Exploring ADHD Diagnosis in 8-Year-Old Katie: Medication or Behavioral Therapy?

ASSIGNMENT INSTRUCTIONS:

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 the PMHNP 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’s primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, and 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 schoolwork and is easily distracted. Katie is also noted to start things but never finish them, 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 outbursts” adds her father.
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 has dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. The self-reported mood is euthymic. The effect is bright. Katie denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Attention and concentration are grossly intact based on Katie’s attendance at the clinical interview and her ability to count backward from 100 by serial 2s and 5s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
Options provided in the exercise
Decision Point One
Begin Wellbutrin (bupropion) XL 150 mg orally daily
RESULTS OF DECISION POINT ONE
The client returns to the clinic in four weeks
Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks
Decision Point Two
Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose
RESULTS OF DECISION POINT TWO
The client returns to the clinic in four weeks
Katie’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication
At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer
Decision Point Three
Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD

HOW TO WORK ON THIS ASSIGNMENT (EXAMPLE ESSAY / DRAFT)

In the instance of Katie, an 8-year-old girl, Attention Deficit Hyperactivity Disorder (ADHD) symptoms are mostly inattentive. After her instructor suspected that she might have ADHD, her primary care provider referred her parents to a psychiatric examination. According to the teacher’s “Conner’s Teacher Rating Scale-Revised” form, Katie was easily distracted, inattentive, forgetful, and had a short attention span. Additionally, she performed poorly in reading, math, and spelling. Katie reported feeling disoriented and preoccupied with subjects other than her favorite ones, painting, and recess, even though her parents claimed she had ADHD.

Katie had appropriate speech, orientation, mood, affect, attention, and focus, according to the Mental Status Exam. But her parents were alarmed when she started having suicidal thoughts while taking the drug Bupropion, so they stopped taking it. The parents were upset and sure that medicine was not the solution after continuing the medication at the prior dose and experiencing a similar outcome.

Referring Katie to a child psychologist who can address her ADHD symptoms with behavioral therapy is the suggested Decision Point Three. By treating the underlying behavioral and emotional difficulties linked to ADHD, this strategy strives to improve her academic and social functioning. Children with ADHD who may not respond well to medication may benefit from behavioral therapy, which teaches kids how to control their emotions and behavior.

In conclusion, ADHD is a typical disorder in kids that impairs social and intellectual functioning. Although medication can be a helpful intervention, it also has drawbacks. For kids with ADHD, behavioral treatment is a secure and reliable alternative to medication. It is reasonable and efficient to refer Katie to a child psychologist who can use behavioral therapy to manage her issues.