Psychiatric Diagnosis and Management: Child

Psychiatric Diagnosis and Management: Child

 

Response to Kimberly

Hi Kimberly,

As you have correctly highlighted, some ADHD (Attention-deficit/hyperactivity disorder) symptoms include impulsive behavior, challenges in sustaining attention, and hyperactivity. Krull (2022) informs that these symptoms affect a child’s academic, intellectual, emotional, behavioral, and social functioning. A stigma surrounding psychological health exists, and as a result, most persons with mental ailments do not look for treatment. Panic of the stigma is a hindrance to admitting the problem, particularly for adults. A medical visit for psychological disorders like hypertension or ADHD might be routine to a mental professional (Yalom, 2017). Patients fear making such visits due to the evaluation criteria results. Essentially, stimulants are often utilized to treat ADHD. The stimulants function by intensifying the disposal of certain essentials in the brain, facilitating brain pathways to work more competently. Significantly, treatments ease the symptoms of ADHD by enabling message transmission by neurons (Krull, 2020). ADHD treatment upsurges the release of neurotransmitters.

Pointedly, ADHD treatments improve neurotransmission, making kids less overactive and advancing their attentiveness. Therefore, the kids can quickly process and acquire novel information. Notably, the treatment is operative in around eight out of ten persons. This treatment is not a cure for the ailment but lessens ADHD symptoms. Behavior therapy, a technique for comprehending and altering behavior, also alleviates ADHD symptoms. The approach encompasses various methodologies and tactics to teach ADHD persons novel skills and reduce their problematic conduct. The method also lessens inappropriate behavior like screaming, inattention, and aggression. It gives kids affirmative results for decent conduct, not problematic conduct. Notably, behavioral therapy is practical and evidence-based practice therapy. Conclusively, ADHD affects numerous children, leading to poor academic performance, hyperactivity, and inattentiveness. Most studies evidence that stimulant medications and behavior therapy alleviate ADHD symptoms. Without medication, individuals with ADHD regularly encounter inferior long-term results, and treatment can progress the long-term consequences of the syndrome for some individuals. Further research is vital to classify if the short-term treatment benefits turn unswervingly into long-term outcomes.

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References

Krull, K.R. (2020). Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. Retrieved from https://www-uptodate-com.ezproxy.otterbein.edu/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-overview-of-treatment-and-prognosis?source=history_widget

Krull, K.R. (2022). Attention deficit hyperactivity disorder in children and adolescents: Treatment with medications. Retrieved from https://www-uptodate-com.ezproxy.otterbein.edu/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-treatment-with medications?search=attention%20deficit%20hyperactivity%20disorder%20children&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H2007898707

Yalom, I. D. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.

26 days ago

Kimberly Bernacki 

Case Study 9 yr-old Brian

COLLAPSE

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Differential Diagnoses

 

1. Attention-Deficit/Hyperactivity Disorder (ADHD)– High index of probability. DSM-5 states ADHD diagnostic criteria as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning characterized by inattention and/or hyperactivity and impulsivity (APA, 2013).

The inattentive type has six or more of the following symptoms for at least 6 months that interferes with social and academic/occupational activities: overlooks or misses details, difficulty sustaining attention in tasks, mind seems to wonder and doesn’t listen when spoken to directly, doesn’t follow through on instructions and fails to finish chores or duties, difficulty managing and organizing task and fails to meet deadlines, reluctant to engage in task that take sustained mental effort, loses things, distracted by external stimuli, forgetful in daily activities (APA, 2013).

The hyperactivity/impulsivity type has six or more of the following symptoms and have persisted for 6 months: fidgets and can’t stay in seat, leaves seat when remaining seating is expected such as in classroom, runs or climbs when not appropriate, unable to play or engage in leisure activities quietly, restless and unable to stay still for a period of time when appropriate, talks excessively, blurts out answers in class, difficulty waiting in line or his/her turn, interrupts or intrudes on others (APA, 2013).

1. Oppositional Defiant Disorder (ODD)– High index of probability. DSM-5 states ODD is a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by 4 symptoms from any of the following categories: Angry/Irritable Mood: loses temper, touchy and easily annoyed, angry and resentful, Argumentative/Defiant behavior: argues with authority figures, children, adults, Vindictiveness: spiteful or vindictive at least 2 times within the past 6 months (APA, 2013).
2. Conduct Disorder – Moderate index of probability. DSM-5 states diagnostic criteria for conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated as manifested by the presence of at least 3 of the following 15 criteria in the past 12 months from any of the categories listed, with a at least 1 criterion present in the past 6 months: Aggression to people/animals bullies, threatens/intimidates others, initiates physical fights, has used a weapon to harm others, has been cruel to people or animals, has stolen something, forced someone into sexual activity (APA, 2013).

Destruction of property, Deceitfulness or theft, serious violation of rules violating parental rules such as staying out at night or running away from home overnight at least 2 times while living in parent’s house (APA, 2013).

1. Autism spectrum disorder – Low index of probability. DSM-5 criteria for autism spectrum disorder is persistent deficits in social communication and social interaction across multiple contexts (APA, 2013).

Restrictive/repetitive patterns of behavior, interests, or activities as manifested by at least 2 of the following (repetitive motor movements (lining up toys), inflexible adherence to routines and ritualized patterns of verbal/nonverbal behavior (extreme distress with changing up routines, difficulty with transitions, rigid thinking, and rituals such as taking same route every day or eating same food everyday), highly restricted fixated interest in unusual objects, adverse response to specific sounds or textures, excessive smelling/touching of objects and fascination of lights/movement (APA, 2013).

