Introduction
Attention deficit hyperactivity disorder (ADHD) is a common mental health condition, particularly among children and adolescents in the United States. It manifests as a chronic disorder that causes stigma due to impaired neurotransmitter systems that affect a person’s executive functioning. ADHD impairs adaptive functioning, which is often displayed by unusual behaviors. Children and adolescents with ADHD show high aggression, learning difficulties, inability to delay gratification, poor impulse control, poor rule-regulated behavior, behavioral disinhibition, and low motivation. The disorder’s symptoms are pervasive and affect a person’s conduct and cognition, which may interfere with personal social relations. Therefore, this essay aims to assess the state of Katie, an eight-year-old Caucasian girl. She has shown probable signs of ADHD, and the paper will propose the appropriate pharmacological therapy to control the disorder.
Decision Point One
The decision chosen is to begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning. Ritalin is a stimulant belonging to a group of drugs called methylphenidate that act by boosting brain activity. The drug mainly aims to help patients better control their behavior and attention. It is preferred for treating children with ADHD since it helps with impulse control and hyperactivity, which allows for better concentration. Ritalin promotes the presence of neurotransmitters dopamine and norepinephrine in the central nervous system, which speeds up brain activity. It was selected as the first-choice drug because it is cost-effective and can be readily accessed in the market. Tarrant et al. (2018) state that Ritalin acts quickly and reaches topmost performance sooner than other stimulants. Therefore, it comes first among the options provided as it can better help Katie alleviate ADHD. It is not advisable to introduce the patient to a higher drug dosage. The 10mg chewable Ritalin would be a perfect choice to introduce to an 8-year-old child.
Wellbutrin and Intuniv could be good choices, but they are not better than Ritalin. Intuniv is a non-stimulant drug best used to help manage oppositional behaviors in children with ADHD. However, it has a low or no effect on helping Late improve her attention. It also causes sedation in patients, which would make the patient sluggish. This would negatively impact Katie’s quality of life, academic performance, and social functioning. Wellbutrin is disqualified because it is mainly used to manage ADHD in adults. Its mode of action causes an increase in the amount of dopamine and norepinephrine in the frontal cortex (Mechler et al., 2021). Wellbutrin was avoided because it induces suicidal ideation in children and adolescents. It could not be preferred in Katie’s case as she is barely eight.
Expected Outcome
Ritalin 10mg is a high-quality stimulant that is approved by the Food and Drugs Agency (FDA). It was preferred to be used in the first case because it has shown better capability to manage the symptoms of ADHD. Therefore, it was expected to help Katie to improve on her attention in class all through the day. The expectation is that after one month of medication, Katie will report improved concentration and attentiveness and somewhat concentrate on what she is doing.
Difference between Expected Outcome and Actual Outcome
Katie returned to the clinic after four weeks at the company of her parents. The parents reported that Katie’s teacher had observed slight improvement in her general academic performance. In particular, Ritalin was more effective in the morning class sessions. However, Katie experienced difficulties being attentive in class in the afternoon. Instead, the parents reported that she would stare into space and start daydreaming and had signs of heart-felt funny. She reported the expected side effects of using Ritalin in the form of increased heartbeat rate at about 130 beats per minute and tachycardia.
Decision Point Two
The second decision preferred for the case of Katie is to discontinue Ritalin and begin Adderall XR 15 mg orally daily. Adderall XR belongs to the group of drugs called amphetamine, which helps to boost coordination between the brain and the body through the central nervous system. Therefore, Adderall XR, a timed-release stimulant, is a good choice for treating ADHD (Childress, 2021). It is recommended for children aged 6 to 12, adolescents, and adults and is therefore suitable for Katie as she is eight years old.
The other alternatives were not applied because Adderall XR is a substitute stimulant to Ritalin. In general, stimulants are equally effective in managing ADHD symptoms. However, the patient may respond better to one stimulant than another. This is why Adderall XR was considered in the second instance, given that Katie did not show total improvement after using Ritalin in the first instance.
Expected Outcome
Administering Adderall XR was informed by its high efficacy in containing ADHD symptoms by over 70 percent. The expectation was that the drug would help Katie to improve her focus in class, especially in the afternoon. Adderall XR would also help her to reduce hyperactive behavior and impulsivity (Wolraich et al., 2021). It is administered orally once daily in the morning, and the 15mg dose is expected to show better results.
Difference between Expected Outcome and Actual Outcome
After using the second line of medication for a month, Adderall XR 15mg, Katie reported back to the clinic. Great progress was observed and Adderall XR 15mg proved to be more effective in containing the symptoms of the disorder. Her performance in class was above average, and Adderall XR was effective in helping Katie be attentive during all sessions in the morning and afternoon. She did not report significant side effects for using Adderall XR 15mg apart from tachycardia.
Decision Point Three
The third alternative preferred was to decrease to Adderall XR 10 mg orally daily. Adderall XR showed higher efficacy in helping Katie contain the symptoms and sustained attention in class all day. The other alternative of administering a higher dose was avoided because Katie did not show signs of necessitating an increased dosage of Adderall XR or changing to a different drug. Brown et al. (2018) state that low effective dosages of stimulant medications are preferred in dealing with ADHD. Thus, the dosage of Adderall XR was revised downwards from 15mg to 10mg. Reducing the daily dosage intake was informed by the understanding that a change was required to avoid Katie from getting accustomed to the same drug.
Expected Outcome
After administering a lower dose of Adderall XR the expectation was that her condition would be better, even though Katie would still experience tachycardia, which is a side effect of the drug. The situation may be made worse if the high dosage is maintained. Therefore, decreasing the dose to 10 mg orally daily, as recommended by the FDA, would help reduce the occurrence of tachycardia.
Difference between Expected Outcome and Actual Outcome
The third alternative did not yield a notable difference between the expected outcome and the actual outcome. After four weeks Katie in the company of her parents, came back to the clinic and reported improved academic performance. Adderall XR had helped her to maintain focus in class in the morning and afternoon. Given the efficacy of Adderall XR, there was no need to discontinue the drug.
Ethical Considerations
It is essential to observe ethics when handling patients with ADHD by ensuring that the prescribed medicine will be beneficial in managing the condition. In particular, the ethical principles of the benefits of beneficence and non-maleficence should be considered (Tseng,2021). Patient information should be handled with privacy and confidentiality. For instance, it would be unethical to discuss the problem Katie had with fellow students because she could be subjected to ridicule at school. The patient’s discussion about the treatment plan should be open and transparent.
Conclusion
In summary, Katie was referred to the clinic because she had shown signs and symptoms that indicated she could be suffering from ADHD. Even though she and her parents were in denial, it was prudent her to manage the symptoms. Three alternatives were preferred and Katie would be observed after four weeks to check on her progress following the recommended course of action. In the first instance, she was required to take Ritalin 10 mg orally daily in the morning. It was observed that her focus was still poor in the afternoon and her heartbeat had increased. This caused the medication to be changed to another stimulant, Adderall XR 15mg, taken orally daily in the morning. After four weeks she reported improved performance and focus in class in the afternoon but she continued to experience tachycardia. In the third instance, the medication was scaled down to Adderall XR 10mg to help reduce the side effects. The prescription of drugs was done by observing ethical standards on beneficence and non-maleficence, privacy and confidentiality.
References
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Tarrant, N., Roy, M., Deb, S., Odedra, S., Retzer, A., & Roy, A. (2018). The effectiveness of methylphenidate in the management of attention deficit hyperactivity disorder (ADHD) in people with intellectual disabilities: A systematic review. Research in Developmental Disabilities, 83, 217–232. Web.
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