Therapy / Assessing and Treating Clients With ADHD Discussion Assignment

Week 9: Therapy for Clients with ADHD

Tyler, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Tyler, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Tyler was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).
ADHD is a prevalent disorder for clients across the lifespan, as more than 6 million children (CDC, 2016) and 8 million adults (ADAA, 2016) have been diagnosed with the disorder. Like Tyler, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, clients often respond well to therapies and have positive health outcomes.
This week, as you study ADHD therapies, you examine the assessment and treatment of clients with ADHD. You also explore ethical and legal implications of these therapies.

---

Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized therapy plans for clients with ADHD
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
• Evaluate efficacy of treatment plans
• Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
 
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder.New York, NY: Cambridge University Press.
 
To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

• Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
 
To access information on the following medications, click on The Prescriber’s Guide, 5th edtab on the Stahl Online website and select the appropriate medication.
 
Review the following medications:
For ADHD

• armodafinil
• amphetamine (d)
• amphetamine (d,l)
• atomoxetine
• bupropion
• chlorpromazine
• clonidine

• guanfacine
• haloperidol
• lisdexamfetamine
• methylphenidate (d)
• methylphenidate (d,l)
• modafinil
• reboxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.

Optional Resources

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. doi:10.2165/11599630-000000000-00000

Psychiatric Times. (2016). A 5-question quiz on ADHD. Retrieved from http://www.psychiatrictimes.com/adhd/5-question-quiz-adhd?GUID=AA46068B-C6FF-4020-8933-087041A0B140&rememberme=1&ts=22072016

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty
Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter
Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder

• Review this week’s Learning Resources and reflect on the insights they provide.
• Go to the Stahl Online website and examine the case study you were assigned.
• Take the pretest for the case study.
• Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
• Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
• Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
• Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
• Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
• Review the posttest for the case study.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post a response to the following:

• Provide the case number in the subject line of the Discussion.
• List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who were assigned to a different case than you. For example, if you were assigned to Case Study 1, respond to one colleague assigned to Case Study 2 and one colleague assigned to Case Study 3. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 9 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 9 Discussion

Assignment: Assessing and Treating Clients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized therapy plans for clients with ADHD
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
• Evaluate efficacy of treatment plans
• Evaluate ethical and legal implications related to prescribing therapy for clients with ADHD

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: Review all materials from the Discussion.

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.
Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

• This case study will serve as the foundation for this week’s Assignment.

The Assignment

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.
At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • 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.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
• Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:
Week 9 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:
Submit your Week 9 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:
Week 9 Assignment

---

Making Connections

Now that you have:

• Assessed clients presenting with ADHD
• Developed personalized plans of therapy for clients with ADHD
• Examined factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
• Explored ethical and legal implications of prescribing therapy to clients with ADHD

Next week, you will build on your assessment and treatment skills as you examine clients presenting for therapy for impulsivity, compulsivity, and addiction. Therapy / Assessing and Treating Clients With ADHD Discussion Assignment.

Discussion: Treating Childhood Abuse

Week 4: Trauma and Stressor-Related Disorders in Childhood

“He was drunk again, so I should have known better. I should have stayed away from the house, but that would have made him madder. He has done this before, but not nearly this bad. He broke my wrist as I was protecting my mom. The neighbor heard the screaming and called the cops. They hauled him away, but I know he will be back. She always lets him come back.”
Avery, age 14

In August of 2005, thousands of children lost their homes in Hurricane Katrina. On December 14, 2012, the students at Sandy Hook Elementary School experienced the death of 20 of their classmates and six of their teachers. Every day, children experience physical and sexual abuse and neglect by their parents or caregivers. These types of trauma have a lifelong impact on the children involved and those witnessing the events. As much as we try to prevent unwanted childhood trauma and stressors, the phenomena are present in our culture. Childhood trauma is a significant contributor to both physical and mental health problems in children and adults. Discussion: Treating Childhood Abuse.
This week, you examine several cases of child abuse and neglect, and you recommend strategies for assessing for abuse. You analyze influences of media and social media on mental health and evaluate the need for mandatory reporting of abuse. You also submit your Practicum Journal and Assignments.
ORDER A CUSTOM-WRITTEN PAPER NOW

---

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 31, “Child Psychiatry” (pp. 1216–1226)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Discussion: Treating Childhood Abuse.

