Assignment: Assessing and Treating Patients With ADHD

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Attention De�cit Hyperactivity Disorder A Young Girl With ADHD

Decision Point One

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in

the MORNING

RESULTS OF DECISION POINT ONE � Client returns to clinic in four weeks

� Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic

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performance. However, by the afternoon, Katie is “staring o� into space” and “daydreaming” again

� Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and �nd that Katie’s heart is beating about 130 beats per minute

Decision Point Two

Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO � Client returns to clinic in four weeks

� Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day

� Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s o�ce visit

Decision Point Three

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

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Guidance to Student

At this point, Katie’s symptoms are well controlled (her attention is

sustained throughout the school day) and her side e�ects have

gone away following change to a long-acting preparation. There is

no indication at this point that the dose should be increased as it is

always advisable to use the lowest e�ective dose of stimulant

medication. Katie’s heart rate is appropriate for an 8 year old girl

and an EKG would not be indicated based on her heart rate.

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