A Young Caucasian Girl With ADHD Essay

A Young Caucasian Girl With ADHD Essay

A Young Caucasian Girl With ADHD Essay

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.A Young Caucasian Girl With ADHD Essay

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.A Young Caucasian Girl With ADHD Essay


Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

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Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.


The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.A Young Caucasian Girl With ADHD Essay

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation


§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?A Young Caucasian Girl With ADHD Essay
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.

Attention deficit hyperactivity disorder (ADHD) refers to a mental disorder of the neurodevelopmental type. Some of its features include difficulties in paying attention, too much activity, or difficulty controlling behavior which is inappropriate for a person’s age (Cormier, 2008). A person suffering from this condition has trouble concentrating and focusing on tasks, has a tendency of acting without thinking, and faces difficulty sitting still. While condition may begin in early childhood, it can continue in adulthood. According to Eme (2012), if ADHD is not treated, it can result to problems at home, at learning institutions, at workplace, and with relationships (Parritz, 2013). This case considers an 8 year old girl who has been diagnosed with attention deficit hyperactivity disorder, predominantly inattentive presentation to determine the best therapy for the girl.A Young Caucasian Girl With ADHD Essay
Decision Point One
Selected Decision
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.
Reason for Selection
Whereas there is no cure for ADHD, the current available treatments involve medications which can reduce its symptoms and enhance functioning. Such treatments comprise medication, psychotherapy, education or training, or a blend of treatments. Methylphenidate is a good prescription because it appears to improve symptoms according to reports by teachers and parents. Other non-stimulant medications are available but they are more equal to methylphenidate in terms of side effects. Moreover, the drug was chosen to reduce hyperactivity and impulsivity and enhance Kate’s ability to concentrate, work, and learn.
Expected Results
It is expected that Kate’s symptoms will be much better when she returns to the hospital four weeks later. In particular, her hyperactivity and impulsivity is expected to reduce and her ability to concentrate, work, and learn expected to improve (Jensen, Arnold & Swanson, 2007). All these changes will sum up to improve her performance in school.
Difference between Expected Results and Actual Results
Actual results reveal that the symptoms are much better though this is only in the morning. In the afternoon she stares off into space and day dreams again. Moreover, the drug has led to a funny feeling in the heart. Kate’s heartbeat has increased to beating about 130 beats per minute.A Young Caucasian Girl With ADHD Essay
Decision Point Two
Selected Decision
Discontinue Ritalin and begin Adderall XR 15 mg orally daily.
Reason for Selection
Adderall XR was selected because it is a once-daily, timed-release stimulant medication. It is mainly used to treat ADHD in children ages 6-12, adolescents, and adults. Kate is currently 8 years old which means she falls in this age bracket. It was administered because it can improve focus for people with inattentive ADHD, and reduce impulsivity and hyperactive conduct.
Expected Results
It is expected to improve Kate’s focus and reduce her impulsivity and hyperactive conduct which could lead to better performance in school. In addition, it is expected to continue treating ADHD (Faraone, 2005). However, unlike Ritalin (methylphenidate) which was only effective in the morning, this drug will sustain Kate’s attention throughout the school day.
Difference between Expected Results and Actual Results
While Kate reported improving academic performance and sustained performance throughout the school day, the experienced tachycardia with this medication.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms of inattention, hyperactivity, and impulsivity that present in multiple settings [1]. Initially ADHD was viewed as a disease of childhood that declined or disappeared in adulthood. Research over the past 30 years has found ADHD to persist in adolescence and adulthood for 50% to 60% of childhood ADHD cases [2]; though ranges as extreme as 4% to 80% have also been reported [1–6].A Young Caucasian Girl With ADHD Essay

Although symptoms of ADHD have been extended developmentally upward to adults and the diagnostic criteria of ADHD have been revised in the DSM-5 to reflect more accurately the experience of affected adults, adult ADHD research is in an early stage [1, 7, 8]. Most ADHD research has focused on homogeneous samples of clinically referred, young Caucasian males [9]. These samples have the advantage of extensive assessment but lack representation from nonclinical groups exhibiting ADHD symptoms [10, 11]. Clinical samples are found to show more symptoms and impairment [11]. Moreover, many of these studies suffer from major methodological shortcomings, including small sample sizes, referral biases, high loss to follow-up, inadequate matching of groups, and lack of gender inclusion and analysis [9, 10, 12]. On the other hand, population-based, representative samples overcome many of these methodological weaknesses, while their findings allow inferences to be made to the general population [11, 13].A Young Caucasian Girl With ADHD Essay

Data on prevalence of adult ADHD are limited, but estimates based on international studies using multistage household probability samples range from 1.2 to 7.3% with an average of 3.4% [14]. No population-based adult ADHD prevalence estimates are available for Canada.

