Value: 5 points
Due: Day 7
To view the grading rubric associated with this assignment, please go to My Grades in the course menu, locate the assignment in the list, and select View Rubric.
Overview
When we discuss attention-deficit/hyperactivity disorder (ADHD), we typically imagine a young boy who is “bouncing off the walls” and getting into trouble at school. We also may consider the lesser-known variant of this disorder, a young girl who is staring out the window during class, unable to answer the question when called on by her teacher. While these are, indeed, two very important presentations of this disorder, they represent only two presentations.
Instructions
For this case study paper, consider a client you have seen in your practicum or, perhaps, a client you have worked with in your practice who has ADHD. You may also consider someone you know in your personal life. It is preferred that you select an adult; however, a child or adolescent client is acceptable.
You will often find that not everyone diagnosed with ADHD presents as the textbooks describe. Approach your paper from this perspective.
Address the following areas in your paper:
• Demographic Information
• Omit identifying information for confidentiality purposes.
• Assessment of School Experiences, Work Experiences, and Interpersonal Relationships
• Assessment of elementary school experiences
• Did your client attend a rural, suburban, or urban school? How did this affect their plan of care and availability of community-based resources?
• Assessment of high school experiences before diagnosis (as applicable)
• Did your client attend a rural, suburban, or urban school? How did this affect their plan of care and availability of community-based resources?
• Assessment of college experiences before diagnosis (as applicable)
• Did your client attend a rural, suburban, or urban school? How did this affect their plan of care and availability of community-based resources?
• Assessment of work experiences before diagnosis (as applicable)
• Assessment of important interpersonal relationships before diagnosis (as applicable)
• Affect on Client and Treatment History
• Discussion of when the client first acknowledged or realized that something was “wrong” and that they were in some way “different” or “unlike” others (as applicable)
• Exploration of the impact of challenges of ADHD on the client’s self-concept/self-esteem (as applicable)
• At what point did they seek help for their condition?
• What treatments were used, and how effective were they?
• Describe a theoretical framework applicable to the care of the client.
• What has changed since effective treatment began?
• Treatment Outcomes
• Overall, how does the client appraise their life’s trajectory since their ADHD was identified and successfully treated?
• Legal and Ethical Issues
• Discuss any legal or ethical issues that may have influenced the client’s care.
• Discuss any cultural and diversity issues that may have influenced the client’s care.
References and Citations
Include citations and references with APA 7th edition format as applicable.
Submit
Submit your approximately six- to nine-page APA-formatted paper in Microsoft Word.
ADHD Case Study
Student’s Name
Institutional Affiliations
ADHD Case Study
Attention Deficit Hyperactivity Disorder (ADHD) has for a long time been known to be a mental illness affecting children. However, the condition is commonly diagnosed among adults today. The prevalence of ADHD is steadily increasing and this is posing a great concern among nurses and other healthcare professionals (Song et al., 2021). The diagnosis of ADHD across age groups is usually based on the diagnostic criteria outlined in the fifth version of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) (Centers for Disease Control and Prevention, 2021). Most adults who are diagnosed with ADHD usually start to develop symptoms during their childhood years. Therefore, it is imperative for nurse practitioners who are handling adults with ADHD to collect information regarding their experiences at school, at work, and in their social settings to understand the history of their present conditions (Waltereit et al., 2020). Nurse practitioners should also analyze how ADHD has affected the patient’s life, treatment history, and therapeutic outcomes after providing patient-centered care. The purpose of this case study is to describe an adult client with ADHD. The analysis will include a description of his demographic information as well as the assessment of his school experiences, work experiences, and interpersonal relationships. The assignment will also discuss the impacts of ADHD on the client’s life, his treatment history, therapeutic outcomes, and legal/ethical issues.
Demographic Information
It is by collecting the client’s demographic information that the nurse practitioner can identify an appropriate caring approach that will generate optimum therapeutic outcomes. The client that will be the focus of the present case study is a 38-year-old male adult who was seen during practicum. Alex (not his real name) resides in a nearby city and has reported to the clinic for the first time for treatment. He reports that he is married with two children aged 10 years and 8 years. The client has denied having any food or drug allergies. Alex’s father and mother are both alive. His parents live in the countryside while he is staying with his family in town. His wife is a secretary who is also employed in a manufacturing company nearby. Their two children are still in elementary school. Alex speaks fluent English and Spanish. He is a college graduate who went through elementary school, high school, and college. He is working as an accountant at a tea factory in the city. He has worked here for the past 5 years. However, Alex indicates that he has was diagnosed with ADHD about 3 months ago. His reason for visiting the clinic is to obtain a medication refill for his medications (Ritalin-LA).
