The 8-Year-Old Girl Who Was Naughty

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The 8-Year-Old Girl Who Was Naughty

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Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date

The 8-Year-Old Girl Who Was Naughty
Case Number
Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty.
Questions for the Patient
a) Do you get sufficient sleep at night and if yes, how frequently do you experience sleep problems?
b) Do you have close friends, what are their names, are they from the same school or the neighborhood, do you talk to or play with them often?
c) Do you allow your small sister to play with your toys? If yes, why or why not.
The rationale for the three questions is to understand how the patient interacts with other people at school and home. ADHD is a condition that impairs the ability of a person to socially interact with other people, make friends and sustain a friendship (Danielson et al., 2018). If the answers indicate she has a poor relationship, it will be a good starting point to know if further information is needed. The questions will also be essential in assessing the severity of the condition.
Relevant People and Questions
The relevant people who can provide further information on the patient’s condition include the mother, grandmother, and teachers. The father is rarely available and thus he cannot provide critical information. Her little sister is 6 years and thus unable to comprehend such questions. The reason for selecting the three categories of people is because they interact with the girl often. For example, the teachers are with the girl at school while the mother spends time with her daily at home. Therefore, they can provide critical information about her mental health and behavior. The mother is also essential in providing the medical history of the patient.
The three categories of people should answer questions such as;
a) When did the symptoms begin and what has been the progress? Is the girl worsening or improving or no change at all?
b) Are there any health stressors or risk factors for the condition at home or in school?
c) How do you respond to her behavior and how does she respond, does she improve or get worse?
d) Under which circumstances does the girl demonstrate the behaviors or what triggers the negative or naughty behavior?
e) How is the child disciplined at home and how does the parent or the little sister respond?
f) How does the girl behave in school and how do teachers respond to her behavior.
Physical exams and Diagnostic Tests
Physical exams will focus on assessing the patient to find out the symptoms related to the suspected conditions. In this case, the provider will assess the condition of a patient by observing and using specific questioning. For example, it is essential to document the grooming, physical signs, the child’s size, interaction with friends and family members and nutritional value (Rohlman et al., 2019). For example, a patient’s mood affects the mental condition, memory, thought process, and judgment should be evaluated. Additionally, it is essential to use child and adolescent psychological assessments to determine the level of intellectual disability of a child (Rohlman et al., 2019). For instance, Behavioral System Assessment for Children (BSAC) is essential in assessing the intellectual disability (Rohlman et al., 2019).
The test and examinations should also involve reports from the teacher, parent, and child. The reports will assess the personality in what is called multi-reporter assessment. The assessment will be based on home, school, and community. Another technique is the ADHD rating scale which involves the symptoms included in the DSM-IV assessment of ADHD (Cortese et al.., 2018).
A broadband rating scale is also necessary to assess the condition of the patient. The assessment tool is essential in internalizing symptoms of ADHD such as feeling withdrawn, anxious or depressed. It also helps in externalizing behaviors other than ADHD such as aggression (Cortese et al.., 2018). The various rating scales are essential to ensure an accurate assessment of the symptoms is carried out.
Three Differential Diagnosis
1. Conduct disorder – the condition involves engaging in risky behavior that can harm self. A child engages in violent behavior that violates the safety and rights of other people (Wegner et al., 2017). Treatment involves psychosocial interventions and antipsychotic drugs that are effective in addressing the assaultive behavior.
2. Opposition Defiant Disorder (ODD) – Opposition defiant disorder involves negative behavior, disobedient and hostile characteristics. Children with ODD are not respectful since they oppose authority figures such as parents or teachers (Wegner et al., 2017). They also fail to take responsibility and thus shift the blame to other people.
3. ADHD – The symptoms indicate that the child is suffering from ADHD. The results of the diagnosis and the comparison with other conditions indicate that the girl has ADHD (Wegner et al., 2017). The condition causes hyperactivity and impulsivity. Symptoms include difficulty in paying attention or sitting for a long time. Other problems include poor relationships with other people, lack of focus and unfinished tasks.

