You are working at the pediatric hospital during your medical rotations and a mo

Question

You are working at the pediatric hospital during your medical rotations and a mother brings her 11-year old son into the clinic for an evaluation. She reports that he has difficulty completing tasks that he must do for school. Even so, he scores exceptional on all of his tests and has been moved into the Gifted Student program. He seems to be fidgeting and you ask if this is normal, his mother tells you that he fidgets often when the family gathers for dinner or when allowed to watch television. The fidgeting decreases and ability to complete tasks improves after he gets a chance to play outside or after soccer practice. She tells you that if she tries to correct his behavior, ask him to cleanup after himself or clean up the yard and take care of ‘his’ dog he becomes obstinate and refuses to listen to her. She also says that some days after school, he seems to be very sullen and when asked how his day was at school he just responds, “fine,” even though he seems very upset; a response that he also has when he is given an assignment, or project, that he cannot figure out.

Based on your current understanding of Human Anatomy and Physiology, and with the use of correct medical/scientific terminology, generate a 2-3 paragraph response with a diagramed feedback loop describing the physiology of the case, that indicates the systems of the body that are impacted and the physiology of that system which was impacted, include in your response:

What is abnormal in the findings and what is the most likely issue affecting the 11-year old boy? What is the most likely etiology (cause) for the issue? What tests would you want to perform to confirm? What are the possible pharmacological treatments? Are there non-pharmacological treatments?

Explanation / Answer

Fidgeting and ADHD

There are three types of ADHD: inattentive, hyperactive, and combined. Hyperactive and combined ADHD may produce the following behaviors:

fidgeting and squirming
difficulty with quiet activities
excessive talking
interrupting others often

These symptoms are often typical of children.

Causes of Fidgeting

Mild fidgeting appears to be caused by inattention. Serious fidgeting can be caused by conditions such as attention-deficit/hyperactivity disorder (ADHD) and restless leg syndrome (RLS)

Test to diagnose

There's no single test to diagnose ADHD. Instead, doctors rely on several things, including:

Interviews with the parents, relatives, teachers, or other adults
Personally watching the child or adult
Questionnaires or rating scales that measure symptoms of ADHD
Psychological tests

The doctor needs to see how much a person’s symptoms are affecting his daily moods, behavior, productivity, and lifestyle habits. And he needs to rule out other conditions.

With children, the doctor will talk with the parents about ADHD symptoms they have seen. The doctor will want to know what age the behaviors began and where and when the child shows symptoms. The doctor may ask for a behavior report from the child's teacher, report cards, and samples of schoolwork.

With adults, the doctor may want to talk with a spouse or other family members. He'll want to find out if they had symptoms in childhood. Knowing if an adult had ADHD behavior as a child is important for making a diagnosis.

Treatment of ADHD in Children

Attention deficit hyperactivity disorder (ADHD) can take quite a toll on both the adults and the child or teen who has the disorder. It’s tough for the individual who must cope with daily frustrations. It’s rough on family members whose lives are regularly disrupted by the disorganization, outbursts, temper tantrums, or other misbehavior of the child or teen.

It’s normal for parents to feel helpless and confused about the best ways to handle their child in these situations. Because kids with ADHD do not purposely decide to act up or not pay attention, traditional discipline — like spanking, yelling at, or calmly trying to reason with your son or daughter — usually doesn’t work. Fortunately there are treatment options that can help alleviate the symptoms of ADHD and arm families with the tools needed to better handle problem behaviors when they arise.

These interventions include:

Medication
Psychotherapy
A combination of these two approaches

Medications for ADHD

Used properly, medicines such as methylphenidate hydrochloride (Ritalin) and other stimulants help suppress and regulate impulsive behavior. They squelch hyperactivity, improve social interactions, and help people with ADHD concentrate, enabling them to perform better in school and at work.

These medications also may help children with co-existing disorders control destructive behaviors. When used with proper medical supervision, they are considered generally safe and free of major unwanted side effects. (Some children may experience insomnia, stomachache, or headache.) They rarely make children feel “high” or, on the flip side, overly sleepy or “out of it.” Although not known to be a significant problem, height and weight should be monitored with long term use of these medications. These medications are not considered addictive in children. However, they should be carefully monitored in teenagers and adults because they can be misused.