Current research suggests that gender differences in the prevalence of adult ADHD may differ from prevalence patterns reported in children. Studies of ADHD in children find that boys are much more affected than girls, with clinically referred studies having gender differences closer to 9 : 1 and epidemiological studies closer to 3 : 1 [15]. Among adults, results are mixed. Kessler et al. [16] found that diagnosis of ADHD in their survey of 18–44-year olds was 5.4% for men and 3.2% for women, while Faraone and Biederman [6] found no differences (men = 3.0%; women = 2.8%). Information on ADHD and age is very limited, despite the historical controversy on whether ADHD stays the same, declines, changes, or disappears in adulthood. A recent meta-analysis on adult ADHD found that only two studies included participants over 60 years of age; the mean ages of most studies were upper teens to mid-30s [9]. The meta-analysis of these age-limited studies showed a gender by age interaction with symptoms declining as men but not women reached their 40s.A Young Caucasian Girl With ADHD Essay

Clinical studies of adolescents and adults with ADHD have found higher rates of psychopathology, such as mood, anxiety, childhood disruptive, antisocial personality, and substance use disorders compared with control groups [4, 5, 15, 17]. A recent meta-analytic study examining the association of childhood ADHD and substance use and abuse/dependence found that children with ADHD were significantly more likely as young adults to have ever used nicotine, cannabis, and cocaine but not alcohol and were significantly more likely to develop substance use disorders than controls [18].

Those with ADHD are also less likely to enter college and to graduate and generally have 2 years less schooling [19]. They are less likely to be employed and have lower SES and income and higher crash and criminal offence rates, although in some studies direct relationships between ADHD and various delinquencies disappear when comorbid conditions are included [2, 5, 20]. However, Weiss and Hechtman [3] found in their 15-year follow-up that although 50–60% of young adults initially diagnosed with ADHD continue to exhibit symptoms, their adult ADHD patients had lower risk of antisocial or criminal behaviours, despite slightly elevated rates in adolescence. Thus, there is a need for sound epidemiological data to understand the manifestations of ADHD symptoms in adulthood by gender, psychiatric comorbidity, and social outcomes.A Young Caucasian Girl With ADHD Essay

The purpose of this study was to examine prevalence of ADHD symptoms and their relationship with comorbidities and social outcomes and to explore differences by gender, in a large population-based survey of adults in Ontario, Canada.

2. Methods
2.1. Sample
The data are based on telephone interviews (landlines and cell phones) with 4,014 Ontario adults (ages 18 or older) over 24 months between January 2011 and December 2012. The data are from the Centre for Addiction and Mental Health (CAMH) Monitor, an ongoing cross-sectional, computer-assisted telephone survey administered by the Institute for Social Research at York University, Canada (see [21] for details). Each monthly cycle uses a two-stage probability sampling procedure. In the first stage, a random sample of telephone numbers was selected with equal probability from within each regional stratum. In the second stage, one respondent aged 18 or older who was able to complete the interview in English was then selected from within each household according to the most recent birthday of all household members. Response rates based on estimated eligible sample averaged 52.89%.A Young Caucasian Girl With ADHD Essay

2.2. Measures
All scales were based on well-validated measures and demonstrated good internal consistency.

2.2.1. ADHD Measures
(1) Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) was developed by Kessler et al. [22] as part of the WHO Composite Diagnostic Interview. Psychometric validation against DSM-IV based psychiatric diagnoses by experienced clinicians demonstrated that the 6-item, 5-point Likert scale screener was superior to the 18-item version on specificity (99.5% versus 98.3%), sensitivity (68.7% versus 56.3%), total classification accuracy (97.9% versus 96.2%), and Cohen’s kappa (0.76 versus 0.58) [23–25]. Positive ADHD symptoms screen is a total score greater than 13 [25]. (2) Previous ADHD diagnosis was assessed by the item “have you ever been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) by a doctor or health care professional?” (3) ADHD medication use was assessed by items querying if, when and how long, they had been treated with medication for ADHD or ADD by a doctor or health care professional, and whether they are currently taking it (adapted from Ontario Student Drug Use and Health Survey) [26].A Young Caucasian Girl With ADHD Essay

2.2.2. Psychiatric Distress and Medication Use Measures
(1) General Health Questionnaire (GHQ12) is a 12-item, 4-point widely used screening instrument for current psychiatric distress that captures depression/anxiety and problems with social functioning [27–29] with a score of three and higher as a positive screen; (2) depression/anxiety/pain medication use: in the past 12 months have you taken any prescription medication: to reduce depression? to reduce anxiety or panic attacks? for pain?

