ATTENTION-
DEFICIT/HYPERACTIVITY
DISORDER
Deborah Heffington
Patient Scenario
Chief Complaint: " My teacher is mad ‘cause I don’t get my work done.”
History of Present Illness: O.H. is an 8 yo female who presents for evaluation of increased
distractibility, loss of concentration, restlessness and fidgeting, and impulsivity causing
interpersonal difficulties with her peers in her third-grade classroom. Her teachers report O.H. is
unable to complete her classwork and requires continual refocusing of attention to the tasks at
hand. They attempted to decrease distracting stimuli and moving her closer to the teachers
without significant success. Her parents have noticed the same behaviors at home when trying to
complete homework assignments or her chores.
O.H. underwent physical and eye examinations 6 months prior to rule out other medical
diagnoses. At that time, she was fitted with a pair of corrective lenses to address a minor vision
impairment and her diet was adjusted to reduce her intake of highly processed foods and sugar.
Finally, the patient and her parents began to work with a therapeutic mental health professional in
parent training in behavior management (PTBM) with a goal of implementing behavioral
interventions to address her symptoms, utilizing positive reinforcement. Her parents are
concerned with her ongoing attention problems, impulsivity, emotional lability, and the patient’s
reports of social isolation and bullying because of her behaviors at school and inability to stay
focused in her classroom. . Both her parents and teachers each completed an ADHD Rating Scale-
5 to assess for the six domains of ADHD impairment which indicated a diagnosis of ADHD. The
patient and family present for discussion and treatment recommendations.
“the ADHD Rating Scale–5 assesses six domains of impairment that are common among children with ADHD:
relationships with significant others (family members for the home version and teachers for the school version), peer
relationships, academic functioning, behavioral functioning, homework performance, and self-esteem” (Barbaresi et
al., 2020, p.S62)
Social History Family History Past Medical History
Patient is the biological granddaughter of her
Father: HTN, DM II
adopted parents. She lives with both parents and Seasonal Allergies
has 4 older adult siblings. She is UTD on all Mother: Hypothyroid
vaccinations and has achieved all anticipated
developmental milestones. There are no concerns Siblings:1 brother and 3 sisters. All in
with her developmental or intellectual abilities to good health. Brother was diagnosed
Medications
learn.
Patient is in the third grade and performs well with ADHD at age 7. Biological Allegra (fexofenadine) 30mg/
academically, when able to remain on task. Her
grades and assessments indicate that she is highly
mother diagnosed with ADD at age 5ml every 12 hours as needed
intelligent. She enjoys art, music, and socializing and 10. MVI daily
participates in organized swimming and volleyball
activities
Treatment Plan
Adzenys XR-ODT(Amphetamine Extended Release) 9.4 mg. Dissolve 1 tablet on
tongue every
This study morning.
source (Maybyskip
was downloaded doses on weekends
100000884024057 and school
from CourseHero.com holidays).
on 11-21-2024 11:53:22 GMT
-06:00
https://www.coursehero.com/file/240031977/Understanding-ADHD-in-Children-Evaluation-and-Treatment-
Options/
, Rationale “For elementary and middle school–aged children (age 6-12 years) with ADHD, the PCC should prescribe FDA–
approved medications for ADHD, along with PTBM and/or behavioral classroom intervention… Educational
interventions and individualized instructional supports, including school environment, class placement,
instructional placement, and behavioral supports…and often include an Individualized Education Program (IEP).
(Grade A: strong recommendation for medications; grade A: strong recommendation for PTBM training and
behavioral treatments for ADHD implemented with the family and school.)(Wolraich et al., 2020, p. 17).
South Carolina has some laws and regulations that affect the nurse
South Carolina practitioners who prescribe behavioral health medications. Here are some of
them:
Nurse Practice Act: Nurse Practitioners must complete an accredited
graduate program in their specialty area, achieve national certification, apply
for APRN licensure with the Board of Nursing, and apply for prescriptive
authority if they plan to prescribe medications (SC Legislature, 2023).
Code of Laws - Title 44 - Chapter 22 - Rights Of Mental Health Patients: This
law defines authorized health care provider as advanced practice registered
nurses and physician assistants licensed in South Carolina and authorized to
provide specific treatments, care, or services pursuant to their respective
practice acts in Title 40. This law affects the rights and responsibilities of
nurse practitioners who prescribe behavioral health medications to mental
health patients (SC Legislature, 2023)
The Affordable Care Act and Behavioral Health Care
The Affordable Care Act (ACA) paired medical care coverage
expansion, leading to increased access to mental health care.
Expansion efforts ensured that young people could stay in their
parent's plans until the age of 26 years, which reduced the number of
uninsured.
The expansion of coverage also ensured that individuals could access
preventive services such as mental screening at no cost.
Due to the ACA, plans could no longer deny coverage or impose cost
barriers on patients with preexisting mental conditions.
The ACA generally led to improved coverage, access, and outcomes
(Courtemanche et al., 2018).
ACA Impacts on O.H.'s Behavioral Health Treatment
The benefits from coverage under the Affordable Care Act (ACA), ensures that O.H. will have
access to a variety of insurance plans, coverage of mental health care, and the provision of
preventative services. Because of the existence of the program, she will be able to have an
evaluation of his mental health to acquire a diagnosis of ADHD and obtain access to the proper
treatment choices. In the end, this all-encompassing coverage, and O.H.'s access to treatment
can contribute to her general mental health, increased success in learning, and her emotional
well-being.
This study source was downloaded by 100000884024057 from CourseHero.com on 11-21-2024 11:53:22 GMT
-06:00
https://www.coursehero.com/file/240031977/Understanding-ADHD-in-Children-Evaluation-and-Treatment-
Options/
DEFICIT/HYPERACTIVITY
DISORDER
Deborah Heffington
Patient Scenario
Chief Complaint: " My teacher is mad ‘cause I don’t get my work done.”
