Essay on Decision Tree (Children/Adolescent)

Introduction

The client, Katie an 8-year-old female presented with her parents with complaints that ADHD medications have not been helpful. The parents wanted Katie to be re-evaluated.  The “Conner’s Teacher Rating Scale-Revised” indicated that Katie was easily distracted, inattentive, forgetful, makes careless mistakes in schoolwork, short attention span, difficulties interacting and socializing with her peers, plays alone, and poor in reading, spelling, and arithmetic. Katie is not able to sit still and keeps interrupting during the interview. She reports that her mind wanders while in class. The MSE indicates that her speech is coherent, logical, and clear. She is well-oriented and denies any paranoid thought process and paranoid. Concentration and attention are somewhat limited. This paper will discuss three decisions regarding Katie’s diagnosis and treatment plan, as well as ethical considerations relevant to her treatment plan.

Decision Point One

The diagnosis for Katie is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This diagnosis was chosen since Katie meets the diagnosis criteria A1 (inattention) for ADHD. Katie meets more than 6 symptoms of Criterion A1 (inattention) for ADHD as per DSM diagnostic criteria. Katie manifests symptoms such as easy distraction, inattentive, forgetfulness, poor concentration, careless mistakes in schoolwork, inability to sit still during the interview, and constant interruptions during the interview (Cabral et al., 2020). Standardized assessment tools useful in confirming ADHD symptoms for Katie include ACTeRS and the Vanderbilt Assessment Scale. Katie also needs to be screened for other disorders that present like ADHD and her behavior needs to be assessed further using the Child Behavior Checklist.

The selection of ADHD as the diagnosis hopes that it would facilitate the correct treatment for Katie.

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Decision Point Two

Katie should begin Adderall XR 10 mg orally daily. Adderall was selected because the medication is a stimulant whose efficacy in treating ADHD has been demonstrated. Briars & Todd (2016) explain that Adderall works by elevating and balancing the amount of neurotransmitters within the brain. Therefore, the medication will help in improving ADHD symptoms for Katie.

The selection of Adderall hopes that ADHD symptoms would gradually improve since the medication has been demonstrated to be effective in improving ADHD symptoms. It is also expected that Katie would not experience side effects (Briars & Todd, 2016).

As it was anticipated, Katie started manifesting symptom improvement as she was becoming more attentive at school and maintained attention during morning classes. This is due to the mediation’s efficacy in treating ADHD. However, the client was not able to maintain attention during the afternoon classes as she reported daydreaming in the afternoon. This is attributable to the fact that the efficacy of the medication wears off and the symptoms resurface again (Sallee, 2015). The client also reported appetite loss, which is a side effect of the medication (Sallee, 2015).

Decision Point Three

The third decision is the addition of a small dose of immediate-release Adderall in the early afternoon. This decision was selected to enable Katie to maintain attention throughout the day. According to Brown et al (2018), adding a dose of immediate release of the medication will increase the client’s attention span, lead to increased efficacy, and better symptom improvement. The other two decisions were not chosen as they will not address the inattentive symptoms for Katie. By selecting this decision, it is hoped that Katie would be able to maintain attention and concentration throughout the day.

Ethical Considerations

The use of amphetamines such as Adderall can lead to addiction and have also been shown to lead to permanent effects on the central nervous system. Therefore, the PMHNP should educate the parents of Katie regarding the potential side effects of the medication (Merman et al, 2017). The other relevant ethical aspects when treating this client include informed consent and autonomy. The PMHNP should explain to parents about the diagnosis and the available treatment options to ensure the parents make an informed choice. The parents also have the autonomy to accept or reject the treatment choices (Merman et al., 2017).

Conclusion

The diagnosis for the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation because she manifests more than six symptoms of the condition. The first decision is to have Katie administered with Adderall XR 10 mg orally daily since the medication is effective in the treatment of ADHD. However, Katie was not able to maintain attention throughout the day and hence the third decision is the addition of a small dose of immediate-release Adderall in the early afternoon. The PHMNP should educate the client’s parents about the possible side effects of the prescribed medications and ensure that informed consent is sought from the parents prior to starting any treatment.

References

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

Brown K, Samuel S & Patel D. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Transl Pediatr, 7(1), 36–47.

Cabral, M., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors, and evaluation in youth. Translational Pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08

Merman S, Batstra L, Hans G, Frances A. (2017). ADHD: a critical update for educational professionals. Int J Qual Stud Health Well-being, 12(sup1): 1298267.

Sallee F. (2015). Early Morning Functioning in Stimulant-Treated Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, and its Impact on Caregivers. J Child Adolesc Psychopharmacol, 25(7): 558–565.

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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.

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.
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.

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