Synopsis of a Clinical Case

ANSWER

Synopsis of a Clinical Case
Due to his behavioral and attentional problems, an 8-year-old child is frequently disciplined at school and faces the possibility of suspension. He acts impulsively, such sprinting across the street without looking, struggles to concentrate, and acts aggressively both verbally and physically toward teachers. His mother observes that although he can focus well enough when playing computer games, he exhibits indicators of restlessness (such as wiggling in his seat) and has trouble maintaining attention in other situations. His actions point to a developmental or attention-related issue, according to the school psychologist who has been consulted.

DSM-5-TR Identification
Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation is the most likely diagnosis based on the symptoms that have been presented (F90.2). This diagnosis is backed up by:

persistent hyperactivity-impulsivity and inattention that hinders one’s ability to perform.
behaviors including impulsive activities (like rushing across the road), trouble keeping sitting, and short attention spans.
symptoms that significantly hinder functioning and appear in at least two contexts (such as the home and the school).
Pharmacological Intervention
Drugs: Methylphenidate, such as that found in Concerta and Ritalin
Justification: Methylphenidate is a stimulant drug that is frequently prescribed as a first-line treatment for children with ADHD. It enhances focus, attention, and impulse control by raising dopamine and norepinephrine levels in the brain.

Effectiveness: It has been shown in numerous trials to be effective in lowering the primary symptoms of ADHD in children (Subcommittee on ADHD, 2019).
Safety: Methylphenidate is usually well tolerated; the most frequent adverse effects include minor stomachaches, sleeplessness, and decreased appetite.
Dosage: Start with a modest dose of immediate-release methylphenidate and increase it in accordance with adverse effects and symptom response.
Parental Behavior Management Training (PTBM) is a non-pharmacological treatment intervention.
Justification: PTBM aims to give parents the tools they need to successfully handle their child’s difficult behaviors. Clinical recommendations advise it should be used in addition to pharmaceutical therapy.

Among the strategies are regular routines, constant discipline, and positive reinforcement.
Effectiveness: Research indicates that PTBM lessens disruptive behaviors and enhances parent-child interactions (Jensen et al., 2021).
Applicability: By encouraging consistency across contexts, this strategy can indirectly enhance academic achievement while also supporting the child’s conduct at home.
Evaluation of Treatment Suitability
1. Adequacy of Medication
Effectiveness: Methylphenidate works very well to control the symptoms of ADHD, especially impulsivity and hyperactivity.
Safety: Extensive research supports long-term use, and side effects are mild to moderate. Risks are reduced by routine monitoring.
2. Price
According to information from a local drugstore, generic methylphenidate (immediate release) costs $20 to $30 per month without insurance.
Concerta and other extended-release medications cost $100 to $200 per month without insurance. For families with limited funds, generic alternatives offer a more economical option.
3. Adherence of Patients
Medication Adherence: Several doses per day may be necessary for short-acting formulations, which may impact adherence. Dosing is made easier with extended-release formulations, but they could cost more.
Adherence to Non-Pharmacological Treatment: The success of PTBM depends on parental involvement. Family dedication to planned training sessions might enhance results and adherence.
In conclusion
The best way to manage this child’s ADHD symptoms is to combine non-pharmacological therapies (PTBM) with pharmacological treatment (methylphenidate). While PTBM offers long-term methods for behavior modification, methylphenidate will deal with the immediate issues of hyperactivity and inattention. The success, safety, and adherence of treatment can be guaranteed by routine monitoring and affordable pharmaceutical options. The family’s requirements and evidence-based recommendations are met by the comprehensive plan.

Citations: ADHD Subcommittee, 2019. Clinical practice guidelines for ADHD. e20192528 in Pediatrics, 144(4).
Swanson, J. M., Jensen, P. S., and Arnold, L. E. (2021). ADHD is treated with behavioral therapies. Psychiatry and Child Psychology Journal, 62(4), 405–415.
Psychiatric Association of America, 2022. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has been revised. American Psychiatric Publishing, Arlington, VA.

 

 

 

 

 

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 3 academic sources.

· Due Wednesday, October 2 at 11:59pm