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 this link provided.

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 ed tab 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.

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