2.2.3. Antisocial Behaviour Measure
(1) Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview (MINI-APD), a 12-item, dichotomous scale, was designed to provide a short clinical screening tool to assess delinquencies (truancy, cheating/lying/stealing, bullying, and hurting animals/people) before and after age 15. We excluded one item of the MINI-APD (forced someone to have sex before age 15), as required by the ethics review board. A score of three or more on the latter six MINI-APD questions indicated a positive APD screen [30].A Young Caucasian Girl With ADHD Essay

2.2.4. Substance Use and Abuse Measures
(1) Lifetime cannabis and cocaine use (never used = 0, ever used = 1); (2) Alcohol Use Disorders Identification Test (AUDIT) is a validated screening instrument developed by the WHO, to detect individuals at the less severe end of the spectrum of alcohol problems, with a score greater than seven indicating hazardous alcohol use [31–33]. The AUDIT has been extensively used in both national and Ontario surveys which demonstrate the validity of the instrument in Canadian populations and the utility of the 8+ cutoff [34–36]. (3) The cannabis subscale of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a 6-item screening instrument to assess risk of experiencing health and other problems (social, financial, legal, and relationship) from their current pattern of cannabis use, with scores of four or more indicating moderate or high risk of problems [37].

2.2.5. Social Problems
These were self-report items: (1) vehicle crash involvement in past year and (2) ever in lifetime arrested for a criminal offence.A Young Caucasian Girl With ADHD Essay

2.2.6. Sociodemographics
(1) Gender, (2) age, (3) marital status, (4) educational status, (5) employment status, and (6) income were included.

2.3. Statistical Analysis
All analyses used linearized methods based on sample design and weighted by probability of selection. The percentages reported are considered representative for the population surveyed. We used logistic regression analysis to estimate odds ratios for ADHD positive symptoms associated with sociodemographics, previous ADHD diagnosis, medication use, comorbidities, substance use and abuse, and social problems. We conducted separate regression analyses for men and women. We adjusted for age, marital status, education, and employment. Results are based on “valid” responses; responses such as “do not know” and refusals were considered missing data and excluded from analyses.

3. Results
Overall, 3.30% (C.I.2.75%, 3.85%) of the sample screened above the cutoff for positive ADHD symptoms. Table 1 indicates significant differences between those who screened positively and negatively for ADHD symptoms. A greater percent of those who screened positively were younger, less likely to be married, had lower education, and were part-time employed or other, compared to those who screened negatively. A higher percentage of those who screened positively for ADHD symptoms reported previous ADHD diagnosis, psychiatric, substance use, and social problems compared to those who screened negatively.A Young Caucasian Girl With ADHD Essay

Screen Screen
% %
18–24 26 5.4 458 94.6 <0.001
25–44 54 3.9 1346 96.1
45–64 49 3.6 1326 96.4
≥65 4 0.6 666 99.4
Female 76 3.6 2023 96.4 0.254
Male 57 3.0 1847 97.0
Marital status
Married/partner 70 2.6 2584 97.4 0.002
Widowed/sep./div. 18 4.1 421 95.9
Never married 44 5.0 831 95.0
High school 20 5.2 366 94.8 0.015
Completed HS 20 2.5 791 97.5
Some after sec. 56 3.9 1377 96.1
Univ. deg. 33 2.5 1304 97.5
Employment status
Full time 54 2.8 1903 97.2 0.018
Part time 22 5.5 380 94.5
Other 56 3.4 1586 96.6
Household income
<20,000 11 8.3 121 91.7 <0.001
20–49,999 31 15.4 579 94.9
50–100,000 39 19.0 1042 96.4
>100,000 31 2.6 1152 97.4
ADHD previously diagnosed
Yes 22 22.7 75 77.3 <0.001
No 111 2.9 3783 97.1
ASPD screen (≥4)
ASPD 10 25.6 29 74.4 <0.001
Non-ASPD 121 3.1 3791 96.9
Psychiatric distress (GHQ-12)
Yes (+3) 67 11.8 502 88.2 <0.001
No (0–2) 66 1.9 3368 98.1
Ever treated with ADHD meds
Yes 6 15.0 34 85.0 <0.001
No 62 3.3 1802 96.7
Antidepressant meds use
No 48
85 17.5
2.3 227
3633 82.5
97.7  <0.001
Anti-anxiety Meds Use
Yes 27 19.6 111 80.4 <0.001
No 42 2.4 1725 97.6
Pain Meds Use (with and without pres.)
Yes 47 5.3 843 94.7 <0.001
No 85 2.8 2996 97.2
Yes (8+) 25 5.0 477 95.0 0.039
No (0–7) 106 3.1 3295 96.9
Mod/High (4+) 15 7.7 180 92.3 <0.001
Low (0–3) 116 3.1 3678 96.9
Lifetime used cannabis
Yes 94 5.8 1520 94.2 <0.001
No 38 1.6 2329 98.4
Past 12 mths cannabis use
Yes 38 7.3 486 92.9 0.008
No 94 2.7 3352 97.3
Lifetime used cocaine
Yes 32 11.3 251 88.7 <0.001
No 100 2.7 3606 97.3
Ever arrested for a crime?
Yes 23 7.5 284 92.5 <0.001
No 110 3.0 3573 97.0
Crash in past year
Yes 13 6.0 202 94.0 0.03
No 120 3.0 3868 97.0
Table 1

