Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree
Assignment 1: Practicum: Decision Tree
Introduction
The focus of the assignment is on making three decisions regarding the diagnosis and treatment of a client, 8-year-old Caucasian female with school difficulties. The first decision will involve making a differential diagnosis for the client and providing a rationale for selecting the decision. The second decision will involve making a decision about the treatment pan psychotherapy and providing a rationale for the decision. The last decision will be about treatment plan psychopharmacology and justifying the decision. In addition, the co-morbid physical and mental factors that may affect the diagnosis and treatment of the client will be considered. Finally, the paper will discuss the ethical considerations that may influence the treatment plan and communication with the client and her family. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
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Decision #1: Differential Diagnosis
The selected decision for the differential diagnosis of the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This decision was selected because the client meets the criterion for A1 (inattention) for ADHD.  According to American Psychiatric Association (2013) the DSM-5 criteria confirming diagnosis of ADHD inattention include: the person fails to be attentive to details or makes mistakes in work, classwork, and other activities; difficulties in maintaining attention in tasks or play activities; often seems like one is not listening when spoken to directly; fails to follow through on instructions, does not finish classwork, chore or workplace duties; experiences difficulties in tasks and activities organization; normally avoids, does not like or is unwilling to take part in activities or tasks that need sustained mental efforts such as classwork or homework; regularly misplaces things essential for activities or tasks such as pens, books, toys; gets easily diverted and distracted by unnecessary stimuli and is often forgetful in daily activities (Volkmar et al, 2014). The client meets most of the above symptoms as indicated by the scoring of the Conner’s Teacher Rating Scale, subjective data and mental status exam. The Conner’s Teacher Rating Scale indicated that the client is inattentive, gets distracted easily, makes careless mistakes in her classwork, forgetful about the already learned content, poor in arithmetic, spelling and reading, short attention span and has difficulties in peer interactions. Subjective data indicated that the client could not sit still during the interview, was interruptive and reported that her mind wanders during class Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. The mental status exam revealed that the client’s attention and concentration were somehow limited.  Other standardized assessment instruments that might be essential in identifying symptoms of ADHD include ACTeRS and the Vanderbilt Assessment Scale. In addition, the Child Behavior Checklist can be used to further assess the behavior of the client (Sadock et al, 2014).
By selecting this decision, the expectation was that the correct diagnosis for the client would facilitate appropriate prescribing of the treatment regimen for the client.
Decision #2: Treatment Plan for Psychotherapy
The selected decision is to begin Adderall XR 10 mg orally daily. Adderall is a branded combination of (75%) dextroamphetamine along with (25%) levoamphetamine salts. This decision was selected because Adderall is FDA approved for the treatment of ADHD. In addition, evidence shows that Adderall is a stimulant that is effective in improving and balancing neurotransmitters level within the brain. Adderall also has minimal side effects and has fewer rebound symptoms because the medication wears off gradually and it is typically a long-lasting medication (Lakhan & Kirchgessner, 2013). According to Lakhan & Kirchgessner (2013), Adderall is an extended-release formulation that has a duration action of about 10-12 hours. This is a notably longer duration of action when compared to the majority of other methylphenidate formulations whose duration of action is a maximum of 6 hours. In addition, studies show that Adderall is a neuro-enhancement medication that is effective in memory improvement, improving focus and attention span (Lakhan & Kirchgessner, 2013). Accordingly, Adderall would be effective in treating the symptoms and signs of ADHD for the client. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
By choosing this decision, it was expected that symptoms and signs of ADHD for the client would improve since Adderall has been shown to be effective in improving symptoms such as attention span. Specifically, it was hoped that the client’s disruptive behavior would reduce as well as her ability to focus and pay attention. It was also hoped that the medication would improve the client’s episodic memory and hence reduce her forgetfulness. This is because a study conducted by Advokat & Mindy (2013) demonstrated that Adderall is a stimulant that has the ability to improve episodic memory in individuals with ADHD and also has some cognitive benefit.
The result for this decision was that there was an improvement in signs and symptoms of ADHD for the client as manifested by the ability of the client to be more attentive at school and the ability to maintain attention throughout the morning classes. This outcome was consistent with the expected outcome. However, during the afternoon the client would “daydream” which means she was not able to maintain attention in the afternoon. The reason for the client being not able to maintain attention in the afternoon was that the medication dose administered had worn off and therefore the inattentive symptoms would begin manifesting again prior to the administration of the subsequent dose of Adderall (Advokat & Mindy, 2013).  It was also reported that the client started losing appetite after she started taking Adderall. The loss of appetite for the client can be attributed to the medication’s side effects. Appetite loss is a common side effect with this medication because it suppresses appetite (Sallee, 2015).
Decision #3: Treatment Plan for Psychopharmacology
The selected decision for the client’s treatment plan for psychopharmacology is the addition of a small dose of immediate release of Adderall in the early afternoon. This decision was selected because the client has been showing inattentiveness during the afternoon because by afternoon the medication wears off. Therefore, the addition of a small dose of Adderall in the afternoon for the client will ensure that the client will maintain attention in the afternoon as well. In addition, the addition of a small dose of immediate release of Adderall would help the client to maintain attention during early evening and hence she will be able to do any homework given at school (Heal et al, 2013).
The reason why the decision to assure the parents that weight loss is a common side effect with Adderall was not chosen is because this option will not assist the client in maintaining attention in the afternoon classes. Secondly, the option of augmenting the Adderall treatment with family therapy was not selected because the family therapy would not solve the issue of return of the return of inattentive symptoms during the afternoon classes (Heal et al, 2013). Accordingly, this justifies the decision to add a small dose of immediate release of Adderall in the early afternoon in order to enable the client to maintain attention even during the afternoon. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
Ethical Considerations in Treatment Plan
It will be important to ensure that the professional legal obligations of ensuring optimal treatment for the client are met. Therefore, it should be ensured that the assessment and treatment of Katie is I accordance with the current professional guidelines (American Nurses Association, 2014). Informed consent should be sought from the parents of Katie while Katie should also be allowed to assent to the treatment. This is because any assessment or treatment without seeking informed consent involves a legal misdemeanor of battery. Accordingly, in this case, it will be important to seek consent from the client’s parents but at the same time try to take into account the views and wishes of Katie (Merman et al, 2017). The treatment process for the client will also involve respect for autonomy by obtaining suitable consent Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. Moreover, the hyperactivity presents an ethical conflict between justice and beneficence/non‐maleficence. Other ethical aspects include the addictive effects of ADHD treatments and also evidence shows that ADHD treatment may have irreversible effects on the central nervous system. Accordingly, the healthcare practitioner should educate the client’s parents regarding the potential side effects of the proposed treatment to ensure the parents are fully informed before they consent into the treatment (Merman et al, 2017).
Conclusion
The selected decision for the differential diagnosis of the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This is because the client meets the criterion for A1 (inattention) for ADHD as per DSM-5. The selected decision for decision point two is to begin Adderall XR 10 mg orally daily. The rationale for selecting this decision is because Adderall has been shown to be effective in improving signs and symptoms of ADHD by improving and balancing neurotransmitters level within the brain. The selected decision for decision point three is to add a small dose of immediate release of Adderall in the early afternoon. The rationale for selecting this decision is to ensure that the client will be able to maintain attention even during the afternoon.  Finally, it will be important to seek consent from the parents of Katie and also integrate wishes and views of Katie in the treatment plan. It is also important to educate the parents about the possible side effects of the proposed treatment regimen.
 
