and respond to your
colleagues’ postings. Begin by clicking on the “Post to Discussion
Question” link and then select “Create Thread” to complete your initial
post. Remember, once you click on Submit, you cannot delete or edit your
own posts, and you cannot post anonymously. Please check your post
carefully before clicking on Submit!

By Day 3

Post a response to the following:

  • Provide the case number in the subject line of the Discussion.
  • List three questions you might ask the patient if he or she were in
    your office. Provide a rationale for why you might ask these questions.
  • Identify people in the patient’s life you would need to speak to or
    get feedback from to further assess the patient’s situation. Include
    specific questions you might ask these people and why.
  • Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
  • List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
  • List two pharmacologic agents and their dosing that would be
    appropriate for the patient’s ADHD therapy based on pharmacokinetics and
    pharmacodynamics. From a mechanism of action perspective, provide a
    rationale for why you might choose one agent over the other.
  • If your assigned case includes “check points” (i.e., follow-up data
    at week 4, 8, 12, etc.), indicate any therapeutic changes that you
    might make based on the data provided.
  • Explain “lessons learned” from this case study, including how you
    might apply this case to your own practice when providing care to
    patients with similar clinical presentations.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two
of your colleagues who were assigned to a different case than you. For
example, if you were assigned to Case Study 1, respond to one colleague
assigned to Case Study 2 and one colleague assigned to Case Study 3.
Explain how you might apply knowledge gained from your colleagues’ case
studies to you own practice in clinical settings.

Submission and Grading Information

Grading Criteria


To access your rubric:Week 9 Discussion Rubric

Post by Day 3 and Respond by Day 6


To participate in this Discussion:Week 9 Discussion


Assignment: Assessing and Treating Clients With ADHD

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

Learning Objectives

Students will:
  • Assess client factors and history to develop personalized therapy plans for clients with ADHD
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
  • Evaluate efficacy of treatment plans
  • Evaluate ethical and legal implications related to prescribing therapy for clients with ADHD

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: Review all materials from the Discussion.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: AuthorNote: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

  • This case study will serve as the foundation for this week’s Assignment.

The Assignment

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

At each decision point stop to complete the following:

  • Decision #1
    • 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
    • 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
    • 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 #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.

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.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria


To access your rubric:Week 9 Assignment Rubric

Check Your Assignment Draft for Authenticity


To check your Assignment draft for authenticity:Submit your Week 9 Assignment draft and review the originality report.

Submit Your Assignment by Day 7


To submit your Assignment:Week 9 Assignment


Making Connections

Now that you have:

  • Assessed clients presenting with ADHD
  • Developed personalized plans of therapy for clients with ADHD
  • Examined factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
  • Explored ethical and legal implications of prescribing therapy to clients with ADHD

Next week, you will build on your
assessment and treatment skills as you examine clients presenting for
therapy for impulsivity, compulsivity, and addiction.
To go to the next week:Week 10

 

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Week 9: Therapy for Clients with ADHD was first posted on February 3, 2020 at 2:36 pm.
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