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Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD

Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD

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Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD

Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD

Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD

BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office 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 filled 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. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

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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 defiant 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 finds 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 fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

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. Affect 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. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

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

Begin Wellbutrin (bupropion) XL 150 mg orally daily

Begin Intuniv extended release 1 mg orally at BEDTIME

Begin Intuniv extended release 1 mg orally at BEDTIME

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

The below is a simple paper, the three medication have to be discussed in all three decision, the reasons for selecting the one selected and the reason for not the other two that were not selected.

Week 2 Assignment: Assessing and Treating Pediatric Clients with Mood Disorders
Depression is considered an affective disorder due to its effect on the internal emotions and external mood seen by others (Stahl, 2013). Symptoms of depression include generalized sadness which can lead to feelings of guilt, fatigue, anxiety, poor concentration, changes in sleep pattern, increased or poor appetite and social isolation among many others. It is theorized that the cause of depression is due to a deficiency of monoamine neurotransmitters which are responsible for the amount of norepinephrine, serotonin and dopamine in the brain (Stahl, 2013). When treating a patient with depression, medications generally target this deficiency in hopes to provide relief from the symptoms the client is experiencing. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
Case Study Information
The case study presented this week consists of an 8-year-old African American male presenting to the emergency department with mom due to increased feelings of sadness, withdrawn behavior in school, decreased appetite and occasional agitated behaviors (Laureate Education, 2016e). While the physical examination and laboratory studies were within normal limits, the mental status exam proved to be normal with reported “sad” mood, blunted affect but appropriately smiled at times and endorses thoughts of passive suicidal ideation (Laureate Education, 2016e). The client scored a 30 on the Children’s Depression Rating Scale, indicating significant depression (Laureate Education, 2016e).
The purpose of this assignment is to consider the 8-year-old client and information and make three decisions concerning medications to prescribe to the client. Each decision offers multiple options to choose from. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. The decision will be chosen based on evidence consisting of recent academic resources and research studies along with a rational for why the other two options were not chosen. Each outcome will be discussed based on if it was expected or not and what the next step will be. Lastly, ethical considerations will be discussed and how they may impact the treatment plan for the client and the communication with the client and his family.
Decision One
The first decision point the Psychiatric Mental Health Nurse Practitioner (PMHNP) must choose which medication the client will start. The medications to choose from include Zoloft (sertraline) 25 mg by mouth daily, Paxil (paroxetine) 10 mg by mouth daily, and Wellbutrin (bupropion) 75 mg by mouth twice daily (Laureate Education, 2016e). As the PMHNP caring for this client, Zoloft 25 mg daily would be the first choice of therapy for this patient. Selective serotonin reuptake inhibitors (SSRIs) are known to be the first line of treatment for children with depression (DeFilippis & Wagner, 2014). While sertraline and paroxetine are both SSRIs, sertraline is FDA approved when treating children whereas paroxetine has been found to be affective when treating children with depression, it is not specifically approved by the FDA at this point in time (Stahl, 2014b). Sertraline is approved by the FDA for use in children with depression beginning at the age of six (Stahl, 2013). Additionally, paroxetine is not recommended in use for children due to its short half-life which can lead to withdrawal when the medication is stopped abruptly (Nathan & Gorman, 2015).
The safety and efficacy of bupropion have not been established thus far but it some research that has been done suggests that this medication is effective for treatment of a client with both attention deficit disorder and depression, something that the client in this case study does not exhibit (Stahl, 2014b). Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. Research has also shown that often the placebo effect alone on prescription medications can play a part in reduction of depressive symptoms in both children and adults (DeFilippis & Wagner, 2014).
As a new prescriber, I would most likely make a cautious decision when treating a child for the first time. Due to the fact that sertraline is FDA approved in the treatment of depression in children, I would most likely go with that medication as a primary action for prescribing for this client. The goal of this treatment is to alleviate depressive symptoms in the client while minimizing the risk for side effects of the medication.
When the client returned to the clinic four weeks after starting on Zoloft 25 mg daily, there was no change in the depressive symptoms at all (Laureate Education, 2016e). I am surprised that there was absolutely no change given the fact that the effects can be either medicinal or placebo, with changes seen as early as a week into the medication trial (Nathan & Gorman, 2015). As with all medications, there is always the chance that the client does not see an improvement in symptoms.
Decision Two
After the initial trial of Zoloft 25 mg yielded no change in the client’s symptoms, the treatment options are to increase the dose to 37.5 mg daily, increase the dose to 50 mg daily or to change the medication completely to Prozac 10 mg daily (Laureate Education, 2016e). Because the patient has not exhibited any adverse reactions to the medication, there is no need to change the medication at this time. As for titrating the sertraline, it can be titrated in increments of 25 mg with the maximum dosage not to exceed 200 mg daily (Southammakosane & Schmitz, 2015). Once the medication is started and tolerated, research supports titrating the medication up to minimize depressive symptoms (Cheung et al., 2018). Paroxetine, in general, was not recommended for treatment of pediatric depression based on research by Nathan & Gorman (2015) and this will not be considered for this client. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
