Understanding ADHD: A Comprehensive Case Study

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a neurological condition that affects an individual’s mental health. Although symptoms start early in childhood, a practical diagnosis is made in adulthood. According to Posner et al. (2020), around 8% to 13% of all children around the world are affected by ADHD. This condition has been shown to dramatically raise the chance of developing other psychiatric disorders, academic and vocational failure, accidents, criminality, social handicap, and addictions over the course of a person’s lifetime (Posner et al., 2020). In adults, ADHD can have severe implications such as failed relationships and occupational challenges since patients have difficulties focusing on assigned tasks. In many cases, ADHD may be confused with other underlying conditions such as bipolar disorders, necessitating a thorough medical examination. Inattentional/hyperactive-impulsive behavior is a trend of ADHD that persists over time and interferes with one’s ability to function or develop. This paper presents a fictional case of hyperactivity disorder that entails diagnosis, problems, and treatment recommendations.

Identifying information

• Name: Laura Shell
• Age: 48
• Gender: Female
• Race/Ethnicity: Caucasian
• Marital status: Divorced

Reason for referral: “I know I have had ADHD my entire life, but I was never formally diagnosed. I feel like it is really starting to become a problem for me. I am tired of always feeling like I cannot relax and always need to be busy. I am not sure if therapy will be enough or if I need medication, which is why I am here today.”

In summary, Laura is an adult female who came for an ADHD diagnosis. According to her, the symptoms started early in her life, but she had never been formally diagnosed. Although Posner et al. (2020) show that ADHD can begin in childhood, some life events can worsen the condition. This information aligns with Laura’s report since she comments that now the ADHD symptoms are posing severe challenges to her daily life. To facilitate diagnosis and treatment, Laura had to give a concise description of her problem, which is then to be analyzed in line with the DSM characteristics.

Presenting Problem

ADHD presents three main characteristic issues; inattention, hyperactivity, and impulsivity. According to the DSM-5 diagnostic criteria, ADHD is characterized by at least five inattention symptoms present for more than six months in adults above seventeen years (Posner et al., 2020). Hyperactivity and impulsivity are connected in that an individual seems to show interest in multiple projects, but they can quickly abandon them without careful thought of the consequences. The client gave a report that included specific inattention symptoms and hyperactivity as indicated below:

Client report “I am almost 50 years old and always felt like my ADHD was a benefit and helped me with multi-tasking. However, now that I have gotten older, I feel tired, almost like I can’t keep up with my brain anymore. I feel so smart and capable, yet I find that I make a lot of little mindless mistakes and find activities that require complete concentration, physically painfully to my brain. My kids always think I’m not listening, but I really am. I just find myself thinking ten steps ahead of what they are saying. That makes me feel like a bad mom. I feel like I do a bunch of nothing all day but am so busy doing things, which then makes me feel like I’m lazy. I will have five different projects going at once and not complete any of them. I have started more businesses than you can imagine, and, at the moment, I am 110% invested, and within weeks, I get bored and am ready to move on to the next thing. It’s getting really frustrating. My house is a mess, and I just can’t seem to get a handle on it, yet I feel like I clean all of the time. Something as simple as mailing a birthday card is a huge task, yet when I finally do it, it feels like the biggest accomplishment.

From Laura’s report, inattention is demonstrated by several instances. First, making mindless mistakes implies that she can’t pay attention to details. Second, complete concentration feels painful to her brain, and she cannot get her mind to focus. Third, she seems not to listen, even when she has given her children full attention. This symptom shows that although Laura is focused in her mind, she cannot demonstrate the same when interacting with her children. According to Luo et al. (2019), ADHD results in strained parent-child relationships, an element found in Laura’s condition. Although she would love to show full support and concern for her children’s welfare, she cannot organize herself to do it effectively, qualifying it as a disorder beyond her control. Laura also notes that these symptoms have been evident in her life for more than six months.

