ANSWER
Analysis of Case Studies on Attention and Substance-Related Disorders
1. Synopsis of a Clinical Case
An 8-year-old child is the subject of this case; he is displaying disruptive behaviors at school, such as verbal and physical aggressiveness toward a teacher. His school has referred him to the school psychologist due to allegations of hyperactivity and focus problems. His mother notes that he can concentrate when playing computer games, but she sometimes witnesses impulsive conduct at home, such as recklessly racing across the street. He also fidgets a lot and finds it difficult to stay seated. All of the signs point to issues with impulsivity, hyperactivity, and attentiveness.
2. Diagnosis of DSM-5-TR
The boy most certainly satisfies the DSM-5-TR’s criteria for Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation (314.01), based on the facts supplied.
Inattention: The inability to focus on activities that call for prolonged mental effort, like schoolwork.
Fidgeting and an inability to stay seated are signs of hyperactivity.
Impulsivity: Behaving without thinking through the repercussions of one’s actions (e.g., sprinting across the road).
The behaviors fulfill the DSM-5-TR criteria for ADHD since they impair his ability to perform both at home and at school.
3. Pharmacological Intervention and Justification
Clinical recommendations state that stimulant medications, such as methylphenidate (Ritalin) or amphetamine-based drugs (Adderall XR), are the first-line pharmacological treatment for ADHD in children. Methylphenidate would be the suggested treatment for this patient.
Justification of Methylphenidate
Mechanism of Action: Methylphenidate improves attention and impulse control by increasing dopamine and norepinephrine activity in the prefrontal cortex.
Efficacy: Children’s ADHD symptoms have been shown to be significantly reduced by stimulants such as methylphenidate.
Safety Profile: In pediatric populations, methylphenidate has a well-established safety record.
4. Non-Medical Intervention and Justification
With the exception of psychotherapy techniques, parent education in behavioral management (PTBM) is a non-pharmacological intervention.
Justification for PTBM Focus: PTBM gives parents tools to reduce disruptive behaviors and increase positive ones.
Evidence-Based: Research indicates that by establishing disciplined routines and structured surroundings, PTBM enhances children’s behavior.
Integration with Medication: By treating behavioral disorders holistically, PTBM in conjunction with pharmaceutical treatment improves results.
5. Evaluation of Adherence, Safety, Effectiveness, Cost, and Appropriateness of Treatment
Drugs: Ritalin (methylphenidate)
Appropriateness: Given the severity of the patient’s ADHD symptoms and the FDA’s approval for its use in children, methylphenidate is suitable for the patient. It specifically addresses fundamental symptoms like impulsivity and inattention.
Cost: At most local pharmacies (such Walgreens or CVS), a 30-day supply of generic methylphenidate (10 mg pills) costs between $20 and $30. Branded versions, like as Ritalin, can cost anywhere from $100 to $200 a month. The least expensive choice is generic methylphenidate.
Effectiveness: Methylphenidate reduces ADHD symptoms with a success rate of roughly 70–80%. It helps children become more focused, less impulsive, and less hyperactive.
Safety: Mild stomach discomfort, sleeplessness, and decreased appetite are typical adverse effects. Blood pressure and heart rate increases are uncommon yet dangerous side effects. These dangers are reduced by the prescribing clinician’s supervision.
Adherence: Because methylphenidate relieves symptoms right away, kids frequently take medicine as prescribed. The drug should be regularly administered by parents, who should also monitor its effects. By lowering the frequency of doses, extended-release versions (like Concerta) may increase adherence.
Intervention Without Drugs: PTBM
Cost: The price range for parent education programs varies, from $300 to $500 for organized courses to free community-based alternatives. Numerous insurance plans and educational institutions provide subsidized programs.
Effectiveness: PTBM improves parent-child connections, considerably lowers oppositional behaviors, and supports pharmaceutical treatment.
Adherence: The availability and willingness of parents are essential for adherence. Participation rates are frequently greater for programs that are easily available and incorporate practical exercises.
In conclusion
Methylphenidate and behavioral management training for parents provide a holistic approach to treating the boy’s ADHD symptoms. PTBM prepares parents to assist behavioral improvements, while methylphenidate directly tackles impulsive and attention problems. Treatment efficacy, safety, and adherence will be guaranteed by routine monitoring and follow-ups.
Citations
Psychiatric Association of America, 2022. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has been revised. APA Publishing.
Sonuga-Barke, E., Cortese, S., Asherson, P., & Buitelaar, J. (2020). treatment of ADHD in children. 207–222 in The Lancet Child & Adolescent Health, 4(3). 10.1016/S2352-4642(20)30015-4 is the link to the article.
Attention-Deficit/Hyperactivity Disorder Subcommittee, Quality Improvement and Management Steering Committee. (2019). Clinical practice guidelines for ADHD. e20192528 in Pediatrics, 144(4). Peds.2019-2528 https://doi.org/10.1542/
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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.