Assignment: Assessing and Treating Patients With ADHD

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Attention De�cit Hyperactivity Disorder A Young Girl With ADHD

BACKGROUND Katie is an 8 year old Caucasian female who is brought to your o�ce today by her mother

& father. They report that they were referred to you by their primary care provider after

seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s

parents reported that their PCP felt that she should be evaluated by psychiatry to

determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-

Revised”. This scale was �lled out by Katie’s teacher and sent home to the parents so that

they could share it with their family primary care provider. According to the scoring

provided by her teacher, Katie is inattentive, easily distracted, forgets things she already

learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she

is noted to only pay attention to things she is interested in. The teacher opined that she

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lacks interest in school work and is easily distracted. Katie is also noted to start things but

never �nish them, and seldom follows through on instructions and fails to �nish her

school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a

wild person if she had ADHD” reports her mother. “She is never de�ant or has temper

outburst” adds her father.

SUBJECTIVE Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”-

her favorite subjects are “art” and “recess.” She states that she �nds her other subjects

boring, and sometimes hard because she feels “lost”. She admits that her mind does

wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I

will just be thinking about nothing and the teacher will call my name and I don’t know

what they were talking about.”

Katie reports that her home life is just �ne. She reports that she loves her parents and

that they are very good and kind to her. Denies any abuse, denies bullying at school.

O�ers no other concerns at this time.

MENTAL STATUS EXAM The client is an 8 year old Caucasian female who appears appropriately developed for

her age. Her speech is clear, coherent, and logical. She is appropriately oriented to

person, place, time, and event. She is dressed appropriately for the weather and time of

year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported

mood is euthymic. A�ect is bright. Katie denies visual or auditory hallucinations, no

delusional or paranoid thought processes readily appreciated. Attention and

concentration are grossly intact based on Katie’s attending to the clinical interview and

her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment

appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention de�cit hyperactivity disorder, predominantly inattentive

presentation

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RESOURCES § Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and

restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure,

reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Decision Point One Select what the PMHNP should do:

Begin Wellbutrin (bupropion) XL 150 mg orally daily

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Begin Intuniv extended release 1 mg orally at BEDTIME

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Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in

the MORNING

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