In addition, Laura demonstrates hyperactivity in that she is busy all day, although she feels like she has done nothing at the end of the day. She also confirms that although she has commenced many projects with 100% initial focus, she ends up completing none of them. This shows that she can multi-task, a trait that was beneficial to her in the past. However, although she gets busy cleaning all day, she confesses that her house is a mess. This further proves her lack of attention since she cannot keep her house in order, showing that she ignores some crucial areas of her cleaning routine. Lastly, impulsivity is demonstrated in her neglect of important projects before she can complete them. Her report indicates that she can abandon all her tasks in a few weeks and be ready for other initiatives. A full diagnosis depends on the patients’ social and medical history, which necessitated a thorough analysis of Laura’s history, noting how it relates to ADHD symptoms, which is indicated in the next section.

History

Family History

A family is a fundamental unit in an individual’s life, affecting physical, emotional, and mental wellbeing. According to Luo et al. (2019), comparing the biological relatives of affected cohorts to those of unaffected controls, family-based epidemiological studies have reported a greater incidence of ADHD in the family members of affected groups. Laura is a divorced woman, living with her four children, two teenagers, and two younger ones below twelve years. She is passionate about parenting and feels that her divorce was unfortunate. She believes that her family is her most important asset and would do anything to support them. She was obedient and loyal to her former husband, although they disagreed on many issues.

Physical Health and occupational history

Laura is five feet tall with no physical deformities and no records of long-term ailments. She has had no surgery throughout her life and does not remember being hospitalized for any condition. Her eyesight is good, and all her senses operate well. However, she notes that she suffers from migraines from time to time, for which she uses over-the-counter painkillers. She worked as a banker for five years, after which she quit to focus on her family and businesses. She operates a clothes shop and is involved in multiple projects involving school wear.

Substance Use and Spiritual Information

Laura is a Christian, born and raised in the Roman Catholic Church. All her children are strong believers, and her family is founded on Christian morals. She has never used drugs in her lifetime and has no intention of using them. She believes that engaging in substance abuse would deter her from focusing on her family and social responsibilities. None of her family members have been involved in substance abuse.

Cultural Factors and Barriers to Successful Treatment

Laura is Caucasian and has adopted the Native American culture. Although she has not been discriminated against on a racial basis, she has lived in North America, where minorities have been segregated in all sectors of society, including hospital settings. She has often fought against racial discrimination, after which she received backlashes from fellow Caucasians. From her social-cultural standpoint, she foresees no barrier to effective treatment.

Mental Status Exam

• Presenting Appearance- fidgety and easily distracted, making it challenging to maintain a medical appointment.
• Thinking ahead
• Difficulties cleaning and organizing the house
• Multi-tasking abilities
• Excellent intelligence levels
• Ineffective operations
• Has normal speech but is sometimes louder.
• Maintains eye contact for a few minutes before being distracted by other objects.
• Difficulties maintaining vocal quality when talking. She is not fluent in her communication.
• Demonstrates delays in content acquisition.
• Normal orientation
• Has difficulties staying alert on simple events and circumstances.
• Mostly non-coherent
• Has difficulties paying attention to small details and forgets soon after hearing a question.
• Thought Processes- directed on the goal but sometimes wanders off the main topic.
• Judgement/ Insight- poor judgement
• Intellectual Ability- shows excellent intellectual ability. She seems not to be affected by the ADHD condition.
• Mood- euthymic mood
• Affect- appropriate Affect, but sometimes gets elevated.
• Suicidal and Homicidal Ideation- no suicidal ideas
• Risk of Violence- no risk of violence

This mental examination confirms that Laura has ADHD, which is distinguished from bipolar disorder. Posner et al. (2020) argue that many patients showing symptoms of ADHD could have bipolar disorder. Therefore, this mental exam confirmed that while bipolar disorder would affect Laura’s moods only, ADHD has affected her attention and hyperactivity dimensions. Although signs of anti-social personality disorder were evident in Laura’s examination, they were less dominant, confirming that she had ADHD. Although she had difficulties staying focused and answering questions coherently, enough evidence was obtained to facilitate medication recommendations.