Characteristics of CAMH Monitor survey respondents who screened positively and negatively for symptoms on the Adult ADHD Self-Report Scale-V1.1 January 2011–December 2012.
Examination of sociodemographics by gender indicates (Table 2) that for men and women the odds of screening positively for ADHD symptoms were significantly lower for the 25–44-year-old age group compared to the 18–24-year-old group. However, women aged 45–64 had significantly lower rates than those aged 25–44, and those aged 65 and older showed lower rates than those aged 45–64. For marital status, no differences were found by gender.

Variables Men Women
OR 95% CI OR 95% CI
18–24 (ref.)
25–44 0.18 0.06–0.53 0.13 0.02–0.64
45–64 0.86 0.36–2.03 NS 0.12 0.03–0.40
≥65 0.83 0.47–1.47 NS 0.51 0.28–0.95
Marital status
Married (ref.)
Wid./div./sep. 2.20 0.84–5.77 NS 1.91 0.96–3.79 NS
Never married 1.12 0.44–2.80 NS 1.41 0.73–2.74 NS
<high school (ref.)
High school compl. 0.59 0.33–1.04 NS 0.55 0.28–1.06 NS
Some after sec. 2.1 1.15–3.65 0.93 0.52–1.66 NS
University degree 0.88 0.48–1.59 NS 0.51 0.31–0.83
Unemployed (ref.)
Full time 0.82 0.41–1.67 NS 0.57 0.33–0.98
Part time 2.17 0.94–4.99 NS 0.91 0.46–1.78 NS
NS: not significant, , , and .
Table 2

Odds ratios (ORs) and confidence intervals (CIs) for positive ADHD symptoms by sociodemographic variables for men and women.A Young Caucasian Girl With ADHD Essay
Different patterns emerged between men and women on education and employment. Among men, those who reported not completing postsecondary education showed higher odds of screening positively for ADHD symptoms than those with only a high school education. For women, those who reported achieving a postsecondary diploma or degree showed significantly lower odds of screening positively for ADHD symptoms than those who did not complete a postsecondary degree. For employment no significant differences were observed among men between those who reported being unemployed and those who reported working either full or part time. Among women, however, those who reported being employed full time showed significantly lower odds of screening positively for ADHD symptoms.

The adjusted logistic regression (Table 3) shows variables with significant odds ratios. Those who reported previous diagnosis for ADHD and ADHD medication use showed significantly higher odds of screening positively for ADHD symptoms. Gender differences were also found: women showed much higher odds of screening positively for ADHD symptoms when they had been diagnosed (adjusted odds ratio [OR] 15.04, 95% confidence interval [CI] 6.40–35.25) or treated for ADHD (OR 19.25, CI 7.47–49.61) compared to men who reported being diagnosed (OR 6.14, CI 2.65–14.24) or treated (OR 9.00, CI 3.73–21.70). The results also indicated that psychiatric symptoms and medications were comorbid with ADHD positive symptoms. Those who screened positively on the GHQ for distress and reported antidepressant and antianxiety medication use had higher odds of screening for ADHD symptoms. Women also showed significantly higher odds of screening for ADHD symptoms when they reported using prescription pain killers in the last year, while men showed no significant relationship. Both men and women who reported past year cannabis use and cocaine use ever showed significantly higher odds of screening positively for ADHD symptoms. A Young Caucasian Girl With ADHD Essay