 
References
Advokat C & Mindy S. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Front Neurosci. 7(82).
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Heal D, Smith S, Gosden  & Nutt D. (2013). Amphetamine, past and present – a pharmacological and clinical perspective. J Psychopharmacology. 27(6), 479–496.
Lakhan S & Kirchgessner A. (2013). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain Behav. 2(5), 661–677.
Merman S, Laura B, Hans G & Frances A. (2017). ADHD: a critical update for educational professionals. Int J Qual Stud Health Well-being. 12(1): 1298267.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwe
Sallee F. (2015). Early Morning Functioning in Stimulant-Treated Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, and its Impact on Caregivers. J Child Adolesc Psychopharmacol. 25(7): 558–565.
Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 53(2), 237–257.
 
Week 3: Autism Spectrum Disorder, ADHD, ODD, and ICD
”I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She does not care about me. She only cares about my little brother and that man that keeps coming around. I don’t care anything about her. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.  That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.
Jacob, age 11”
There are many mental disorders that occur early in the life course. The DSM-5 describes neurodevelopmental disorders such as autism spectrum disorder and ADHD and disruptive, impulse-control, and conduct disorders, such as oppositional defiant disorder and conduct disorder. These disorders are examined together with a particular emphasis on comparing and contrasting presenting features. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. Diagnosis of these various conditions can rarely be made in a single office setting and often require a comprehensive approach involving multiple stakeholders, including the child, as well as his or her parents, teachers, and other significant figures in the child’s life and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.
The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
This week, you begin exploring disorders that occur early in the life course by working with your group to develop a Parent Guide. You also examine a case to determine a differential diagnosis and treatment plan that incorporates both psychotherapy and psychopharmacology.
Photo Credit: Cultura/Seb Oliver / Cultura / Getty Images
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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
Required Readings
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
•Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
•Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)
•Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253) Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
•“Neurodevelopmental Disorders”
•“Intellectual Disabilities”
•“Communication Disorders”
•“Disruptive, Impulse-Control, and Conduct Disorders”
Note: You will access this book from the Walden Library databases.
Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.
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.
Review the following medications:
Irritability in autism
Attention-deficit/hyperactivity disorder
aripiprazole
risperidone
armodafinil
amphetamine (d)
amphetamine (d,l)
atomoxetine
bupropion
chlorpromazine (hyperactivity)
clonidine
guanfacine
haloperidol (hyperactivity)
lisdexamfetamine
methylphenidate (d)
methylphenidate (d,l)
modafinil
reboxetine
Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
Required Media
Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author.
Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.
•Chapter 51, “Autism Spectrum Disorder” (pp. 665–682)
Assignment 1: Practicum: Decision Tree
For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.
Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
Learning Objectives
Students will:
•Evaluate clients for treatment of mental health disorders
•Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
•Decision #1: Differential Diagnosis
•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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree
•Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
•Decision #2: Treatment Plan for Psychotherapy
•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: Treatment Plan for Psychopharmacology
•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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
•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 and their families. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.
 
 

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