History of Present Illness: O.H. is an 8 yo female who presents for evaluation of increased
distractibility, loss of concentration, restlessness and fidgeting, and impulsivity causing
interpersonal difficulties with her peers in her third-grade classroom. Her teachers report O.H. is
unable to complete her classwork and requires continual refocusing of attention to the tasks at
hand. They attempted to decrease distracting stimuli and moving her closer to the teachers
without significant success. Her parents have noticed the same behaviors at home when trying to
complete homework assignments or her chores.
O.H. underwent physical and eye examinations 6 months prior to rule out other medical
diagnoses. At that time, she was fitted with a pair of corrective lenses to address a minor vision
impairment and her diet was adjusted to reduce her intake of highly processed foods and sugar.
Finally, the patient and her parents began to work with a therapeutic mental health professional in
parent training in behavior management (PTBM) with a goal of implementing behavioral
interventions to address her symptoms, utilizing positive reinforcement. Her parents are
concerned with her ongoing attention problems, impulsivity, emotional lability, and the patient’s
reports of social isolation and bullying because of her behaviors at school and inability to stay
focused in her classroom. . Both her parents and teachers each completed an ADHD Rating Scale-
5 to assess for the six domains of ADHD impairment which indicated a diagnosis of ADHD. The
patient and family present for discussion and treatment recommendations.
“the ADHD Rating Scale–5 assesses six domains of impairment that are common among children with ADHD:
relationships with significant others (family members for the home version and teachers for the school version), peer
relationships, academic functioning, behavioral functioning, homework performance, and self-esteem” (Barbaresi et
al., 2020, p.S62)
Social History Family History Past Medical History
Patient is the biological granddaughter of her
Father: HTN, DM II
adopted parents. She lives with both parents and Seasonal Allergies
has 4 older adult siblings. She is UTD on all Mother: Hypothyroid
vaccinations and has achieved all anticipated
developmental milestones. There are no concerns Siblings:1 brother and 3 sisters. All in
with her developmental or intellectual abilities to good health. Brother was diagnosed
Medications
learn.
Patient is in the third grade and performs well with ADHD at age 7. Biological Allegra (fexofenadine) 30mg/
academically, when able to remain on task. Her
grades and assessments indicate that she is highly
mother diagnosed with ADD at age 5ml every 12 hours as needed
intelligent. She enjoys art, music, and socializing and 10. MVI daily
participates in organized swimming and volleyball
activities
Treatment Plan
Adzenys XR-ODT(Amphetamine Extended Release) 9.4 mg. Dissolve 1 tablet on
tongue every
This study morning.
source (Maybyskip
was downloaded doses on weekends
100000884024057 and school
from CourseHero.com holidays).
on 11-21-2024 11:53:22 GMT
-06:00
https://www.coursehero.com/file/240031977/Understanding-ADHD-in-Children-Evaluation-and-Treatment-
Options/
, Rationale “For elementary and middle school–aged children (age 6-12 years) with ADHD, the PCC should prescribe FDA–
approved medications for ADHD, along with PTBM and/or behavioral classroom intervention… Educational
interventions and individualized instructional supports, including school environment, class placement,
instructional placement, and behavioral supports…and often include an Individualized Education Program (IEP).
(Grade A: strong recommendation for medications; grade A: strong recommendation for PTBM training and
behavioral treatments for ADHD implemented with the family and school.)(Wolraich et al., 2020, p. 17).
South Carolina has some laws and regulations that affect the nurse
South Carolina practitioners who prescribe behavioral health medications. Here are some of
them:
Nurse Practice Act: Nurse Practitioners must complete an accredited
graduate program in their specialty area, achieve national certification, apply
for APRN licensure with the Board of Nursing, and apply for prescriptive
authority if they plan to prescribe medications (SC Legislature, 2023).
Code of Laws - Title 44 - Chapter 22 - Rights Of Mental Health Patients: This
law defines authorized health care provider as advanced practice registered
nurses and physician assistants licensed in South Carolina and authorized to
provide specific treatments, care, or services pursuant to their respective
practice acts in Title 40. This law affects the rights and responsibilities of
nurse practitioners who prescribe behavioral health medications to mental
health patients (SC Legislature, 2023)
The Affordable Care Act and Behavioral Health Care
The Affordable Care Act (ACA) paired medical care coverage
expansion, leading to increased access to mental health care.
Expansion efforts ensured that young people could stay in their
parent's plans until the age of 26 years, which reduced the number of
uninsured.
The expansion of coverage also ensured that individuals could access
preventive services such as mental screening at no cost.
Due to the ACA, plans could no longer deny coverage or impose cost
barriers on patients with preexisting mental conditions.
The ACA generally led to improved coverage, access, and outcomes
(Courtemanche et al., 2018).
ACA Impacts on O.H.'s Behavioral Health Treatment
The benefits from coverage under the Affordable Care Act (ACA), ensures that O.H. will have
access to a variety of insurance plans, coverage of mental health care, and the provision of
preventative services. Because of the existence of the program, she will be able to have an
evaluation of his mental health to acquire a diagnosis of ADHD and obtain access to the proper
treatment choices. In the end, this all-encompassing coverage, and O.H.'s access to treatment
can contribute to her general mental health, increased success in learning, and her emotional
well-being.
This study source was downloaded by 100000884024057 from CourseHero.com on 11-21-2024 11:53:22 GMT
-06:00
https://www.coursehero.com/file/240031977/Understanding-ADHD-in-Children-Evaluation-and-Treatment-
Options/
