NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology | Week 9

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). NURS 6630:Week 9: Therapy for Clients with ADHD Paper.

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 – NURS 6630:Week 9: Therapy for Clients with ADHD Paper

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 ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications: NURS 6630:Week 9: Therapy for Clients with ADHD Paper

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 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 – NURS 6630:Week 9: Therapy for Clients with ADHD Paper

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.

ADDITIONAL INFORMATION 

Therapy for Clients with ADHD

Introduction

ADHD is a neurodevelopmental disorder that affects at least 7% of children and adults. It’s characterized by inattention, hyperactivity, and impulsivity. There are three main types of ADHD: predominantly inattentive, predominantly hyperactive/impulsive, and combined type (also known as combined type). While the symptoms may vary slightly depending on the subtype you have, they can all be treated with medication or therapy.

Attaching symptoms of ADHD to a “diagnosis” can be helpful for clients.

For some clients, attaching symptoms of ADHD to a “diagnosis” can be helpful for them. By doing so, they can understand their symptoms and find a therapist who specializes in ADHD. It also helps explain the situation to family members and other people who are not familiar with ADHD.

Be aware of the potential for co-occurring mental health disorders in clients with ADHD.

You should be aware of the potential for co-occurring mental health disorders in clients with ADHD. The National Institute of Mental Health estimates that 23 percent of people with ADHD also have at least one other mental illness, including anxiety disorders, depression and substance abuse (1).

It’s possible that these co-occurring conditions may cause some symptoms of ADHD to worsen or change over time (2). For example, if you have both an anxiety disorder and a mood disorder—as one in five adults do—your anxiety could become more intense when you feel stressed out by your symptoms of ADHD (3).

If your client has experienced trauma in childhood or adolescence that has resulted in significant emotional pain and distress for years now but wasn’t addressed before treatment could start working its magic; it’s important for providers to recognize this as part of their process so they’re able help these clients get back on track without making things worse than they already are!

Many clients with ADHD struggle with anxiety, depression, and other mood problems.

ADHD is not just a problem with attention. It’s associated with other mental health problems, including depression, anxiety and mood disorders. In fact, it’s estimated that about 25% of adults with ADHD also have depression or another mood disorder.

So how do you know if your client has an official diagnosis of ADHD? First look at the symptoms listed in their medical records: difficulty staying focused on tasks for longer than 15 minutes; interrupting others when they’re talking; difficulty doing things slowly (such as reading); losing things easily; getting into trouble at school or work because they can’t stay on task for long periods of time (for example forgetting what they’re supposed to be doing). If these criteria sound familiar then there’s a good chance you’re seeing someone who struggles with this condition every day!

Therapists should be active and directive when treating clients with ADHD.

It’s important to be active and directive when treating clients with ADHD. This includes giving suggestions for what they can do in therapy, such as making eye contact with you or saying “please” and “thank you.” It also means giving examples of active and directive therapy, such as encouraging the client to use his hands when speaking in order to increase volume (or using a pointer), or getting him up out of his chair if he hasn’t moved since entering the room.

You can also help your client feel more confident by taking control of certain situations that may cause anxiety for him or her—for example: telling them not to worry about anything until after the session is over; asking them if there’s anything else you need from them before we start; reminding them not just once but twice before leaving our office (and again after we’ve left); asking how things went today so far and where I see us going tomorrow?

Structured sessions focused on specific goals are helpful for clients with ADHD.

Structured sessions focused on specific goals are helpful for clients with ADHD. An active, directive therapist can help your clients achieve their goals by providing a structure for the session that promotes success and helps them identify specific areas for improvement. The goal of therapy is not to give up or give in, but rather to find ways to improve daily life through positive behaviors and attitudes.

• Structured Sessions: Therapy should be structured and directed towards achieving specific goals in order to maximize treatment effectiveness and maximize outcomes. Clients who have been diagnosed with ADHD need focused attention from their therapists so they can learn how best to manage their symptoms at home or school, as well as any social interactions with others (such as family members).

Concrete, simple language can help clients with ADHD remember what you say during therapy.

When you use concrete language, it’s easier for clients with ADHD to remember what you say. This is because concrete words are easily recognizable and can be used as a means of connecting with your client.

Concrete words include:

• “I am feeling bored today.”

• “I feel like I am not doing anything interesting at work.”

The key here is the use of short sentences and keeping things simple so that the message gets across easily. The active voice also helps clarify meaning by making both subject and verb agree in number (e.g., “I am bored”). You should also make sure that your examples match up with their feelings or situations; if they’re having trouble understanding how something works, ask them questions about how it feels or how they would react in this situation so that they’ll get an intuitive grasp on what’s going on with them mentally when experiencing these kinds of emotions/situations/thoughts etc…

Cognitive behavioral behavioral therapy and behavioral parent training have been found to be effective tactics for ADHD treatment.

Cognitive behavioral therapy is a form of psychotherapy that focuses on helping clients recognize and change their automatic thoughts, beliefs, and behaviors. For example, if you notice yourself becoming anxious or worried about an upcoming event before it happens, cognitive behavioral therapy could help you recognize these thoughts as irrational and change them by replacing them with more rational ones (e.g., “I’m going to be fine”).

Behavioral parent training is another effective tool for ADHD treatment because it teaches parents how to manage their child’s hyperactivity in everyday situations so they don’t have tantrums at school or become frustrated when trying to do homework at home. The most common behavioral parent training program involves teaching parents how to set limits for their children (e.g., no TV after dinner), which helps reduce impulsivity outside of structured environments

Active listening can help create a sense of trust in the client/therapist relationship

Active listening is a method of listening that requires the listener to pay attention to the speaker, respond appropriately and show empathy. It’s important for therapists because it helps create a sense of trust in the client/therapist relationship.

Active listening is also considered an essential skill for anyone who wants to build rapport with others, regardless of their profession or interests. The good news is that active listening can be learned—you just need patience and practice!

Clients should be encouraged to actively participate in their therapy

Clients should be encouraged to actively participate in their therapy. The therapist should help clients understand the importance of active participation and how it will affect them positively.

The following are examples of how therapists can encourage clients to participate actively:

• The client should be aware that they are part of their own recovery process, not just another patient with ADHD or other mental illness.

• The therapist can use role-play scenarios where the client takes on different roles in order to practice being able to make decisions and solve problems effectively. This can help build confidence as well as increase motivation for change within yourself!

Clients with ADHD benefit from therapy that is active and directive.

Clients with ADHD benefit from therapy that is active and directive. During an active listening session, the therapist will ask questions to elicit information from the client and provide appropriate feedback. The goal is to help you become more aware of your own behavior patterns so that you can make better choices in the future.

Structured sessions are also helpful for clients with ADHD because they provide a structure for learning new skills or improving existing ones. Therapy should include activities such as role-playing scenarios where clients are encouraged to try out different strategies until they find one that works best for them; this type of activity helps strengthen weak areas while challenging strong ones at the same time! Concrete language also plays an important role here: instead of using abstract terms such as “I think,” use concrete statements like “I am afraid I might forget my keys when I’m stressed out.” Cognitive behavioral therapy (CBT) involves identifying negative thought patterns and challenging them through behavioral parent training or other interventions like relaxation exercises.”

Conclusion

The key to helping clients with ADHD is for therapists to be active and directive. This means being active in the therapy session, and giving clear instructions when needed. It also means that you should use concrete language when talking with your clients about their symptoms, so they can remember what you say during therapy. Clients should be encouraged to actively participate in their therapy by taking an active role in understanding their own behaviors, learning new skills or strategies for dealing with challenges in everyday life, and working towards specific goals that are important to them