It is important to understand that these medications are not a cure-all, but they can be highly effective when used appropriately in the right dosage for each individual. In fact, as many as nine out of 10 children do better when they are taking one of the most commonly used stimulants. However, in combination with other techniques such as behavior modification or counseling, symptoms may improve even more. Researchers are currently evaluating the effectiveness of medications in combination with these other approaches to determine the best route to take.

Individuals taking any of the medications listed below should see their doctor regularly for a check-up to review the types and timing of ADHD symptoms. The benefits and potential risks of using these medications also should be discussed before the first prescription is filled.

The most commonly used stimulants are:

methylphenidate hydrochloride (Ritalin, Ritalin SR, and Ritalin LA)
dextroamphetamine sulfate (Dexedrine or Dextrostat)
a dextroamphetamine/amphetamine formulation (Adderall)
methylphenidate (Concerta, Daytrana)
atomoxetine (Strattera, marketed as a “non-stimulant,” although its mechanism of action and potential side effects are essentially equivalent to the “psychostimulant” medications)

When these “front-line” medications are not effective, physicians sometimes opt to use one of the following:

buproprion hydrochloride (Wellbutrin) — an antidepressant that has been shown to decrease hyperactivity, aggression, and conduct problems.
imipramine (Tofranil) or nortriptyline (Pamelor) — these antidepressants can improve hyperactivity and inattentiveness. They can be especially helpful in children experiencing depression or anxiety.
clonidine hydrochloride (Catapress) — used to treat high blood pressure, clonidine also can help manage ADHD and treat conduct disorder, sleep disturbances, or a tic disorder. Research has shown it decreases hyperactivity, impulsivity, and distractibility, and improves interactions with peers and adults.
guanfacine (Tenex, Inuniv) — this antihypertensive decreases fidgeting and restlessness and increases attention and a child’s ability to tolerate frustration. Tenex is the short-term preparation, while Inuniv is the long-term preparation.

Duration of treatment

On the one hand, health professionals know that attention deficit hyperactivity disorder is a chronic condition that lasts for years and sometimes for a lifetime. On the other hand, the risks and benefits of medications can change over time, so typically the treating physician and the family need to regularly re-evaluate medication use. Unlike a short course of antibiotics, ADHD medications are intended to be taken for a longer period of time. Parents should anticipate that, for example, if the child begins taking a medication at the start of the school year, then they are generally going to be committed to working with that medication for the rest of the school year. A child’s situation may improve to where other interventions and accommodations kick in and the child can function pretty well without the medication.

Because children change as they grow — and their environments and the demands they face evolve as well — it is important for families and the treating physician to maintain an open line of communication. Problems can be encountered when a family discontinues a medication without discussing their concerns with the practitioner first.

Adults with ADHD also respond well to similar interventions, including stimulant medications. When making treatment choices, practitioners should consider the individual’s lifestyle. While these medicines can be very beneficial, side effects can occur and should be monitored. Non-stimulant medications, including the antidepressant buproprion hydrochloride (Wellbutrin), have been used. Newer reports show other antidepressants such as venlafaxine (Effexor) may be beneficial in adults as well.

Psychotherapy for ADHD

Research has shown that medication alone is not always sufficient. For more than two decades, psychosocial interventions such as parent training and behavioral modifications have been used for children with ADHD. A key goal is to teach parents and educators methods that equip them to better handle problems when they arise. In this approach they learn how to reward a child for positive behaviors and how to discourage negative behaviors. This therapy also seeks to teach a child techniques that can be used to control inattention and impulsive behaviors.

Preliminary research has shown that behavior modification is also effective for children with severe oppositional problems. Such an approach may lower the number or severity of oppositional behaviors, although the underlying condition — ADHD — remains.

Some people with ADHD benefit from emotional counseling or psychotherapy. In this approach, counselors help patients deal with their emotions and learn ways to cope with their thoughts and feelings in a more general sense.

Group therapy and parenting education can help many children and their families master valuable skills or new behaviors. The goal is to help parents learn about the particular problems their children with ADHD have, and give them ways to handle those problems when they arise. Likewise, children can be taught social skills and gain exposure to the same techniques the parents are learning, easing the way for those methods to be incorporated at home.

Support groups link families or adults who share similar concerns.

Hope you got it!

Related Questions

Navigate

• Browse (All)
• Browse Y
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.