Introduction
The patient is a Caucasian 8-year-old girl referred for treatment by their primary care provider after her teacher feared she could have ADHD. According to Katie’s teacher’s “Conner’s Teacher Rating Scale-Revised” score, she is inattentive, easily distracted, forgets what she has previously learned, and does poorly in spelling, reading, and arithmetic. She is known to only pay attention to things that attract her, and her attention span is short. Her teacher claims she appears bored in her studies and frequently sidetracked. Another trait of Katie is that she frequently disobeys instructions, starts things but never finishes them, and neglects to do her studies.
The patient states that she frequently feels “lost.” she finds her other lessons dull and occasionally challenging. Katie admits that she does get distracted during class by more exciting things. When the teacher calls her name, Katie continues that she occasionally has nothing on her mind and has no idea what is being discussed. Katie claims that her home life is fulfilling and rejects the harassment and bullying she has experienced at school.
After the mental status examination, Katie, a Caucasian 8-year-old girl, appears to be developing in line with her age. She speaks persuasively, coherently, and logically. She has the proper sense of person, place, time, and occasion. She is also dressed correctly for the season and the weather. She does not have any apparent motions, tics, or body language. She describes her mood as euthymic and her affect as bright. Katie denies having visual or aural hallucinations and freely admits to having neither delusional nor paranoid thought processes. Katie’s ability to pay attention throughout the clinical interview and count backward from 100 using successive 2s and 5s show that she is mostly in control of her attention and focus. Discrimination and comprehension appear age-appropriate.
Katie denies any ideas of suicide or murder. After assessing Katie’s status and development, the matter was evaluated in three stages and resolved. The pertinent conclusions influenced the decision-making process and the information acquired from each step. In this case, the consumer requires a prescription for Ritalin. This medication treats attention deficit hyperactivity disorder, a form of ADHD. It works by changing the brain’s concentrations of specific chemical molecules. Methylphenidate belongs to the subclass of stimulant medications. It can enhance a patient’s ability to pay attention, help them stay focused during an activity, and help them deal with behavioral problems. Additionally, it could promote the development of listening skills and job organization (Conners et al., 1998). This medication also treats narcolepsy, a particular kind of sleep disorder.
Decision Point One
Katie has reached the required age to get Ritalin at eight years old. By maintaining optimal levels of dopamine and norepinephrine throughout the body and brain, the stimulant medicine Ritalin boosts activity in the brain and body (Bélanger, 2018). IR Ritalin must be divided into smaller doses for the total daily intake for the initial dose. Given the girl’s young age, it would be prudent to begin the therapy with low dosages of the medication in order to reduce the likelihood of side effects.
The other two options were sticking with the current dosage, reassessing to see if any significant changes have occurred, and giving Ritalin LA (Pakdaman, 2018). Due to a successful outcome from the tiny initial dosages, the re-evaluation was chosen for the second point. It was necessary to keep an eye on Katie to see whether the symptoms would improve. As it requires proof of tolerance or inefficacy from the frequent administration of the preceding medicine, the third alternative, which entails providing Ritalin LA, would not be acceptable for the first decision.
The primary goal of giving IR Ritalin is to lessen ADHD symptoms. The particular objective was to assist Katie in becoming more focused and capable of finishing her chores. This should lead to improved interactions with her classmates and academic success. Ethical concerns and disagreements may be lessened if the restoration of Quality of Life for ADHD patients and their families was recognized as the goal of treatment options. Children with ADHD appear to have a high rate of prescription non-adherence; as a result, it is ethically essential for the doctor to enhance compliance throughout the diagnostic and therapy phases (Conners et al., 1998). Because of this, Katie must always participate as fully as she can in the informed consent process. The girl’s parents would have to keep an eye on her development and let the hospital know if they noticed any strange behaviors. This choice was made based on the circumstances, the patient’s condition, and the potential for more therapy.
