Assignment: Assessing and diagnosing a patient with ADHD

Assignment: Assessing and diagnosing a patient with ADHD

Assignment: Assessing and diagnosing a patient with ADHD

Assessment:

-What are the differential diagnoses of Attention Hyperactivity Deficit Disorder?

-Provide a minimum of three possible differential diagnoses and why you chose them. List them from highest priority to lowest priority.

-What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms.

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Plan:

-Describe a treatment plan for a patient diagnosed with ADHD using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research.

All treatment choices must discuss your rationale for the choice supported by valid research.

What are the recommended follow-up plan and parameters for a patient with ADHD?

What referrals would you make or recommend as a result of this treatment?

Include one social determinant of health according to Healthy People 2030 as applied to this case in the realm of psychiatry and mental health.

What are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

Reflection notes:

What would you do differently with this patient if you could conduct a session wth ADHD. If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

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Assessing and Diagnosing a Patient with ADHD

Attention deficit hyperactive disorder (ADHD) is a mental health condition characterized by inattention and hyperactivity commonly diagnosed in childhood. The impact of ADHD affects children’s schoolwork and daily social living. The purpose of this paper is to describe the assessment and treatment plan and reflect on a case of ADHD.

Assessment

The common differential diagnosis for ADHD include:

1. Anxiety disorders
2. Depression
3. Learning disorders

Patients experiencing the above conditions have symptoms that may mimic ADHD (Drechsler et al., 2020). Poor concentration, easy distractibility, and memory loss are commonly seen in anxiety and depressed patients. In addition, he has significant weight loss due to loss of appetite commonly seen in depressed patients.Lastly, just like in ADHD, patients with learning disorders and some anxiety disorders, such as panic disorders, may experience learning difficulties.

My primary diagnosis for the patient is ADHD. According to DSM-V, hyperactive symptoms of ADHD include fidgeting, restlessness, inability to play quietly, excessive talking, motor agitation, inappropriate intrusion, and impatience (Cabral et al., 2020). On the other hand, inattention symptoms include inattention to details, making careless mistakes, not listening when spoken to, not following instructions, and being unable to complete or organize a task. In addition, they avoid tasks that require concentration, easily get distracted, and forgetful. The patient, in this case, has most of the symptoms of ADHD, including symptoms of impulsivity, hyperactivity, and inattention.

Plan

Management of ADHD patients includes the use of pharmacotherapy and psychotherapy. Pharmacologic agents commonly used in ADHD patients include psychostimulants such as methylphenidate (Drechsler et al., 2020). Psychostimulants aim at targeting impulsivity, distractibility, poor task adherence, hyperactivity, and lack of attention. Atomoxetine, a serotonin-noradrenaline receptor inhibitor (SNRI), is a non-psychostimulant that has also been used in patients who fail to tolerate methylphenidate (Nunez-Jaramillo et al., 2021). Other medications that have been utilized include antidepressants such as selective serotonin receptor inhibitors, SNRIs, and tricyclic antidepressants. The drugs can be used as adjunctive therapy for the management of anxiety and depression symptoms that may be present in ADHD patients.

Behavioral psychotherapy is crucial in the management of ADHD symptoms. Psychotherapy aims to improve attention and organizational skills and decrease distractibility (Drechsler et al., 2020). Another form of psychotherapy used is cognitive behavioral therapy, which helps alleviate depression and anxiety symptoms. Additionally, psychosocial treatments such as behavioral parent training and classroom management can allow the patients to adapt to school and home environments(Nunez-Jaramillo et al., 2021). Neuropsychological treatment, a cognitive training intervention, utilizes cognitive exercises to work on memory and impulsivity.

Follow-up for these patients includes looking into symptom alleviation, side effects of drugs used, and the response to the form of therapy used. Additional doses and more intensified psychotherapy are commonly used when the response is sub-optimal. Referrals to psychiatrists are vital while managing patients when the response is sub-optimal or non-tolerant to the medications, allowing for further evaluation (Price et al., 2020). One major social determinant of health I would advocate for ADHD patients is education access and equity. I would advocate for special schools and trained personnel to ensure the facilities can provide a good quality education while meeting their needs in an understanding environment. I would advocate for a health promotion program that engages in physical activity, stress adjustment, and mindfulness relaxation that may help the patient learn how to improve attention, impulsivity, and hyperactivity (Hahn, 2021). For such kind of patient with a previous medication non-adherence, it is crucial to educate the patient about the condition he is experiencing and why he needs to take the prescribed medication.

Reflection Notes

First, I would ensure I address what is causing the medication non-compliance, such as inadequate funds and lack of a therapist or psychiatrist. I would also encourage open communication that would help get more unmentioned concerns the patient may be facing in his employment and at school. I would also recommend the patient to a support group for patients with ADHD to help him adjust. I would need to reintroduce the patient to pharmacotherapy and psychotherapy as part of his treatment plan and schedule for follow-up (Price et al., 2020). The interventions would be successful if the patient is compliant, is reintroduced to medical insurance to cover the costs, can go to his psychiatrists’ or therapists’ consultation visits, and has a supportive social support group. The interventions may fail due to non-compliance, or the case may be a treatment-resistant form of ADHD. Referral is vital, especially when one cannot follow up on the patient (Streeter et al., 2023). examples of referrals include other therapists who may be close to where he works, social workers, or leaders of various ADHD support groups. One may contact the various persons for follow-up on the patient’s progress.

Conclusion

Inattention and hyperactivity are characteristic of ADHD patients. Proper diagnosis is needed to ensure prompt management of the patient. Treatment of ADHD involves psychotherapy, pharmacotherapy, and a good follow-up plan. Close follow-up and patient education for ADHD patients have been associated with positive health outcomes and an improved quality of life.

References

Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08

Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics, 51(5), 315–335. https://doi.org/10.1055/s-0040-1701658

Hahn R. A. (2021). What is a social determinant of health? Back to basics. Journal of public health research, 10(4), 2324. https://doi.org/10.4081/jphr.2021.2324

Núñez-Jaramillo, L., Herrera-Solís, A., & Herrera-Morales, W. V. (2021). ADHD: Reviewing the Causes and Evaluating Solutions. Journal of personalized medicine, 11(3), 166. https://doi.org/10.3390/jpm11030166

Price, M. E., Done, N., & Pizer, S. D. (2020). The Relationship Between Follow-up Appointments and Access to Primary Care. Journal of general internal medicine, 35(6), 1678–1683. https://doi.org/10.1007/s11606-020-05785-3

Streeter, C., Dankyi, S., & Akin-Ojo, I. (2023). Quality Improvement Project: Referral Process for Adults With Suspected ADHD. BJPsych Open, 9(Suppl 1), S76. https://doi.org/10.1192/bjo.2023.247