Recommendations

From Laura’s diagnosis, the most important factors to consider for treatment and management are hyperactivity, distractibility, impulsivity, and poor task adherence. These conditions require particular focus because they interfere with her daily life. Issues with poor task adherence could cost her financially because, as she indicated, she has difficulties finishing simple tasks, and she ends up abandoning crucial projects before completion. If these conditions are handled, she will control her moods more easily and maintain her social relationships, thereby improving her quality of life.

A combination of medication and psychological counseling would yield the best results regarding ADHD treatment and management. According to Luo et al. (2019), people react differently to ADHD treatment, and it is crucial to use stimulants that have minimal side effects. Essentially, stimulants form the first-line intervention for ADHD treatment. In Laura’s case, Dexmethylphenidate, dextroamphetamine, serdexmethylphenidate, lisdexamfetamine, and amphetamine are the most appropriate treatment options. Since these medications can cause insomnia, they should be taken in the morning, as indicated by Posner et al. (2020). Other side effects may include headaches and mood changes, which can be addressed by pain killers and effective social interactions. These medications would boost and eventually balance transmitter levels, effectively treating ADHD symptoms.

Psychological counseling is the second treatment option for Laura’s medical condition. As a counselor, I would begin by educating Laura about her condition, showing her that she can manage it. Since time management seems to be a significant challenge for Laura, I would use examples to show her the best way she can manage her time to enable her to tackle all activities without feeling pressured to perform. Posner et al. (2020) assert that improved problem-solving skills can result from psychological counseling sessions. To this effect, I would recommend cognitive behavioral therapy for ADHD management. These particular techniques help to govern patient behavior and turn negative beliefs into more positive thoughts in this structured sort of counseling session. Luo et al. (2019) show that these methods can assist ADHD patients in coping with life obstacles such as school, work, or relationship difficulties. Cognitive therapy would also help Laura to address other mental and psychological disorders such as chronic depression, which may result from her frustrations.

Answer Key

Diagnosis

• Patient’s name: Laura Shell
• ICD-10 code: F90.0, Attention-deficit hyperactivity disorder, predominantly inattentive type. Although Laura has signs of hyperactivity and impulsivity, her main problem results from a lack of attention to detail. This is also the main problem causing her frustrations and limiting her daily operations.

Key Issues in Order of Importance

• Inattention
• Hyperactivity
• Impulsivity

Symptoms Presented

• Fidgety and easily distracted, making it difficult to maintain a medical appointment.
• Basic Grooming and Hygiene- well dressed and clean.
• She has normal speech but is sometimes louder.
• Maintains eye contact for a few minutes before being distracted by other objects.
• Difficulties maintaining vocal quality when talking. She is not fluent in her communication.
• Demonstrates delays in content acquisition.
• Normal orientation, not affected by ADHD.
• Difficulties staying alert on simple events and circumstances.
• Non-coherent.
• Difficulties paying attention to small details and forget soon after hearing a question.
• Goal-oriented thought processes but sometimes wanders off the main topic.
• Poor judgment.
• Excellent intellectual ability. Seems not to be affected by the ADHD condition.
• Euthymic mood.
• Mood swings
• An appropriate affect that sometimes gets elevated.
• Inability to maintain social relationships

The above symptoms represent a distinct ADHD condition and eliminate the possibility of other psychological disorders. From the mental status examination, Laura proved to be mentally stable and showed no suicidal thoughts. She is not a risk to society but needs immediate help to reduce her frustrations which would cause her to engage in unethical behavior. Apart from the above conditions, Laura displayed other signs and symptoms that are not directly related to ADHD, as indicated below.

Signs and Symptoms not related to the Diagnosis

• Tiredness
• Lack of appetite
• Sleepiness
• Migraines
• Low levels of anxiety
• A desire for perfection

References

Luo, Y., Weibman, D., Halperin, J., & Li, X. (2019). A review of heterogeneity in attention-deficit/hyperactivity disorder (ADHD). Frontiers in Human Neuroscience, 13. Web.

Posner, J., Polanczyk, G., & Sonuga-Barke, E. (2020). Attention-deficit hyperactivity disorder. The Lancet, 395(10222), 450-462. Web.