Attention Deficit Disorder: Diagnosis and Treatment

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Table of Contents

Assessment
Diagnosis
Planning and Treatment
Implementation and Coordination
Health Teaching and Health Promotion
Outcomes
References

Assessment

Demographics of the Patient

The patient is a nine-year-old girl called Alicia.
The patient lives with her parents and 12-year-old brother in a middle-class neighborhood.
Her father has a small business, and her mother works part-time in a daycare center.

Identifying Features/Complaints

She lacks focus and does not do her homework, which has led to multiple arguments with her parents.
In general, the patient does not appear to care about her studies or academic performance.
Alicia has very low grades (ranging between B and D).
She is lagging behind in class and is poor at reading.
The patient often forgets to hand in her homework.
She has trouble maintaining eye contact.
She has trouble concentrating during conversations.
She has had a violent streak.

Past history shows that the patient has had trouble focusing on academic work and has also been reported to have kicked a fellow student. The patient has been taken to a pediatrician, but it was concluded that there was nothing medically wrong with her. She also tested negative for any psychiatric disease. Due to this, there have not been any past medical trials administered to help Alicia live a normal life.

The patient has no history of substance abuse, and neither do her parents. She, however, has problems socializing with others as some children consider her ‘dumb.’ This has affected her self-esteem and could be the reason why she experienced a violent streak. Since she finds it hard to maintain eye contact and concentrate even during conversations, it has been difficult for her to form healthy relationships with people. The constant arguments with her parents over her disinterest in her homework have led both parties to be frustrated with each other. Arguably, the parents do not understand the cause of disinterest and only want their child to perform better in school.

Alicia may pose a risk to her classmates as they do not understand her or her condition. It can be argued that she pushed her classmate due to frustrations caused by a lack of understanding from both involved parties. The patient’s play and sleep patterns are very normal. Eighty percent of a child’s life consists of going to school, and the other 20 percent consists of physical activities (Toselli, Brasili, Iuliano, & Spiga, 2014).With the provided information, therefore, it can be stated that Alicia is only operating on 20 percent of her capacity, which is a very worrying status for a child her age.

Diagnosis

The diagnosis began immediately. The patient arrived at the hospital. The medical personnel who was assessing the patient asked about her early development, and whether she had problems such as late milestones (walking and talking). It was discovered that she had not experienced any developmental problems and that she had always been an active child, except in school.

Since her previous pediatrician had stated that she had no medical condition, Conner’s’ Rating Scales of ADD was implemented to determine whether the patient was healthy or not. This scale is designed to test the patient’s rating in hyperactivity, ADD index, cognitive problems, and oppositional (Singh, 2014). Rating scales are particularly important in diagnosing mental health issues and can diagnose a wide variety of conditions ranging from depression, anxiety to ADD. In as much as they help a physician gather a lot of information regarding the mental state of a patient, it is still imperative that a clinical test is conducted to understand the context in which the condition occurs.

Both clinical and Corners scale results indicate that Alicia has challenges paying attention. It is for this reason that she cannot focus on her homework as it requires attention. Hyperactivity scores were only high with the parents. However, the teachers reported low hyperactivity. Additionally, oppositional behavior was only reported when she was forced to focus on something she did not like, such as her homework.

From the above results, it was clear that Alicia has an Attention Deficiency Disorder (ADD). This is the problem that made her lag behind in school and also lost concentration easily. The stated premise was reached after comparing normal and expected scores with Alicia’s. It is important to note that there was a huge variation in the ability to pay attention to.

ADD has been known to affect children by making them fidget when they are seated (which was observed during consultation), and not adhere to instruction regardless of how many times they are given (case and point the patient’s homework). Also, ADD can, at times, make a child lazy and disobedient. It can be confirmed that Alicia has exuded all the mentioned habits/ characteristics. Suffices to mention, the unique position that Alicia finds herself in, not only affects her but also her parents, her classmates, and her teachers.

Planning and Treatment

The patient can be put on Methylphenidate and Dexamphetamine as the two main drugs for management and treatment. These drugs have the effect of positively affecting the central nervous system, particularly human moods, concentration, and movement. In the case of Alicia, the central nervous system is not sending the right signals regarding the three main components that the patient is suffering (mood, movement, and concentration). These drugs aim at regulating the said issue.

However, the mentioned are trail drugs, and it is recommended that the dose be titrated according to the doctor’s instructions. Alicia should start with a very low dose, which will be increased over time as she is closely monitored for any change and side effects that she may experience. Some of the side effects that may be expected include insomnia, loss of appetite, and nervousness (McCormick, Wilson, Wilson, & Remington, 2013). The said symptoms are, however, expected to reduce overtime. According to Farhud and Shalileh (2014), ADD drugs administered to children also have the potential of causing problems in growth, and Alicia’s height and weight will have to be monitored regularly as well.

