Case Discussion On ADHD: Thomas Delivers A 36-Year-Old Male

Case Discussion On Adhdthomas Deliver A 36 Year Old Mal

Case discussion on ADHD Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment. According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home. He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments. He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old.

On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time. Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job. Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication. Mr. Deliver is 5'11" and his weight is 165 lb. He takes a men’s multivitamin daily, hydrochlorothiazide (HCTZ) at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.

What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD? Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

Paper For Above instruction

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning. Accurate diagnosis and appropriate treatment are essential for improving outcomes and quality of life for both adults and children. This paper discusses the assessment tools used for diagnosing ADHD in adults like Mr. Deliver, current pharmacological treatment options for adult inattentive-type ADHD, and the differences in pharmacological management for a pediatric case such as Thomas, a 13-year-old male with hyperactive ADHD.

Assessment and Diagnostic Tools for Adult ADHD

The diagnosis of ADHD in adults entails a comprehensive clinical assessment supported by standardized screening instruments. These tools help confirm the presence of symptoms consistent with the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Commonly used screening tools include the Adult ADHD Self-Report Scale (ASRS) v1.1, Conners' Adult ADHD Rating Scales (CAARS), and the Wender Utah Rating Scale (WURS) (Kessler et al., 2005; Adler et al., 2008).

The ASRS is one of the most validated screening questionnaires and consists of a brief 6-item scale that assesses core ADHD symptoms over the past six months (Kessler et al., 2005). CAARS offers a comprehensive evaluation across multiple domains of ADHD behaviors and can be used to confirm symptom severity (Conners et al., 1999). While these screening tools are useful for initial assessment, comprehensive clinical interviews, collateral information, and evaluation of functional impairments are critical for establishing an accurate diagnosis (Barkley, 2014).

Pharmacological Treatment for Adult Inattentive ADHD

The pharmacologic management of adult ADHD primarily involves stimulant medications, including methylphenidate and amphetamines, due to their proven efficacy. Non-stimulant medications, such as atomoxetine, are also recommended, especially in cases where stimulants are contraindicated or poorly tolerated (Castells et al., 2018). For Mr. Deliver, considering his comorbidities and medication profile, a judicious choice of medication must be made, balancing efficacy with potential side effects and interactions.

Current guidelines suggest starting with stimulant medications at low doses with gradual titration to optimal therapeutic levels. Methylphenidate-based formulations, such as extended-release versions (e.g., Concerta or Vyvanse), are often preferred for their convenience and efficacy. Atomoxetine, a selective norepinephrine reuptake inhibitor, may be considered if stimulants are contraindicated or if the patient prefers to avoid stimulant therapy (Faraone & Buitelaar, 2010).

Monitoring is crucial to assess treatment response, side effects such as increased blood pressure, insomnia, or appetite suppression, and to modify treatment as needed. Cognitive-behavioral therapy (CBT) and psychoeducation should complement pharmacotherapy to enhance functional outcomes and address underlying organizational or emotional challenges (Safren et al., 2010).

Pharmacological Management in a Pediatric Hyperactive ADHD Case (Thomas)

In contrast, for a 13-year-old male like Thomas with hyperactive ADHD, pharmacological treatment also typically involves stimulant medications, but the emphasis is often on managing hyperactivity and impulsivity. Short-acting stimulants such as racemic amphetamine or methylphenidate can be used initially, with long-acting formulations (e.g., Concerta, Adderall XR) preferred for adherence and convenience (Prasad, 2013).

Dosing strategies begin with the lowest effective dose, titrated based on symptom control and tolerability. In children, monitoring for side effects such as sleep disturbances, appetite reduction, delayed growth, and potential cardiovascular effects is essential. Non-stimulant options like atomoxetine and guanfacine are also available for pediatric patients, especially if stimulant therapy is contraindicated or causes adverse effects (Biederman & Faraone, 2005).

Behavioral interventions, parent training, and school-based supports are integral components of managing childhood ADHD. Combining medication with behavioral strategies often yields superior symptom control and functional improvements (Pelham & Nigg, 2001).

In summary, age-specific considerations influence pharmacological choices. Adults like Mr. Deliver often require careful attention to comorbidities and medication interactions, whereas management of pediatric ADHD focuses on balancing efficacy with growth and developmental factors.

Conclusion

Proper diagnosis of ADHD involves a combination of screening tools, clinical interviews, and collateral reports. Pharmacological treatment choices should be tailored to the patient's age, symptom profile, and comorbidities. For adults, stimulant medications like methylphenidate and non-stimulants such as atomoxetine are the mainstays, whereas in children, similar medications are used with age-specific adjustments and monitoring. An integrated approach combining medication and behavioral therapy provides the best outcomes in both populations, addressing symptoms and enhancing daily functioning.

References

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• Barkley, R. A. (2014). Taking Charge of ADHD: The complete, authoritative guide for parents. Guilford Publications.
• Biederman, J., Faraone, S. V. (2005). Attention-deficit hyperactivity disorder. The Lancet, 366(9481), 237-248.
• Castells, X., Köhler, S., Ramos-Quiroga, J. A., et al. (2018). Non-pharmacological treatments for adults with ADHD: A systematic review. Systematic Reviews in Psychiatry, 10, 183.
• Conners, C. K., Erhardt, D., Parker, J. D. (1999). Conners' Adult ADHD Rating Scales (CAARS). MHS.
• Faraone, S. V., Buitelaar, J. (2010). Comparing the efficacy of medications for ADHD in children and adolescents using meta-analysis. European child & adolescent psychiatry, 19(4), 353-364.
• Kessler, R. C., Adler, L., Ames, M., et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.
• Pelham, W. E., Nigg, J. T. (2001). Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), S99-S121.
• Prasad, M. R. (2013). Pharmacological management of attention deficit hyperactivity disorder in children and adolescents. Journal of Psychosocial Nursing and Mental Health Services, 51(12), 20-27.
• Safren, S. A., Sprich, S., Chulvick, S., et al. (2010). Cognitive-behavioral therapy for ADHD in medication-treated adults. Behaviour Research and Therapy, 48(2), 165-173.