A Young Girl With ADHD

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 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

Discontinue Ritalin and begin Adderall XR 15 mg orally daily

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

� Katie’s academic performance is still improved, and the XR preparation has helped sustain her attention throughout the school day, however, you also learn that Katie is having tachycardia with this medication, too

Decision Point Three

Decrease to Adderall XR 10 mg orally daily

Guidance to StudentGuidance to Student Adderall XR should be initiated at 10 mg orally daily and increased by 5–10 mg/day at weekly intervals; maximum dose generally 30 mg/day. Tachycardia is one of the side e!ects of Adderall, and may be worse because it was started at a higher dose. The PMHNP should decrease the dose to 10 mg orally daily and re-evaluate at the next o"ce visit.

Continuing the same dose will most likely not signi#cantly improve the side e!ect of tachycardia, so maintaining the current dose of medication would not be prudent as Katie may refuse to take the medication if it causes unpleasant side e!ects.

There is no indication to move to a second line agent at this point due to a side e!ect which may be caused by a high starting dose of medication.

Start Over

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