Assessment of School Experiences, Work Experiences, and Interpersonal Relationships
Assessment of Elementary School Experiences
The educational background of a patient influences the type of care plan that will be developed by a healthcare provider. Alex attended elementary school in a suburban educational center located in the community where his parents are currently living. The school is about 1 km from Alex’s home. He indicates that he used to walk to school every day in the company of his two siblings. There were limited healthcare facilities in the community by then. They experienced difficulties accessing healthcare services whenever they were sick because their parents used public means of transport to travel to the dispensary which also lacked drugs most of the time. These challenges negatively affected their plan of care because they could not access the prescribed medications from the available healthcare facilities.
Assessment of High School Experiences Before Diagnosis
The high school that Alex attended is in the same complex as the primary school. The school is a suburban institution located in the same community where they lived with their parents. The institution is about 1 km from Alex’s home. According to Alex, he used to walk to school every day in the company of his two siblings. There were limited healthcare facilities in the community by then. They experienced difficulties accessing healthcare services whenever they were sick because their parents used public means of transport to travel to the dispensary which also lacked drugs most of the time. These challenges negatively affected their plan of care because they could not access the prescribed medications from the available healthcare facilities.
Assessment of College Experiences Before Diagnosis
Alex attended college that is located in an urban area. The urban environment was quite different from the suburban environment where he schooled during his elementary and high school years. While at college, Alex met different people with different lifestyles from that which he used to live while he was still staying with his parents. He lived in a hostel in college with his schoolmates. Unlike his suburban home, the urban college had several healthcare facilities nearby, including the College Health Center. Those facilities that were located far away were easily accessible through different means of transport that were available. Due to limited challenges, Alex found it easy to adhere to health care plans developed by healthcare providers. For example, the prescribed drugs were easily available from chemists and he could easily access other healthcare facilities whenever a referral was made.
Assessment of Work Experiences Before Diagnosis
Alex has been working as an accountant since he graduated from college. He was first employed as an intern but later secured a job in a nearby tea factory. He indicates that he has been working smoothly except for the past 10 months when he started to experience problematic symptoms. These symptoms caused him to visit a healthcare provider about 3 months ago to seek treatment during which he was diagnosed with ADHD.
Assessment of Important Interpersonal Relationships Before Diagnosis
The assessment of a patient’s interpersonal relationships helps the healthcare provider to determine his or her ability to interact with others. Alex indicates that he has positive social connections with others both at home and at work. He further reports that he used to relate well with his peers, a factor that made him make many friends. Alex explains that he has benefited greatly from having positive interpersonal relationships with others.
Impact on Client and Treatment History
Initial Symptoms
Some people can detect that they are unwell based on the strange symptoms that tend to develop over time. Alex first realized that something was wrong about 10 months ago when he began to experience feelings that he did not have before. He states that he could not pay attention to detail while at work. Other symptoms that have been causing trouble include; inability to complete assigned tasks, difficulty organizing tasks, inability to concentrate throughout a conversation, forgetfulness, and he is easily distracted. These symptoms match the DSM-5 criteria of ADHD (Centers for Disease Control and Prevention, 2021).
Impacts of Challenges Caused By ADHD
ADHD normally causes challenges that might negatively affect the self-concept or self-esteem of adult clients. Alex admits that the challenges caused by his ADHD have negatively affected his self-esteem. They have made him feel as if he is different from others. As a result, his interpersonal relationships with others have changed as he always wants to stay in isolated places at work and in other social events. A study conducted by Arsandaux et al. (2021) revealed that ADHD has a direct effect on the self-esteem and depressive symptoms of adults. When not addressed, low self-esteem and uncontrolled depression can cause suicidal ideation.
Initial Point of Seeking Care
Alex reported that he began to seek treatment for his strange symptoms when he realized that he could not pay attention at work and when he faced difficulties organizing his tasks. This was about 3 months ago when his problematic symptoms had lasted for 7 months. At least six symptoms related to inattention must persist for more than 6 months for the diagnosis of ADHD to be confirmed (Centers for Disease Control and Prevention, 2021). Alex felt that seeking care would enable him to get treatment and prevent his symptoms from worsening.
Treatments Used and Their Effectiveness
The healthcare provider prescribed two types of drugs for Alex which he has been using to date. On initial diagnosis, the healthcare provider prescribed 10 mg of Methylphenidate (Ritalin). This is a chewable tablet that Alex was advised to take orally in the morning. However, the drug produced only a slight improvement in disease symptoms after 4 weeks of use. The healthcare provider then changed Alex’s medication to 20 mg of Long-Acting (LA) Ritalin which he was advised to take orally daily in the morning. Methylphenidate (Ritalin) is an evidence-based pharmacological intervention for the treatment of ADHD in adults (Chamakalayil et al., 2021). Ritalin (LA) 20 mg has been effective in reducing symptoms of ADHD.