Decision Point Two
The patient received the same amount of IR Ritalin and was required to continue taking it for an additional four weeks after the results of the first four weeks were evaluated. The dose given during the first four weeks, which had contentious effects on the patient, impacted this choice. Katie’s disorder symptoms had also not been sufficiently managed to stop taking her medication (Conners et al., 1998). She had to continue the therapy as a result. The medicine selection would have been altered if the medication had not been successful (Sayal, 2018). Ritalin LA would not be a suitable substitute for IR Ritalin because it remained effective beyond the first four weeks of use. Ritalin LA was mainly used when ADHD symptoms worsened; there was no clinical need for it.
As it had been noted before in the therapy, the sustained IR Ritalin dose delivery was intended to reduce the symptoms of ADHD further. It was anticipated that Katie’s ability to focus and complete tasks would advance even farther from her current state (Conners et al., 1998). As a result, she will be a better student and make even more friends because she does not find people to be uninteresting. There is a moral requirement to enhance group decision-making in ADHD. The ethical proposal of shared decision-making (SDM) is widespread. However, there is a considerable danger of conflict and misunderstanding in situations when there are several evidence-based therapies available and parents, patients, and physicians evaluate the potential options differently. The elevated heart rate will persist as long as the medication is taken, and the parents will be informed (Conners et al., 1998). They will be given instructions on regularly checking the patient for unfavorable arrhythmias that might lead to potentially fatal heart problems.
Decision Point Three
For eight weeks, the patient had IR Ritalin therapy. It impacted the first four weeks, but the symptoms worsened during the following four. The medicine had to be altered despite the improvement in focus since the patient’s condition had worsened. Ritalin LA 20 mg was recommended because it has a longer duration of action on the patient after delivery than IR Ritalin since IR Ritalin proved ineffective at staying effective throughout the school day (Childress, 2021). This choice was anticipated to prolong the symptom relief while attending school and keep the healing process. Since Katie’s tachycardia was not abnormal, a STAT EKG was ruled out as being necessary.
This choice is anticipated to maintain Katie’s focus throughout her academic days. IR Adderall was an option when switching from IR Ritalin as a medicine. However, it does not work long enough to reduce symptoms (Conners et al., 1998). The duration of action for IR Ritalin and IR Adderall is three to six hours (Childress, 2021). Ritalin LA has some potentially serious adverse effects, but treating ADHD in children diagnosed with it is acceptable and morally right.
With this strategy, Katie might have a fulfilling relationship and elevate her performance (Fleischmann, 2022). The evidence would be presented to Katie’s parents, who would then be told that their daughter would receive stimulant medicine as part of a multimodal treatment plan (Conners et al., 1998). They should be aware that the disease has negatively impacted the child’s life; as a result, when the advantages outweigh the possible hazards, as they do in this instance, it is worthwhile. When the physician, instructors, and family collaborate closely to support the treatment program for success, these dangers might be promptly addressed.
Conclusion
The client is a Caucasian 8-year-old kid diagnosed with ADHD by her teacher. In order to assist the patient focus better and finishing her chores, it was determined following the mental state examination that giving IR Ritalin in tiny doses would be the best course of action. This would result in improved interactions with her classmates and academic success. The patient received the same amount of IR Ritalin after four weeks and was required to continue taking it for an additional four weeks. The excellent results of the dose demonstrated in the first four weeks had an impact on this choice.
In addition, the disorder’s symptoms persisted. Her medicine had to be kept up, so. If the medicine had turned out to be unsuccessful, the pharmaceutical option would have been altered. As shown before, in the course of treatment, the goal of the continuing IR Ritalin dose delivery was to reduce the symptoms of ADHD even further (Conners et al., 1998). It was anticipated that Katie’s ability to focus and finish tasks would advance above the current level. However, the symptoms got worse after eight weeks of therapy. Therefore, Ritalin LA had to be substituted for the original medicine. This choice is anticipated to maintain Katie’s focus throughout her academic day.
When used, the medicine Ritalin may have unwanted consequences. However, in this instance, the patient met the medication’s requirements, and its anticipated benefits outweighed any adverse effects. Involving Katie in any decision-making in this circumstance would be morally right (Conners et al., 1998). She should be aware of the hazards and procedures performed on her body, regardless of age. The fact that the medicine is morally acceptable and that the physician would collaborate with them to reduce Katie’s ADHD symptoms should also be made clear to Katie and her parents.
References
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Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175–186.