ANSWER
Analysis of a Case Study on Attention and Drug-Related Disorders
1. Clinical Case Synopsis
The case concerns an 8-year-old youngster who is acting aggressively against his teacher both verbally and physically at school. His school has referred him to a child psychologist after noticing issues with his focus. According to his mother, while he is playing on his computer or doing other things at home, his level of focus appears to be sufficient. She is concerned about his impulsivity, though, which is demonstrated by his propensity to act recklessly, such racing across the street without looking. He also demonstrates persistent physical restlessness, such as writhing in his chair, which is consistent with hyperactive symptoms.
2. Diagnosis of DSM-5-TR
Given the available data, Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation (F90.2) is the most likely DSM-5-TR diagnosis. The following evidence supports the diagnosis:
Inattention: Having trouble focusing on academic assignments while being overly preoccupied with fun activities (like playing on his computer).
Fidgeting and an inability to stay still in class are signs of hyperactivity.
Impulsivity: Behaving rashly, like when you run across the street.
These symptoms, which satisfy the DSM-5-TR criteria for ADHD, substantially impair his social and intellectual functioning and manifest in both home and school environments.
3. Drug Therapy
Suggested Drug: Methylphenidate (e.g., Ritalin, Concerta) Justification: According to the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE), methylphenidate is a first-line treatment for ADHD in children. This stimulant drug improves attention, lowers hyperactivity, and controls impulsivity by raising dopamine and norepinephrine levels in the brain.
Dosage: Titrate according to effectiveness and tolerance, starting with a modest dose (e.g., Ritalin 5 mg twice daily).
Evaluation of Treatment Appropriateness: Methylphenidate is FDA-approved for use in children aged 6 and up and is very successful in treating the main symptoms of ADHD.
Cost: Compared to extended-release versions, the generic form of methylphenidate (5 mg) is more affordable, costing around $10 to $15 for a 30-day supply in neighborhood pharmacies.
Effectiveness: About 70–80% of children with ADHD experience a reduction in symptoms while using stimulants like methylphenidate.
Safety: Common adverse effects include irritability, disturbed sleep, and decreased appetite. Often, they can be controlled by changing the schedule or dosage.
Adherence Potential: If the child’s conduct and academic performance show appreciable improvements as a result of the medication, adherence is likely.
4. Non-Medical Intervention
Parent and teacher training programs are suggested as an intervention.
Justification: The goal of behavioral interventions is to alter the child’s surroundings in order to better support symptoms of ADHD. Teachers and parents receive training on how to control a child’s conduct through the use of positive reinforcement techniques, regular discipline, and regulated schedules. These methods, which are supported by evidence, enhance symptom management without exclusively depending on medicine.
Why Not Include Psychotherapy?
For older kids or teenagers, psychotherapies like Cognitive Behavioral Therapy (CBT) are frequently more successful. Behavioral training for caregivers is thought to have a greater effect on younger children.
5. Evaluation of Non-Pharmaceutical and Pharmaceutical Interventions
Medication Assessment: Appropriateness: There is strong evidence to support the use of stimulants as first-line therapies for ADHD in children.
Cost: Methylphenidate generics are reasonably priced. Community assistance programs may further lower financial barriers if cost is still an issue.
Effectiveness: Research indicates that methylphenidate significantly enhances behavior and attention in both home and school environments.
Safety: Frequent follow-ups and dose modifications reduce hazards, even though adverse effects including appetite suppression are prevalent.
Adherence: The likelihood of adherence is increased by straightforward dosage instructions and observable symptom alleviation. Administration can be made simpler by using an extended-release formulation (e.g., once daily in the morning).
Evaluation of Behavioral Intervention:
Cost: Behavioral training programs, particularly those provided by community organizations or schools, are usually free or reimbursed by insurance.
Effectiveness: Consistency in handling the child’s conduct across contexts is fostered by the engagement of both parents and teachers.
Safety: It is a very safe intervention because there are no physical dangers.
Adherence: Involves teachers’ and caregivers’ continuous involvement, which can call for dedication but is usually sustainable.
6. Current Developments and Challenges in the Treatment of ADHD
Trend: Children with ADHD are increasingly using digital tools, like games or apps, to help them with self-regulation and concentration.
Problem: Despite the demonstrated advantages of pharmaceutical treatment, some parents put it off or avoid it because of the ongoing stigma associated with its usage.
Highlight: The most effective way to treat ADHD is still to combine behavioral and pharmaceutical therapies.
Citations
(2019) American Academy of Pediatrics. Clinical practice guideline for children and adolescents with ADHD: diagnosis, assessment, and therapy. https://doi.org/10.1542/peds.2019-2528 Pediatrics, 144(4), e20192528
NICE (2018). The diagnosis and treatment of attention deficit hyperactivity disorder. NICE Clinical Guidelines. Guidance/ng87 https://www.nice.org.uk
Allan, C., Wolraich, M. L., Hagan, J. F., et al. (2019). Guidelines for diagnosing and treating ADHD: A comprehensive analysis of the available data. https://doi.org/10.1542/peds.2019-2527 Pediatrics, 144(4), e20192527
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QUESTION
Attention & Substance Related Disorders
Answer the questions below based on the following case study.
An 8-year-old boy is repeatedly in trouble at school. He has been threatened with suspension after he was verbally and physically aggressive to his teacher. The school has suggested that he has a problem with his concentration and advised his parents to seek help. The school also referred him to the school child psychologist. He keeps wriggling in his seat. His mother says his concentration is fine when he is playing on his computer. What worries her is that he does not seem to think before he does things and will run out across the road without looking.
1. Summarize the clinical case.
2. What is the DSM 5-TR diagnosis based on the information provided in the case?
3. Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
4. Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
5. Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
Submission Instructions:
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.