Theoretical Framework
Applying a theoretical approach in healthcare delivery creates room for identifying the most appropriate treatment interventions based on a patient’s needs. The theoretical framework applicable to the care of Alex is the Health Belief Model (HBM). The rationale for choosing the HBM is the availability of sufficient evidence supporting its effectiveness in directing the treatment of patients with ADHD (Rajcumar & Paruk, 2020). In a study conducted by Rajcumar and Paruk (2020), the researchers revealed that the use of HBM in the treatment of patients with ADHD enables them to understand their mental condition and guides the choice of therapeutic interventions that improve quality of life.
What Has Changed
A lot has changed in Alex’s health and life since effective treatment began. For example, his problematic symptoms have improved. His attention, concentration, and ability to organize tasks have improved (Rajcumar & Paruk, 2020). Alex further reports that he has regained his self-esteem because he now feels like he is the same as other people around him.
Treatment Outcomes
Alex appreciates the effort that healthcare professionals involved in his care have made up to this moment to improve his health and well-being. He indicates that his life trajectory has been full of challenges since he was diagnosed with ADHD. Being a mental condition, ADHD can greatly disrupt a patient’s life, especially when no actions are taken to treat the presenting symptoms (Kazda et al., 2021). According to Alex, the cognitive and psychological impacts of ADHD affected his life. Survival became even more difficult when he could not go to work and could not live a normal life like his friends, colleagues at work, and everybody around him. However, since his condition was identified and successfully treated, Alex is happy that his overall quality of life has greatly improved.
Legal/Ethical Issues
Legal, ethical, and cultural issues have influenced Alex’s care. The ethical issue that the nurse strived to address was the need to communicate clearly and in simple language in a manner that Alex could easily understand (McGraw & Mandl, 2021). The nurse presented concepts clearly throughout the treatment process. This strengthened the therapeutic relationship with the patient and promoted Alex’s contribution to the development of his plan of care. One legal issue that was encountered concerns the need to ensure the privacy of Alex’s electronic health information per the Health Insurance Portability and Accountability Act (HIPAA) rules (McGraw & Mandl, 2021). The nurse applied this legal requirement by ensuring that Alex’s health data remained private and confidential. Moreover, cultural and diversity issues have influenced the care for Alex. Alex is a Latino who has personal perceptions, values, and beliefs about illness, health, and treatment with regards to mental illnesses such as ADHD (Molitor & Dvorsky, 2019). The nurse demonstrated cultural competence during healthcare delivery by integrating Alex’s perceptions, values, and beliefs into the development of his care plan and into health care delivery.
References
Arsandaux, J., Orri, M., Tournier, M., Gbessemehlan, A., Coté, S., Salamon, R., Tzourio, C., & Galéra, C. (2021). Pathways from ADHD symptoms to suicidal ideation during college years: A longitudinal study on the i-share cohort. Journal of Attention Disorders, 25(11):1534-1543. doi: 10.1177/1087054720915246.
Centers for Disease Control and Prevention. (2021). Symptoms and diagnosis of ADHD. https://www.cdc.gov/ncbddd/adhd/diagnosis.html.
Chamakalayil, S., Strasser, J., Vogel, M., Brand, S., Walter, M., & Dürsteler, K. M. (2021). Methylphenidate for Attention-Deficit and Hyperactivity Disorder in adult patients with substance use disorders: Good clinical practice. Frontiers in Psychiatry, 11, 540837. https://doi.org/10.3389/fpsyt.2020.540837.
McGraw, D., & Mandl, K. D. (2021). Privacy protections to encourage the use of health-relevant digital data in a learning health system. NPJ Digital Medicine, 4(1), 2. https://doi.org/10.1038/s41746-020-00362-8.
Molitor, S. J., & Dvorsky, M. R. (2019). Ethical Considerations for assessing parent mental health during child assessment services. Ethics & Behavior, 29(2), 87–100. https://doi.org/10.1080/10508422.2018.1482746.
Rajcumar, N. R., & Paruk, S. (2020). Knowledge and misconceptions of parents of children with attention-deficit hyperactivity disorder at a hospital in South Africa. South African Family Practice: Official Journal of the South African Academy of Family Practice/Primary Care, 62(1), e1–e8. https://doi.org/10.4102/safp.v62i1.5124.
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11, 04009. https://doi.org/10.7189/jogh.11.04009.
Waltereit, J., Haas F., Ehrlich, S., Roessner, V., & Waltereit, R. (2020). Family and developmental history of ADHD patients: a structured clinical routine interview identifies a significant profile. European Archives of Psychiatry and Clinical Neuroscience, 270(8):1047-1061. doi: 10.1007/s00406-019-01047-4.