Case Study for Week 6 Discussion
Patient 1:
Malcolm is a 9-year-old male in the 4th grade at the public elementary school. Malcolm
has recently been diagnosed with ADHD, combined presentation. Malcolm struggles
with being fidgety and hyperactive; he often gets into trouble at school for blurting out
answers, getting out of his desk when he should not be, and hitting other children when
upset. Malcolm also has a hard time focusing on anything other than video games at
home. His parents report homework takes “all night” though it should only take 30
minutes. Malcolm has assigned chores but often gets distracted. For example, Malcolm
was to take out the trash but got distracted in the driveway while taking out the trash
and left the full bag in the driveway. He often misplaces the combination code for the
lock on the house door.
Pro Methylphenidate medication assigned to me for this case so you should only focused on the PRO options please
This week, you will present and defend your assigned stance (pro or con) and specific medication for your patient case study scenario with your peers. Within the debate, you will also share your perspective on why the alternative medication class would not be appropriate for the patient case scenario.
Post your response detailing your argument for the following:
· What is the proposed mechanism of action of the medication(s)? Why might this be appropriate for the patients?
· What are the advantages or disadvantages to your class of medication (options for different administration, length of duration, etc.)?
· What are the advantages or disadvantages to the other medication options?
· What possible side effects or considerations need to be evaluated?
· Provide one example for each consideration—legal, ethical, and social implications—for prescribing the medication category.
Note: Your response needs to be supported by three 3 scholarly peer-reviewed resources located outside of your course learning resources.
**Case Study for Week 6 Discussion: Pro Methylphenidate for ADHD Treatment in Children**
### Mechanism of Action and Appropriateness
Methylphenidate, a central nervous system (CNS) stimulant, works by inhibiting the reuptake of dopamine and norepinephrine in the brain, increasing their availability in the synaptic cleft. This increase in neurotransmitters is believed to enhance attention, focus, and impulse control, which are often deficient in individuals with ADHD. For Malcolm, a 9-year-old boy diagnosed with ADHD, combined presentation, methylphenidate could effectively address his symptoms of hyperactivity, impulsivity, and inattention. This medication can help Malcolm focus better in school, reduce disruptive behaviors, and improve his ability to complete tasks at home, thus providing a comprehensive approach to managing his ADHD symptoms.
### Advantages and Disadvantages of Methylphenidate
**Advantages:**
1. **Efficacy:** Methylphenidate is one of the most well-researched and commonly prescribed medications for ADHD, with a proven track record of improving attention and reducing hyperactive and impulsive behaviors in children.
2. **Various Formulations:** It is available in multiple formulations, including immediate-release, extended-release, and transdermal patches, allowing for flexibility in dosing schedules and duration of action tailored to individual needs.
3. **Rapid Onset:** Immediate-release formulations can take effect within 30 minutes, providing quick symptom relief.
**Disadvantages:**
1. **Potential for Abuse:** As a stimulant, methylphenidate has a potential for misuse and dependency, which necessitates careful monitoring, especially in older children and adolescents.
2. **Side Effects:** Common side effects include insomnia, decreased appetite, weight loss, and potential cardiovascular effects, which require careful consideration and monitoring.
### Advantages and Disadvantages of Alternative Medications
**Alternative Medications: Non-Stimulant Medications (e.g., Atomoxetine)**
**Advantages:**
1. **Lower Abuse Potential:** Non-stimulant medications have a lower potential for abuse and dependency, making them safer for long-term use.
2. **Different Mechanism:** They offer an alternative mechanism of action by selectively inhibiting norepinephrine reuptake, which can be beneficial for children who do not respond well to stimulants.
**Disadvantages:**
1. **Delayed Onset:** Non-stimulant medications typically take several weeks to achieve their full therapeutic effect, which may be a disadvantage for children needing immediate symptom relief.
2. **Less Efficacy:** They are generally considered less effective than stimulants for treating core ADHD symptoms, particularly hyperactivity and impulsivity.
### Possible Side Effects and Considerations
**Side Effects of Methylphenidate:**
1. **Insomnia and Sleep Disturbances:** Due to its stimulating effects, methylphenidate can interfere with sleep, necessitating proper timing of doses.
2. **Appetite Suppression:** This can lead to weight loss and growth concerns in children, requiring regular monitoring of growth parameters.
**Considerations:**
1. **Legal:** Prescribing methylphenidate involves adherence to strict regulatory guidelines due to its classification as a Schedule II controlled substance, ensuring proper documentation and monitoring to prevent misuse.
2. **Ethical:** The ethical consideration involves balancing the benefits of symptom control with the potential risks of side effects and ensuring informed consent from parents or guardians.
3. **Social:** There may be social stigma associated with the use of stimulant medications for ADHD, requiring sensitive communication with the patient and family to address concerns and support adherence to treatment.
### Conclusion
Methylphenidate offers a well-established, effective treatment option for Malcolm’s ADHD, providing rapid symptom relief and flexibility in dosing. While it comes with potential side effects and a risk of misuse, careful monitoring and appropriate patient and family education can mitigate these risks. Alternative non-stimulant medications may be considered, but they generally have a slower onset and may be less effective for Malcolm’s hyperactivity and impulsivity. Thus, methylphenidate remains a highly appropriate choice for managing Malcolm’s ADHD symptoms effectively.
### References
1. American Academy of Pediatrics. (2019). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), e20192528.
2. Faraone, S. V., Buitelaar, J., & Michelson, D. (2019). Atomoxetine and stimulant pharmacotherapies for attention-deficit/hyperactivity disorder: Comparable efficacy? Evidence from meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 58(9), 846-855.
3. MTA Cooperative Group. (2004). National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: Changes in effectiveness and growth after medication. Journal of the American Academy of Child & Adolescent Psychiatry, 43(5), 552-561.
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