• “Trauma- and Stressor-related Disorders”

Note: You will access this book from the Walden Library databases.

Pfefferbaum, B., & Shaw, J. A. (2013). Practice parameter on disaster preparedness. Journal of the American Academy of Child & Adolescent Psychiatry, 52(11), 1224–1238. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00550-9/pdf

American Psychiatric Nurses Association. (2017). Childhood and adolescent trauma. Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=4545

Document: Childhood Abuse Case Study (PDF)

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
 
Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. Discussion: Treating Childhood Abuse.
 
To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Posttraumatic stress disorder
citalopram clonidine desvenlafaxine escitalopram fluoxetine fluvoxamine mirtazapine nefazodone paroxetine prazosin (nightmares) propranolol (prophylactic) sertraline venlafaxine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Discussion: Treating Childhood Abuse.

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

• Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
• Chapter 58, “Disorders of Attachment and Social Engagement Related to Deprivation” (pp. 795–805)
• Chapter 59, “Post Traumatic Stress Disorder” (pp. 806–821)
• Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)

---

Discussion: Treating Childhood Abuse

In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse. Discussion: Treating Childhood Abuse.
In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

Learning Objectives

Students will:

• Recommend strategies for assessing for abuse
• Analyze influences of media and social media on mental health
• Evaluate the need for mandatory reporting of abuse

To Prepare for this Discussion:

• Read the Learning Resources concerning treating childhood abuse.
• Read the Child Abuse Case Study in the Learning Resources.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit! Discussion: Treating Childhood Abuse.

By Day 3

Post:

• What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
• How might exposure to the media and/or social media affect the patient?
• What type of mandatory reporting (if any) is required in this case? Why?

By Day 6

Respond to at least two of your colleagues by providing at least two ways that their strategies may be expanded or improved.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 4 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 4 Discussion

---

Assignment 1: Practicum: Week 1 Practicum Journal

By Day 7

Submit your Assignment. Refer to Week 1 for additional guidance.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. Discussion: Treating Childhood Abuse.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:
Week 4 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:
Week 4 Assignment 1

---

Assignment 2: Practicum: Week 3 Decision Tree

By Day 7

Submit your Assignment. Refer to Week 3 for additional guidance.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn2+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn2+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission. Discussion: Treating Childhood Abuse.

Grading Criteria

To access your rubric:
Week 4 Assignment 2 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 2 draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:
Week 4 Assignment 2

---

Assignment 3: Board Vitals

This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point.
These review questions will provide practice that is critical in your preparation for the national certification exam that’s required to certify you to practice as a nurse practitioner. These customized test questions are designed to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability.
You can access Board Vitals through the link sent to you in email or by following the link below:
https://www.boardvitals.com/
By Day 7
Complete the Board Vitals questions.

---

Practicum Reminder

Time Logs

You are required to keep a log of the time you spend related to your practicum experience and enter every patient you see each day. You can access your time log from the Welcome Page in your Meditrek account. You track time individually for each patient you work with. Please make sure to continuously input your hours throughout the term. Discussion: Treating Childhood Abuse.

---

Making Connections

This week, you examined several cases of child abuse and neglect and recommended strategies for assessing for abuse. You analyzed influences of media and social media on mental health and evaluated the need for mandatory reporting of abuse. You also submitted your Practicum Journal and Assignments.
Next week, you analyze case studies to determine the diagnosis and treatment of anxiety disorders. Discussion: Treating Childhood Abuse