Pharmacological treatment

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An 8-year-old boy is repeatedly in trouble at school. He has been threatened with suspension after he was verbally and physically aggressive to his teacher. The school has suggested that he has a problem with his concentration and advised his parents to seek help. The school also referred him to the school child psychologist. He keeps wriggling in his seat. His mother says his concentration is fine when he is playing on his computer. What worries her is that he does not seem to think before he does things and will run out across the road without looking.

Summarize the clinical case.

What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic source

 

Sample Solution

Case Summary

An 8-year-old boy is exhibiting behavioral difficulties at school, characterized by aggression, difficulty concentrating, and impulsivity. His mother reports similar behaviors at home, including difficulty focusing and impulsive actions, such as running into the street without looking. The boy’s academic performance is likely to be affected due to his inability to concentrate.

DSM-5-TR Diagnosis

Based on the provided information, the boy’s symptoms align with the diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD), predominantly inattentive presentation. This diagnosis is supported by the child’s difficulties with concentration, impulsivity (as evidenced by running into the street without looking), and hyperactivity (manifested as fidgeting in his seat).

Pharmacological Treatment

Methylphenidate (Ritalin) is a commonly used first-line medication for ADHD. It is a stimulant that improves attention, reduces impulsivity, and hyperactivity. The American Academy of Pediatrics (AAP) recommends stimulant medications as first-line treatment for ADHD in children (American Academy of Pediatrics, 2011).

  1. Attention deficit hyperactivity disorder (ADHD) – Treatment – NHS

 

www.nhs.uk

 

  1. Methylphenidate: a medicine used to treat attention deficit hyperactivity disorder (ADHD). – NHS

 

www.nhs.uk

 

  1. AAP Guideline on Treatment of Children with ADHD – AAFP

 

www.aafp.org

 

Rationale: Methylphenidate has demonstrated efficacy in addressing the core symptoms of ADHD, including inattention, hyperactivity, and impulsivity. It is well-tolerated in most children and has a proven safety profile.

  1. Effect of short-term methylphenidate on social impairment in children with attention deficit/hyperactivity disorder: systematic review | Child and Adolescent Psychiatry and Mental Health

 

capmh.biomedcentral.com

 

Non-Pharmacological Treatment

Behavioral Therapy: A behavior modification program can be highly effective in managing ADHD symptoms. This involves implementing consistent rules, rewards, and consequences at home and school. Parent training and education are also crucial components of behavioral therapy.

Rationale: Behavioral therapy addresses the underlying behavioral challenges associated with ADHD. By teaching parents and teachers effective behavior management strategies, it can improve the child’s functioning at home and school.

Treatment Assessment

Methylphenidate (Ritalin):

  • Appropriateness: Methylphenidate is appropriate for this child based on the diagnosis of ADHD and the severity of his symptoms.
  • Cost: The cost of methylphenidate can vary depending on the specific formulation and pharmacy. However, generic options are available, making it a relatively affordable treatment.
  1. Methylphenidate Cost 2024: Coupons and More – Healthline

 

www.healthline.com

 

  • Effectiveness: Methylphenidate has a well-established efficacy in treating ADHD symptoms.
  1. Efficacy of Cognitive Behavioral Therapy and Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review | Article – Cureus

 

www.cureus.com

 

  • Safety: While methylphenidate can cause side effects such as decreased appetite, insomnia, and headache, these are generally mild and manageable.
  • Adherence: Adherence to medication can be a challenge, especially in children. Regular monitoring and parent education are essential to optimize treatment outcomes.

Behavioral Therapy:

  • Appropriateness: Behavioral therapy is considered a cornerstone treatment for ADHD and is highly recommended in conjunction with medication.
  • Cost: Behavioral therapy is generally more cost-effective than medication alone, as it provides long-term skills and strategies for managing ADHD.
  • Effectiveness: Research has consistently shown the effectiveness of behavioral therapy in improving ADHD symptoms.
  1. Is behavioral therapy an effective treatment for ADHD? – MedicalNewsToday

 

www.medicalnewstoday.com

 

  • Safety: Behavioral therapy is safe and has no associated side effects.
  • Adherence: Adherence to behavioral therapy can be improved through parental involvement and support.

Conclusion

The child in this case presents with symptoms consistent with ADHD, predominantly inattentive type. A combination of medication and behavioral therapy is recommended for optimal management. Methylphenidate is a suitable first-line pharmacological treatment, and behavior modification strat

 

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