Two Pharmacological Agents
Guanfacine XR – The medication is a norepinephrine receptor agonist and non-stimulant drug for pediatric ADHD patients. The drug is effective for patients with ADHD and hypertension among children between 6-17 years of age (Hoogman et al., 2017). It is also prescribed for other conditions such as oppositional defiant behavior and pervasive developmental disorders. Patients should start with a small dose and increase the dosage if necessary. The decision to increase is based on the outcomes (Hoogman et al., 2017). It has side effects such as dizziness, sedation, dry mouth, constipation, hypotension, fatigue, and abdominal pain.
Methylphenidate – The drug is effective for pediatric patients with ADHD. It is a stimulant that is popular for the treatment of ADHD among children. The drug has side effects such as increasing the heart rate and can cause tachycardia (Rohlman et al., 2019). Other side effects include irritability, insomnia, headache, nervousness, headache, and nausea. It should be taken with caution since it can slow down the growth in children. It helps stabilize the mood and improve the focus of children, especially in classwork (Rohlman et al., 2019). The drug works by affecting the chemical components in the brain that lead to hyperactivity, impulsive behavior or narcolepsy. The maximum dosage is 30mg per day.
The best decision is to select Methylphenidate since it is approved for children and has a long history of effectiveness. The only major side effect is tachycardia which can be managed using a small dose (Cortese et al.., 2018). It is effective compared to Guanfacine which is not approved and with little evidence on its effectiveness in treating ADHD in children.

Check Points
The prescription of Methylphenidate will require to follow up clinics after every four weeks. The decisions will be made after four weeks to determine if the dose should be increased or reduced. For example, initially, the patient can take 10mg tablet every morning. However, if the heart rate is above 110 after the four weeks, a clinician can prescribe 5mg tablet QID to reduce the heart rate (Cortese et al.., 2018). The follow-up clinics will also be used to assess the progress of the patient at school or even at home. It is also essential to check for compliance of the drug to avoid relapse in the delivery of care.
The mother should also submit the rating scale from the teacher to check the performance of the child. The report indicated that the student was making significant progress in academics. It was also noted that the heart rate was high which requires a small dose to be taken in the next four weeks. The patient also needs to continue coming to the clinic every four weeks. It is not effective to change the medication since drugs for mental disorders can take time before visible evidence is manifested (Wegner et al., 2017). Changing the drug can cause adverse effects on the health of a patient.
Lessons Learned
The process of assessing and collecting data from a child requires collaboration with parents and teachers. The information from various sources is essential in ensuring that a clinician has the right perspective of the situation. It is also important for parents to be involved in the decision-making process. Clinicians should also monitor the health of a child to avoid adverse effects. For example, Methylphenidate can cause tachycardia which can lead to death. Treatment of ADHD requires the support of parents and teachers (Hoogman et al., 2017). For example, parents should ensure that children take the medication as prescribed. It is also not safe to combine various medications since their interaction can undermine the process of recovery.

References
Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., … & Hollis, C. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S2215-0366(18)30269-4
Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among US children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199-212. https://doi.org/10.1080/15374416.2017.1417860
Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S., … & de Zeeuw, P. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310-319. https://doi.org/10.1016/S2215-0366(17)30049-4
Rohlman, D. S., Ismail, A., Bonner, M. R., Rasoul, G. A., Hendy, O., Dickey, L. O., … & Olson, J. R. (2019). Occupational pesticide exposure and symptoms of attention deficit hyperactivity disorder in adolescent pesticide applicators in Egypt. NeuroToxicology, 74, 1-6. https://doi.org/10.1016/j.neuro.2019.05.002
Wegner, L., Stiles, A., Vann, J. J., Rasmussen, E., & Wegner, S. (2017). Assessing the sustainability of an intensive primary care training for children and adolescents with attention deficit hyperactivity disorder. European Psychiatry, 41, S617. https://doi.org/10.1016/j.eurpsy.2017.01.987

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