week 14 responses for Ev and SONi

Replies Post

Reply to at least two of your classmates. In your reply posts, discuss the treatment modalities in your peers’ post in relation to the treatment modalities that you identified in your initial post. Are they similar or different?

RESPONSE 1

Hi Group 5, 

Thank you for the educational post on attention-deficit hyperactivity disorder (ADHD) in children and adolescents. Question #2: discuss one non-pharmacological, complementary, and alternative treatment option. Attention-deficit hyperactivity disorder is one of the most common behavioral disorders, and studies reveal that certain non-pharmacological interventions can benefit children (Krull, 2022). One non-pharmacological treatment intervention for children diagnosed with ADHD can include behavioral interventions such as modifications in the social and physical environments. These interventions teach parents, teachers, or therapists to use rewards and nonpunitive consequences to reinforce desirable behaviors (Krull, 2022; van Langen et al., 2020). Some environmental changes and behavior therapy that parents, caregivers, or teachers can use are maintaining a daily schedule, limiting choices, keeping environmental distractions to a minimum, providing specific and logical places for the child to keep their schoolwork, toys, and clothes, setting small and reachable goals, rewarding positive behavior, identifying unintentional reinforcement of negative behaviors, using charts and checklists to help the child stay on task, finding activities in which the child can be successful such as certain hobbies or sports, and using calm discipline such as timeout distraction and removing the child from this situation (Krull, 2022). A recent study concluded that these behavioral interventions relieved symptoms and improved behaviors in children with ADHD; offered persistent improvements in having longer attention spans, lower impulsivity and hyperactivity scores, and increased full-scale attention quotient and full-scale response control quotient scores (Huang et al., 2021).

References

Huang, X., Ou, P., Qian, Q., & Huang, Y. (2021). Long-term effectiveness of behavioural intervention in preschool children with attention deficit hyperactivity disorder in Southeast China – A randomized controlled trial. BMC Pediatrics, 21(1). https://doi.org/10.1186/s12887-021-03046-8

Krull, K. R. (2022). Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-overview-of-treatment-and-prognosis?search=adhd%20children%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

van Langen, M. J., van Hulst, B. M., Douma, M., Steffers, M., van de Wiel, N. H., van den Ban, E., Durston, S., & de Zeeuw, P. (2020). Which child will benefit from a behavioral intervention for ADHD? A pilot study to predict intervention efficacy from individual reward sensitivity. Journal of Attention Disorders, 25(12), 1754–1764. https://doi.org/10.1177/1087054720928136

RESPONSE 2

1. Discuss one pharmacological treatment options that would be considered and what would indicate the choice of a stimulant medication? When would a non-stimulant medication be preferred?

Hi Group 5,

          Thank you for the well-researched information and references for ADHD in children and adolescents. Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%.  ADHD is defined according to behavioral criteria, based on observation and on informant reports (Drechsler et al., 2020). The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) classifies ADHD as a neurodevelopmental disorder which is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development and it negatively impacts directly social, academic, or occupational activities (Belanger et al., 2018).

           Billy has signs and symptoms of ADHD such as increased impulsivity, forgetfulness, declining school performance, inability to complete a task, dislike towards activities that require sustained mental effort, fidgeting, excessive talking, interrupting other students’ conversation, and inability to stay still (American Psychiatric Association (APA}, 2013). These behaviors were observed by parents at home and teachers at school are more confirming.  Pharmacologic interventions are considered first-line treatment for child and adolescent patients diagnosed with ADHD but co-occurring behavioral interventions and school modifications can enhance care (Schroer et al., 2021). I would consider a Stimulant medication for Billy as it is the most researched, most effective, and first-line prescribed medication to treat children diagnosed with ADHD and is FDA approved (Mechler et al., 2022). I would prescribe Adderall 5mg PO daily, if the patient is tolerating the medication, it can be taken twice a day, and can be increased by 5 mg each week, to the maximum dose of 40 mg per day. Stimulants are fast acting than non-stimulant and patients will see improvement in ADHD symptoms within two hours. It is available in short-acting and long-acting forms and minimizes long-term consequences. The stimulants are very effective in improving frustration tolerance, attention span, impulsivity, organizational skills, retaining information, and academic performances. However, there are some common side effects associated with it such as a decrease in appetite, weight loss, and headaches. Whereas non-stimulant medications can be used when the child or teen experiences intolerance to stimulants with side effects such as weight loss and if the person has a history of addiction. The non-stimulant medication shows the same improvement as stimulants, but it might take 3 to 6 weeks to notice effectiveness (Mechler et al., 2022).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing

Belanger, S.A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1—Etiology, diagnosis, and comorbidity. Pediatrics & Child Health, 23(7), 447-453. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199644/

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://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508636/

Mechler, K., Banaschewski, T., Hohmann, S., & Hage, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, 230, 1-11. https://www.sciencedirect.com/science/article/pii/S016372582100142X

Schroer, M., Haskell, B., & Vick, R. (2020). Treating child and adolescent attention-deficit/hyperactivity disorder and behavioral disorders in primary care. The Journal for Nurse Practitioners, 17(1), 70-75. https://www.npjournal.org/article/S1555-4155(20)30442-6/fulltext