Based on this research, the decision was made to increase the Zoloft dose to 50 mg daily for the client. Again, the goals of treatment are to find a medication that reduces depressive symptoms in this pediatric patient while minimizing adverse effects. Once that goal is accomplished, long term goals for the client would be medication compliance and absence of relapse in depressive symptoms and suicidality.
The client returned to the clinic in four weeks with a decrease in depressive symptoms by 50% and is tolerating the medication well (Laureate Education, 2016e). While I anticipated the patient to have a reduction in depressive symptoms with the increase in dose, I had hoped the low dose would be effective for this patient. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. I am pleasantly surprised that the patient is not exhibiting any side effects from the medication.
Decision Three
The increase in the Zoloft dose to 50 mg yielded decreased depressive symptoms and no side effects (Laureate Education, 2016e). The next decision for the client involves maintaining the current dose, increasing the dose by 25 mg again to achieve a total dose of 75 mg daily or changing the medication to a SNRI (Laureate Education, 2016e). When discussing the medication with the client and parent, it would be important to discuss medication adherence to assure the client is taking the medication as directed. If this is the case, I would likely recommend increasing the dose to 75 mg due to the fact that the medication can be titrated up in 25 mg increments with the maximum prescribed dose of Zoloft being no more than 200 mg by mouth each day (Southammakosane & Schmitz, 2015). If the patient had seen no response and had reached the upper limit of Zoloft already, I would consider changing the medication, but it appears as though there is some desired effect from the medication without adverse reactions, which is the goal of treatment. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
Serotonin-norepinephrine reuptake inhibitors (SNRI’s) such as duloxetine, venlafaxine and desvenlafaxine are considered second-line or third-line treatments for children with depression (Koechlin et al., 2018). Additionally, some research shows that there is significant cost benefit as well as safety in using SSRI’s over SNRI’s (Locher et al., 2107). In this case, I would continue with the SSRI medication I have been utilizing for this patient, which is a first line medication until I have exhausted my dosage options.
With increasing the dose of the Zoloft to 75 mg daily, I am hopeful that the medication will have an increased effect, perhaps 75-100% effective with little to no side effects. The response to the decision was that the client had a sufficient response to the medication with associated symptom reduction (Laureate Education, 2016e). It was recommended to either continue the Zoloft at 50 mg daily considering there was a response to the medication and evaluate again in four weeks to see if the medication continues to work or to increase it to 75 mg daily considering it was not complete remission of depressive symptoms (Laureate Education, 2016e).
While an increased dose may yield potential adverse effects, it can also give the necessary response of decreased depressive symptoms. This could be an opportunity to discuss the medication and symptoms with both the client and his parents to make them apart of the decision making. Although the client is only 8-years-old, he is capable of discussing his feelings as well as his response to the medication. Family can offer additional feedback from an external source about the client’s symptoms (Stahl, 2013). Should the patient not be able to tolerate the medication increase, the dose can be decreased as well Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. As I anticipated with the third decision, there is no reason to change the medication to an SNRI at this time considering the client is tolerating the Zoloft dose and exhibiting a response to it.
Conclusion
While there is not one correct answer when treating a child with depression, beginning drug therapy with a SSRI and titrating up slowly and as indicated has proved to be effective for my 8-year-old client with depression. When combined with therapy, such as cognitive behavioral therapy (CBT) treatment is enhanced and side effects of medications are diminished (Giles & Martini, 2016). Along with follow up for medication management, this client and his mom should also be educated on potential side effects including potential increase in suicidality. Should this happen, the client should be encouraged to reach out to a parent or adult he trusts and seek an appointment immediately. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
Ethically, when treating clients with medications, benefit of treatment must outweigh potential harm (Merry et al., 2017). When discussing the treatment plan with the client and family, we must remain transparent and educate them on the pros and cons of the medications and also the potential for a placebo effect from taking an antidepressant medication. Information should be provided based on educational level and should be basic enough for an 8-year-old to understand and also complex enough for the parent to gauge an understanding of the medication their child is taking Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
This assignment was an opportunity to examine different medication therapy for a child with depression and make changes as needed to help alleviate the client’s symptoms. Although there is not one clear answer when diagnosing and treating patients, it is important we treat each patient individually and based upon their needs and responses to medications prescribed.
References
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., Stein, R. E., & GLAD-PC
STEERING GROUP. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics, 141(3), e20174082.
DeFilippis, M., & Wagner, K. D. (2014). Management of treatment-resistant depression in
children and adolescents. Pediatric Drugs, 16(5), 353-361
Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric
psychopharmacology. Academic pediatrics, 16(6), 508-518. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
Koechlin, H., Kossowsky, J., Gaab, J., & Locher, C. (2018). How to address the placebo
response in the prescription SSRIs and SNRIs in children and adolescents.
Laureate Education (2016e). Case study: An African American child suffering from depression
[Interactive media file]. Baltimore, MD: Author.
Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I. & Kossowsky, J. (2017).
Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Psychiatry, 74(10), 1011–1020. http://doi.org/10.1001/ jamapsychiatry.2017.2432
Merry, S. N., Hetrick, S. E., & Stasiak, K. (2017). Effectiveness and Safety of Antidepressants
for Children and Adolescents: Implications for Clinical Practice. JAMA psychiatry, 74(10), 985-986.
Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work. Oxford
University Press Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Introduction

