Case Background
The patient is an 8-year-old female, Katie, who has symptoms of attention deficit hyperactivity disorder. Katie’s teacher states that the girl is often inattentive and has problems with concentration, memory, spelling, reading, and calculations. Therefore, the parents sought advice from their family physician, who referred the patient for examination to a psychiatrist. The parents and Katie deny the presence of ADHD because, in their opinion, there is no necessary evidence for this (Attention Deficit Hyperactivity Disorder, n.d.). The patient has no problems with hyperactivity or sudden mood swings.
Assessing the patient’s condition confirmed the presence of predominantly inattentive ADHD. However, the patient’s assessment revealed no cognitive development issues, and all indicators were age-appropriate. Katie has no difficulties with spatial orientation and calculus (Attention Deficit Hyperactivity Disorder, n.d.). Initial interaction with the patient helped to exclude the trauma-related nature of the symptoms. She also denies any visual or auditory hallucinations or obsessive or suicidal ideation. There is no information available on other diseases or medications being taken.
Decision 1
Ritalin (methylphenidate) chewable tablets, 10 mg, were administered orally in the morning as the first-line treatment. This is the minimum dosage of the drug prescribed for the treatment of ADHD (Methylphenidate, n.d.). This option of drug intervention is the most optimal, based on its effectiveness and possible side effects. This drug belongs to the methylphenidate class, which has an immediate effect on ADHD symptoms, reducing their manifestation (Drechsler et al., 2020). This will help the patient cope with problems related to inattention and poor concentration that she experiences at school and improve her learning outcomes.
Other suggested options, such as Wellbutrin (bupropion) XL 150 mg orally daily and Intuniv extended release 1 mg orally at bedtime, do not have the necessary effectiveness for treating ADHD. Non-stimulants, of which bupropion is an example, show little effect in relieving the symptoms of the disorder (Hodgkins et al., 2012). Failure to achieve the desired results in treatment using Wellbutrin may necessitate a change in intervention. Additionally, the use of Intuniv does not have sufficient evidence for use in children under 12 years of age and is only recommended in cases where methylphenidate and amphetamines do not have the desired effect (Drechsler et al., 2020). Moreover, taking Intuniv may cause severe side effects that worsen current ADHD symptoms.
This intervention aims to achieve a reduction in the patient’s ADHD symptoms. This includes increased concentration, decreased feeling “lost,” and improved academic performance (Drechsler et al., 2020). Ethical considerations for prescribing Ritalin include informing the patient and her parents of possible side effects. These may include decreased appetite, sleep disturbance, tachycardia, arrhythmia, nausea, weight loss, and moodiness (Drechsler et al., 2020). After informing the client and her representatives about the risks and benefits of the intervention, their consent must be obtained for initiating treatment.
Decision 2
Since the primary medication showed partial positive results in achieving the set goals, it was chosen to change the medication to another from the same group, Ritalin LA, increasing the dosage to 20 mg and maintaining the same administration schedule. This will help increase the duration of the medication’s effect throughout the day (Drechsler et al., 2020). Additionally, the slight tachycardia the patient reported is a normal side effect. Changing the medication may help stabilize the patient’s heart rate.
Continuing the same dose of Ritalin as an alternative solution may not be an effective approach. Because methylphenidate has an immediate effect on ADHD symptoms, continuing the current treatment plan has no potential benefit (Storebø et al., 2023). Additionally, it does not exclude tachycardia, which the patient experienced during the first 4 weeks of taking the medication. Discontinuation of Ritalin and beginning Adderall XR 15 mg orally daily is unwarranted because the use of methylphenidate has shown positive results in treatment.
This decision is aimed at increasing the period of influence of the drug on ADHD symptoms. In addition, a change in medication is expected to resolve tachycardia resulting from a previous prescription (Storebø et al., 2023). To uphold ethical standards, it is essential to ensure that both the patient and their guardians are fully informed of potential adverse effects before obtaining their formal authorization to proceed with the care plan.
Moreover, since the patient was diagnosed with disturbances in the functioning of the cardiovascular system, it is necessary to constantly monitor the dynamics to identify negative trends in a timely manner (Drechsler et al., 2020). It is important to inform parents about acceptable dosages and actions in case of overdose.
Decision 3
A follow-up of the patient’s condition four weeks after treatment shows positive changes in the duration of the drug’s effect, as well as the elimination of side effects. This determines the continuation of the current Ritalin LA dose. Additionally, the patient will need to undergo reevaluation in four weeks to observe any changes in symptoms (Drechsler et al., 2020). The option of changing the dosage of Ritalin LA to 30 mg orally daily does not have sufficient grounds, based on the patient’s positive response to the current treatment.
In addition, changing the drug in the previous phase of treatment helped stabilize Katie’s heart rate, so an EKG was no longer necessary. However, this diagnosis may be necessary if tachycardia recurs or other disturbances in the cardiovascular system’s functioning appear. This intervention aims to maintain current results. In addition, continuing to take the prescribed medication will gradually improve the patient’s concentration and attention (Storebø et al., 2023).
However, it is necessary to consider the ethical issues that may arise during the treatment process. First, it is essential to inform patients about potential side effects and the importance of seeking prompt help from a specialist (Storebø et al., 2023). Secondly, it is essential to continually monitor the patient’s condition and prescribe additional diagnostics and laboratory tests as needed.
Summary
The choice of Ritalin as a first-line drug intervention is due to its effectiveness. Clinical studies show that methylphenidate shows a positive effect in the treatment of ADHD in patients of different age groups (Storebø et al., 2023). Due to the nature of their effects, they can instantly reduce the negative symptoms of ADHD and increase a person’s performance. Other options lack sufficient evidence for use in treating children or do not have the required effect and are therefore not recommended for use.
However, when prescribing methylphenidate, it is necessary to take into account the ethical issues associated with the use of the drug and work with children. Patients and their representatives should be aware of possible side effects and know what actions to take for effective self-management (Hodgkins et al., 2012). They should be able to independently choose a treatment plan and provide consent to its implementation. Additionally, constant monitoring of the patient’s condition is crucial to identify and prevent negative outcomes.
References
Attention deficit hyperactivity disorder: A young girl with ADHD. (n.d.). Attention Deficit Hyperactivity Disorder. Walden University.
Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics, 51(5), 315–335.
Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD. CNS Drugs, 26(3), 245–268.
Methylphenidate (Rx). (n.d.). Medscape.
Storebø, O. J., Storm, M. R. O., Pereira Ribeiro, J., Skoog, M., Groth, C., Callesen, H. E., Schaug, J. P., Darling Rasmussen, P., Huus, C. L., Zwi, M., Kirubakaran, R., Simonsen, E., & Gluud, C. (2023). Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane Database of Systematic Reviews, 3(3), 1–721.