Posted: October 30th, 2023

Case Discussion on ADHD

Case Discussion on ADHD

Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment. According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home. He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments. He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old. On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time.

Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job.

Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.

Mr. Deliver is 5’11” and his weight is 165 lb. He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.

What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?AdultSelf-Report Scale (ASRS-v1.1)/ ConnersAdult ADHD Rating Scale (CAARS)
Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver? Stimulants/Non-stimulant/Non-pharmacological interventions, such as behavioral therapy,
Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?
OTHER STUDENT ANSWER/ Methylphenidate and amphetamines are first-line treatments for ADHD as they are considered the most effective pharmaceutical treatments while stimulants are generally beneficial and safe for up to two years for children and adolescents (Kaiser et al., 2022). Regular monitoring such as monthly evaluation by the psychiatrist has been recommended for long-term treatment. There are indicators suggesting that stimulant therapy for children and adolescents should be stopped periodically to assess the continuing need for medication, decrease possible growth delay, and reduce tolerance. Based on the evidenced research of (Pipe et al., 2022) revealed that non-stimulants such as clonidine, atomoxetine, and lisdexamfetamine have fewer side effects and no addiction liability. Even though methylphenidate and amphetamines are potentially addictive at high doses, stimulants used to treat ADHD have a low potential for abuse. Modafinil has shown some efficacy in reducing the severity of ADHD in children and adolescents which can be prescribed off-label to treat ADHD (Kaiser et al., 2022). Non-pharmacological therapy is encouraged such as cognitive behavioral therapy and psychotherapy are adjunct treatments with pharmacological management.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Submission Instructions

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 evidence-based sources.

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Screening Tools
The Adult Self-Report Scale (ASRS-v1.1) and Conners Adult ADHD Rating Scale (CAARS) would be appropriate initial screening tools to evaluate the presence and severity of ADHD symptoms (McGough et al., 2021). The ASRS is a brief 6-item screener that maps directly to DSM-5 criteria, while the CAARS provides a more comprehensive assessment across domains of inattention, hyperactivity, impulsivity, and self-concept (McGough et al., 2021; Reimherr et al., 2020).
Pharmacological Treatment
Given the diagnostic impression of primarily inattentive ADHD, initial pharmacological management for Mr. Deliver would likely involve a stimulant medication (McGough et al., 2021). Options include long-acting methylphenidate formulations or amphetamine salts (McGough et al., 2021). Stimulants are considered first-line treatment for adult ADHD due to their efficacy, favorable safety profile, and rapid onset of action (McGough et al., 2021; Reimherr et al., 2020). Dosage would need to be carefully titrated to achieve optimal control of symptoms and minimization of side effects.
Alternative options include non-stimulant medications such as atomoxetine if stimulants are contraindicated or not tolerated (McGough et al., 2021). Modafinil has shown some promise as an off-label option as well but requires further research (Reimherr et al., 2020).
Pharmacological Treatment for a Child
For a 13-year-old male meeting criteria for the hyperactive/impulsive presentation of ADHD, initial pharmacological management would also involve stimulant medication, with methylphenidate or amphetamine salts as first-line options (Kaiser et al., 2022; McGough et al., 2021). However, due to concerns around potential effects on growth, cardiovascular function, and addiction risk, pediatric treatment guidelines recommend periodic drug holidays or breaks in therapy to reassess needs (Kaiser et al., 2022; McGough et al., 2021; Pipe et al., 2022). Non-stimulant options such as atomoxetine may provide an alternative for those who cannot tolerate or do not sufficiently respond to stimulants (Kaiser et al., 2022; Pipe et al., 2022).

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