Attention Deficit Hyperactive Disorder is a mental health disorder in which children present with symptoms of being impulsive, inattentive or hyperactive. Impulsivity refers to a child acting in a way which is overly rash, impatient, inconsiderate and careless for his/her age. Inattentiveness refers to a child who has a lot of difficulties to focus and gets distracted easily. Hyperactivity refers to a child who constantly keeps fidgeting and is generally restless. For instance, during lessons at school, one is not able to remain still.  ADHD can result in major problems in the life of a child and activities of daily life. Since they behave differently than expected, children with ADHD cause a lot of trouble. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Case Study Overview

In this week, the client is an 8-year-old Caucasian female named Katie who was accompanied by her mother and father as a referral from their primary care provider with reports from her teacher that she could be having ADHD. The PCP was certain that Katie needed to be evaluated by a psychiatrist to establish whether or not she had ADHD. Upon conducting a thorough evaluation, a diagnosis of Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation was made. Based on the client’s presentation, the purpose of this paper is to determine the best psychopharmacologic drugs to use in the management of the client based on three decisions. The reasons for selecting each decision will have a rationale from currently existing academic resources. The expected and actual outcomes for each decision will be discussed alongside the ethical considerations and how they are likely to impact the client’s treatment plan and communication with the family and client.

Decision #1

Decision Selected

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.

Reason for Selecting This Decision

According to Thomas et al., (2015), Ritalin is a stimulant medication that has been used for decades in the management of ADHD since it is a cognitive enhancer. It functions by promoting the presence of neurotransmitters dopamine and norepinephrine in the CNS which speeds up the activity of the brain. Ritalin is fast acting and gets to the peak performance faster than other stimulant medications (Tarrant et al., 2018).  Besides, it is also affordable and readily available in the market, and therefore the best choice in this case. Wellbutrin could be a good choice since it is also used off label for managing ADHD but in adults. It works by increasing the availability of norepinephrine and dopamine in the frontal cortex, which explains its effectiveness in managing symptoms of ADHD. However, it has suicidal ideation as a major side-effect in adolescents and children thus not a good choice for this patient who is 8 years old (Briars & Todd, 2016). Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Intuniv could also be a good choice since it a non-stimulant drug used in the management of oppositional behaviors in children with ADHD. It, however, has a major side effect of sedation which can make a patient be very sluggish in a whole day (Briars & Todd, 2016). It also has very minimal or no effect on improving a child’s attention. Therefore, for Katie in this case, it wouldn’t be a good choice since sedation will negatively impact her quality of life, social functioning, and academic performance.

Expected Outcome

            By starting Katie on Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning, it was expected that Katie would have some improvement in terms of paying attention at school and that her academic performance will also improve. Ritalin has been approved by the FDA for treatment of ADHD in patients aged 6 years and older, although it can also be used for managing children who are younger than 6 years of age and diagnosed with ADHD. It targets norepinephrine and dopamine in the brain to reduce common symptoms of attention, concentration, fidgeting and enhancing listening skills (Huss, et al, 2017). Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Difference between Expected Outcome and Actual Outcome

The client returned to the clinic after four weeks accompanied by her parents who reported that according to Katie’s teacher reports,  her symptoms were much better in the morning, the progress that has resulted to her overall improvement in her academic performance. However, her teacher noted that, in the afternoon, Katie often stared into space and started to daydream again. Katie’s parents were also concerned about Katie’s reports that her heart felt funny. Upon taking a pulse rate, I found that Katie’s heart was regular and beating at about 130 beats per minute. The fast heartbeat that the patient reported was a side effect of Ritalin. The immediate release form of Ritalin has tachycardia as a common side effect (Huss, et al, 2017).   Besides, the immediate release form cannot help Katie maintain her attention throughout the day.

