Week 9 discussion

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 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.NURS6630 Week 9 Discussion – Presentations of ADHD

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.

Note: Retrieved from Walden Library databases.

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. NURS6630 Week 9 Discussion – Presentations of ADHD

 

MORE INFO 

Presentations of ADHD

Introduction

ADHD is a neurodevelopmental disorder that typically presents during childhood and follows a person into adulthood. There are three types of ADHD, as well as several subtypes. Inattentive presentation

Hyperactive-impulsive presentation

Combined presentation

ADHD is a neurodevelopmental disorder that typically presents during childhood and follows a person into adulthood.

ADHD is a neurodevelopmental disorder that typically presents during childhood and follows a person into adulthood. Although it can be diagnosed at any age, many people with ADHD report onset of symptoms in their early teens.

ADHD is classified as either predominantly inattentive or predominantly hyperactive-impulsive (also called combined) based on the type of behavior that causes impairment in daily life. Inattention refers to an inability to focus on tasks or tasks requiring sustained effort such as listening and paying attention; impulsivity refers to an inability to delay gratification in favor of immediate reward; hyperactivity refers to excessive restlessness and fidgeting which may also lead them jumping from one activity into another without finishing what they started.

There are three types of ADHD, as well as several subtypes.

There are three types of ADHD, as well as several subtypes.

• Inattentive presentation: this type of ADHD is characterized by poor attention and concentration, which can cause problems with schoolwork or work-related tasks. People with this form of the disorder may be easily distracted by external stimuli, such as loud noises or bright lights. They also have trouble focusing on details or following instructions. These symptoms can make it difficult for people with this type to do their homework without assistance from others—or even get it done at all!

• Hyperactive-impulsive presentation: this form includes many characteristics found in other forms of ADHD but also includes more intense levels of hyperactivity and impulsivity than other types include (e.g., running around uncontrollably). Additionally, people who have been diagnosed with hyperactive-impulsive presentations may experience mood swings that tend toward depression rather than happiness; this tendency might stem from problems coping with stressors encountered while pursuing goals related to academic achievement (i

Inattentive presentation

• Inattention is the core symptom of ADHD. It’s not that you’re lazy or don’t care, it’s just that your brain doesn’t function as well as it should. You may have trouble focusing on things for long periods of time, forgetting what you were doing previously and having difficulty staying on task.

• You might also have problems with organization, completing tasks and following through with instructions (e.g., “Please pass me my notebook”).

• And if this were all there was to it—if all these symptoms were present in one person—we’d call that person “inattentive.” But remember: There are many types of ADHD presentations!

Hyperactive-impulsive presentation

The hyperactive-impulsive presentation is the most common type of ADHD. Symptoms include trouble paying attention, difficulty staying still, and trouble controlling behavior.

People with this type of ADHD may have a difficult time sitting still in school or at home without fidgeting; they often interrupt others when they speak; they may be restless and unable to stay focused on tasks (and therefore not do well in school); they may respond quickly without thinking about what they’re doing (or saying things that aren’t true). People with this presentation are more likely than those who have other presentations to be diagnosed as having ADD/ADHD because their symptoms tend to appear early in life—often before age 5 years old—and continue into adulthood.

Combined presentation

ADHD is a neurodevelopmental disorder that typically presents during childhood and follows a person into adulthood. There are three types of ADHD, as well as several subtypes. Inattentive presentation includes those with symptoms like difficulty focusing on tasks or paying attention for long periods of time; hyperactive-impulsive presentation includes those who struggle to sit still and may physically act out due to their emotions; combined presentations consist of both inattention and hyperactivity/impulsivity

ADHD has many presentations and may affect each person differently.

ADHD has many presentations and may affect each person differently. Some people are diagnosed with one presentation, while others have more than one presentation. For example, someone who presents as hyperactive may also have a slow start in the morning or afternoon (due to sleepiness). Similarly, someone who presents as impulsive may also be forgetful and absentminded at times (but not all the time).

This can make it difficult for parents and teachers to understand what is going on with their child or student; however, there are some general rules that apply across all presentations of ADHD:

Conclusion

We hope this article has helped give you an understanding of the different presentations of ADHD, as well as some tips on how to determine if your child might have it. We also encourage you to be vigilant about keeping up with their development and looking for signs that could indicate any potential issues in school or behavior problems at home. Good luck!