Symptoms must be present in early developmental period, cause clinically significant impairment in social, occupational, or other important areas of current functioning, and are not better explained by intellectual disability or global development delay (APA, 2013).

Final Diagnosis

Attention Deficit Hyperactivity Disorder (ADHD) Combined Type– due to persistent pattern of inattention and hyperactivity/impulsivity. Although we weren’t given the duration of these known problems with Brian’s behavior, he is a classic example of this disorder displaying inability to stay on task or concentrate, excessively talks in class, constant reminders to stay in bed and go back to bed, disorganized, hyper focused on video games, loses attention easily on things he is not interested in, doesn’t follow instructions, forgets to follow through on tasks, fidgety and is unable to sit and finish homework, blurts out in class and doesn’t take turn, remains distracted in the classroom despite preferential seating at the front of the room.

Management Plan

 

1. Prescribe an extended-release stimulant for patient’s newly diagnosed ADHD. Bowers (2019) and authors concluded that the efficacy of a single morning dose of Adderall was comparable to that of a morning and noon dose of Methylphenidate and that a single morning dose of Adderall can eliminate the need for a noontime dose in school and simplify the medication management of school-age children.

Adderall XR 10 mg

Sig: Take one tablet by mouth daily in the morning for ADHD

Disp # 30 (thirty)

Refills: 0

MOA: A stimulant medication that increases norepinephrine and especially dopamine actions by blocking their reuptake and facilitating their release used for ADHD (Stahl, 2019).

1. Incorporate behavioral therapy to improve target outcomes:

 

1. Maintaining a daily schedule
2. Keeping distractions to a minimum

• Providing specific and logical places for the child to keep his or her schoolwork, toys, and clothes

1. Setting small, reachable goals
2. Rewarding positive behavior
3. Identifying unintentional reinforcement of negative behaviors

• Using charts and checklists to help the child stay “on task”
• Limiting choices and finding activities in which the child can be successful such as hobbies and sports

1. Using calm discipline such as time out, distraction, removing the child from the situation

Rationale

Krull (2020) states for most school-aged children and adolescents (≥6 years of age) who meet the diagnostic criteria for ADHD and specific criteria for medication, initial treatment with stimulant medication combined with behavioral therapy to improve core symptoms and target outcomes is recommended. Krull (2020) medications, with or without behavioral/psychologic interventions, are the first-line therapy for school-aged children (≥6 years) and adolescents who meet diagnostic criteria for ADHD. Krull (2020) states combination therapy may be beneficial for school-aged children and adolescents who have a suboptimal response to pharmacotherapy, have a coexisting condition, or experience stressors in family life. In systematic reviews of randomized trials (including the Multimodal Treatment Study of Children with ADHD), combined medication and behavior treatment was no more effective than medication treatment alone in improving core symptoms of ADHD (Krull, 2020). Krull (2020) states classroom modifications and accommodations may include having assignments written on the board, sitting near the teacher, having extended time to complete tasks, being allowed to take tests in a less distracting environment, or receiving a private signal from the teacher when the child is “off-task.” The teacher’s completion of a daily report card facilitates the monitoring of symptoms and the need for changes in the treatment plan (Krull, 2020). Krull (2020) suggest psychotherapy interventions for children with ADHD are not recommended unless they have coexisting conditions that require psychotherapy interventions such as depression, anxiety, or social deficits. When choosing among stimulants, individual preferences of the clinician and caregiver determine the choice of the initial stimulant medication (Krull, 2020). In choosing among the various stimulants, duration of action is a primary consideration (Krull, 2020). Another consideration is whether the child can swallow pills (Krull, 2020).

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References

 

Bowers, R.T., Weston, C.D., Mast, R.C., Nelson, S.C., Jackson, J.C. (2019). Green’s Child & Adolescent Clinical Psychopharmacology. (6^th ed). Wolters Kluwer.

 

Krull, K.R. (2020). Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. Retrieved from https://www-uptodate-com.ezproxy.otterbein.edu/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-overview-of-treatment-and-prognosis?source=history_widget

 

Krull, K.R. (2022). Attention deficit hyperactivity disorder in children and adolescents: Treatment with medications. Retrieved from https://www-uptodate-com.ezproxy.otterbein.edu/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-treatment-with-medications?search=attention%20deficit%20hyperactivity%20disorder%20children&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H2007898707

 

Stahl, S.M. (2019). In Prescriber’s guide: Children and adolescents. (1^st ed.) Cambridge, U.K.: University Printing House.

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Appendix C1 & C2: Discussion Question Response #1 and #2 15 points per response

 

Assignment Description

Each student submits a response to the Discussion Board question. This is done in the appropriate module discussion board in Blackboard (Course Objectives 1-8).

 

Assignment Objectives

The student will:

1. Synthesize the evidence-based literature for the week (learning opportunities, other identified resources);
2. Apply synthesized knowledge to understand the posted question;
3. Demonstrate understanding by developing a written response to the question; and
4. Demonstrate appropriate application of technology for communication and learning.

 

Assignment Steps

To complete this assignment:

1. Read the posted question.
2. Use the assigned readings and other resources to develop a written response to the question.
3. Post the developed response to the appropriate week discussion board in Blackboard by the date assigned in the course calendar.

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Assignment Evaluation

Each Discussion Board Response will be evaluated according the to the following rubric:

 

Criterion	Possible
Relevance	4	Response addresses the prompt.
Evidence Based	4	Response identifies and synthesizes the evidence in the literature, including DSM 5.
Critical Thinking	5	Review demonstrates critical thinking.
Mechanics	2	Writing is logical, APA 7th used; no errors in spelling, grammar, citations or references.

 

Required text book

Yalom, I. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.