It also worth noting that, since the heartbeat was regular with no other signs of cardiac abnormality, the best way to address this issue is by switching to a long-acting preparation (Huss, et al, 2017).

Decision # 2

Decision Selected

Change to Ritalin LA 20mg orally in the morning

Reason for Selecting This Decision

Ritalin LA is the long-acting formulation of Ritalin. The decision for this choice was attributed to initial reports that although Katie had shown some improvement in her academic performance and could remain focused in the morning hours, she had a lot of difficulties maintaining her attention in the remainder of the day. Therefore, Ritalin LA would her to remain focused the whole day (Briars & Todd, 2016).  Besides, Ritalin LA would help to reduce the severity of the side effect of tachycardia. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Expected Outcome

By starting the client on Ritalin LA 20mg orally in the morning, it was expected that she will be able to pay attention for an entire day in school as compared to previous reports. As a result, her academic performance will also improve significantly. It was also expected that the client will no longer report about ‘hear heart feeling funny’. Therefore, the symptoms of tachycardia will completely disappear and her heartbeat will return to normal for her age (Tarrant et al., 2018).

Difference between Expected Outcome and Actual Outcome

The patient returned to the clinic after four weeks with reports that her academic performance has really improved and that the switch to LA lasted her in the entire school day. Katie also informed that reports of her heart feeling funny had gone away and when taking her pulse during that visit, it was 92 which was good treatment progress (Briars & Todd, 2016).

Decision #3

Decision Selected

Maintain the current dose of Ritalin and re-evaluate the patient again in 4 weeks.

Reason for Selecting This Decision

Based on the client’s previous visit, it was evident that all her symptoms were well contained and her attention could be sustained during the entire school day. Besides, by changing to a long-acting preparation, the side effects that the client experienced went away. It should also be noted that there is no indication to increase the dosage and as recommended by the FDA, maintaining low effective dosages of stimulant medications is the most preferred approach of managing ADHD (Tarrant et al., 2018). Thus, maintaining the current dosage of Ritalin and re-evaluating the client after 4 weeks is the best decision. Ritalin remains the best medication choice for the symptoms of inattentiveness and deficits in concentration. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

Expected Outcome

                        It was expected that the patient will show more improvement as compared to the previous visit. Her symptoms of forgetfulness, inattentiveness, generally lacking interest in school work and poor spelling will totally be diminished and will no longer have tachycardia or other side effects caused by Ritalin(Huss, et al, 2017).

Difference between Expected Outcome and Actual Outcome

There was no significant difference between the expected outcome and the actual outcome. The client returned to the clinic after four weeks accompanied by her parents. She reported that her academic performance had continued to improve and was able to focus throughout the day. There were also no reports about tachycardia and the pulse rate was notably 90 during this visit (Thomas et al., 2015)

How Ethical Considerations Might Impact Treatment Plan and Communication with Families and the Client

            From an ethical perspective, in managing pediatric clients with ADHD, the benefits of  treatment should outweigh the potential harm that can be caused by the same treatment.  This, therefore, requires that mental health practitioners strictly observe the ethical principles of non-maleficence and beneficence (Gardner, Ruest & Cummings, 2016).   During discussions regarding the treatment plan with the client and her family, it is mandatory that a mental health practitioner provides true information and remains transparent. He/she should not forget to provide additional information about the benefits, risks and available options for every treatment for a client to choose from (Gardner, Ruest & Cummings, 2016).

Conclusion

ADHD is a complex mental health disorder that develops in preschool years and whose symptoms can manifest either partially or fully entirely to adulthood. Drugs to treat ADHD in adolescents and children exist in long and short-acting formulations. However, formulations that are short-acting of Ritalin which is generally given 2-3 times daily have proven to be very efficacious in reducing the symptoms of ADHD are flexible in terms of flexibility of the dosages. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.

References

Briars, L., & Todd, T. (2016). A review of pharmacological management of attention-deficit/hyperactivity disorder. The Journal of Pediatric Pharmacology and Therapeutics21(3), 192-206.

Gardner, K., Ruest, S., & Cummings, B. (2016). Diagnostic Uncertainty and Ethical Dilemmas in Medically Complex Pediatric Patients and Psychiatric Boarders. Hospital pediatrics6(11), 689-692.

Huss, M., Duhan, P., Gandhi, P., Chen, C. W., Spannhuth, C., & Kumar, V. (2017). Methylphenidate does optimization f

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