Alicia’s parents were quite apprehensive at first about the treatment plan due to the potential side effects that their child would face. The patient’s parents began to consider and inquire about natural remedies for the problem. During their research process, they came across information claiming that omega 3 and 6 supplements could increase the attention capacity of children (Farhud & Shalileh, 2014). The patient’s parents inquired about the possibility of using Omega 3 and 6 supplements. In as much as there is research that argues for the use of Omega 3 and 6 in such a situation, the healing process is slow and guaranteed. That treatment plan will also rob Alicia of a very important stage in her life as she will not be able to enjoy her childhood due to restrictions in playing. It is recommended that the parents stick to the use of the prescribed medication as it will achieve their main goal, which was to make their daughter perform better in school.

Implementation and Coordination

In this case, the treatment plan will take a bit of time as the chosen medication has to be administered in a graduating manner. It is important that the family members work closely with the physician to ensure that Alicia has a smooth healing process. Teachers in the school will also play a huge role in the patient’s recovery. It will be important for the teachers to write up weekly reports on a performance that can be used as an evaluation tool.

The suggested action will help the physician understand whether the treatment is working or not. Creating a good and strong relationship with the patient’s teachers is very important as they will help with the monitoring of the treatment, management, and healing process. If her concentration and focus improve, it will be concluded that the selected medication plan was successful. Any health care professional that comes into contact with Alicia will have to be made aware of the fact that Alicia’s treatment is on a titration basis; thus, unless her personal doctor recommends, the dosage should not be increased.

Health Teaching and Health Promotion

It is important that Alicia’s parents know that healing for ADD is a process, and changes might not be seen immediately after. However, the beginning will be the hardest part, and the child might find it difficult to cope with the new medication. The parents need to help her in any way possible to ensure a quick recovery. For example, in cases of insomnia, they can read her a book until she falls asleep. In as much as the parents might be busy, they should be the only ones who administer the medicine. Alicia’s classmates need to be sensitized on her condition as well. The biggest challenge with this suggestion is that the classmates are very young and will not fully grasp the situation. However, they can be informed not to bully Alicia and also encouraged to play with her often. The school peer counselor can undertake this role.

Alicia should be made aware of the side effects that she might face in simple terms. Her parents should, however, not scare her as she will refuse to take medicine. A counselor can also be used for this. Medeiros-Melo and Garcia (2016) identify insomnia to be one of the causes of agitation, and it can be argued that the patient might end up being violent with other kids while in the said state of agitation. Parents and teachers should, therefore, be on the look-out for such to avoid fights and discomfort.

Outcomes

ADD medication is not cheap, and the treatment process is also very long. Because of the said reason, Alicia’s parents need to be advised on a payment plan that will ensure consistency of Alicia’s medication. The physician is best placed to give such advice, and can also tell the parents any alternative ways they can pay for the medication or treatment, for instance, through insurance. It is the sole responsibility of a physician to offer comfort to both patients and their caregivers (Reed & Shearer, 2012). One expected outcome of the treatment plan suggested, if taken according to the doctor’s instructions, is that there will be improved concentration levels in the patient.

In order to determine success, it is important that Alicia is assessed from time to time throughout the course of the treatment. A self-generated report that can be done by the parents to highlight changes or lack thereof should be drafted in the form of a schedule. Additionally, there are some providers administered tools such as Conner’s rating scale that can be used by the physicians to assess the patient.

References

Farhud, D., & Shalileh, M. (2014). Relation between omega 3 fatty acid, iron, zinc and treatment of ADHD. Zahedan Journal of Research in Medical Sciences, 16(8), 1-5.

McCormick, P. N., Wilson, V. S., Wilson, A. A., & Remington, G. J. (2013). Acutely administered antipsychotic drugs are highly selective for dopamine D2 over D3 receptors. Pharmacological Research, 70(1), 66-71.

Medeiros-Melo, A. C., & Garcia, L. P. (2016). Involvement of school students in fights with weapons: Prevalence and associated factors in Brazil. BMC Public Health, 16(1), 1-10.

Reed, P., & Shearer, N. (2012). Perspectives on nursing theory. Philadelphia, PA: Wolters Kluwer.

Singh, S. S. (2016). Effects of mindfulness therapy in managing aggression and conduct problem of adolescents with ADHD symptoms. Indian Journal of Health & Wellbeing, 7(5), 483-487.

Toselli, S., Brasili, P., Iuliano, T., & Spiga, F. (2014). Anthropometric variables, lifestyle and sports in school-age children: Comparison between the cities of Bologna and Crotone. HOMO – Journal of Comparative Human Biology, 65(6), 499-508.