Case Study on ADHD: Comprehensive Analysis of Diagnosis & Care

This case study presents a comprehensive analysis of a nine-year-old boy named Joe diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The study details Joe's symptoms, including hyperactivity, difficulty concentrating, and impulsivity, which were evaluated using the DSM-V criteria and the Test of Variable Attention (TOVA). The pathophysiology of ADHD, involving functional impairments in norepinephrine and dopamine release, is discussed, along with brain imaging results showing volume reduction in key areas. The proposed care plan includes a combination of interpersonal psychotherapy (IPT) and stimulant medications like methylphenidate, alongside other interventions such as emotional expression and physical activity. The study concludes that therapeutic and behavioral interventions are crucial for the effective management of ADHD symptoms, offering valuable insights into the treatment and care of patients with similar conditions. Desklib provides a platform for students to access similar case studies and assignments for academic assistance.

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1CASE STUDY
Introduction
The branch of pediatrics encompasses delivering medical care services to children,
infants, and adolescents from birth, till they attain 18 years of age. This essay will discuss a
case study based on Attention Deficit Hyperactivity Disorder (ADHD).
Overview
Joe is a nine year old Grade III pupil who resides with his parents and siblings. He is
the second child and his brother is two years elder. While in kindergarten, his teachers often
used to complaint about Joe being overactive, and always finding it difficult to focus on his
lessons. He had been diagnosed with ADHD at seven years of age. His social history
commonly include being awake till late evening, reporting high levels of activity, forgetting
materials, and regular notes being sent from the school at his home. Differential diagnosis for
the condition includes learning disability, communication disorder, and seizure disorder
(Qureshi et al., 2016). Upon early evaluation, it was found that Joe could not sit still for more
than a minute and also demonstrated difficulties in organizing tasks like schoolwork, and
talked more, when compared to his age-matched counterparts. His condition was diagnosed
using the DSM-V criteria. However, there are no definite laboratory-based clinical tests for
confirming the disorder.
Physical assessment
Despite the absence of any specific laboratory studies, some basic examination that
helped in conforming the diagnosis, thus aiding the treatment process were namely, serum
CBC count, liver function tests, electrolyte level measurement, and thyroid function test. Joe
was subjected to brain imaging fMRI, which demonstrated significant volume reduction in
amygdala, caudate nucleus, hippocampus, and nucleus accumbens (Plichta & Scheres, 2014).

2CASE STUDY
Presentation of diagnosis
Using the DSM-V criteria, symptoms related to forgetfulness, distraction,
daydreaming, poor concentration, and problems in accomplishing difficult tasks were
observed (Doernberg & Hollander, 2016). Results from the Test of Variable Attention
(TOVA) also confirmed difficulty, in relation to attention (O’Mahony et al., 2014). The
pathophysiology of the condition involves functional impairment in the neurological systems
related to norepinephrine and dopamine release. In addition, there occurs a reduction in the
left-side prefrontal cortex and the subcortical volumes (Sharma & Couture, 2014). In
addition, there also occurs deficits present in anterior cingulate activation, while the affected
individual is performing a specific task.
Care plan
Joe’s treatment would typically comprise of medications and counselling, in
combination, with the aim of reducing the severity of the symptoms. Joe will be subjected to
interpersonal psychotherapy. IPT will be based on attachment theory and interpersonal theory
and will form the foundation for gaining an insight into the difficulties of the patient (Dietz et
al., 2015). Joe will be subjected to stimulant medications like methylphenidate, which will
lower risks of ADHD related unintentional injuries (Storebø et al., 2015). Furthermore,
bupropion, and atomoxetine will also be administered to improve his academic performance
(Ding et al., 2014). Other interventions would encompass encouraging Joe to express his
emotions. Simple and direct instructions will be given to Joe for addressing his less attention
span. In addition, Joe will also be encouraged to engage his physical activity for increasing
his sleep, and reducing fatigue.

3CASE STUDY
Conclusion
To conclude, the case study focused on an ADHD patient who suffered from
hyperactivity, impulsive behavior, and inattention. Implementing the therapeutic and
behavioral interventions will help in effective treatment of the patient.

4CASE STUDY
References
Dietz, L. J., Weinberg, R. J., Brent, D. A., & Mufson, L. (2015). Family-based interpersonal
psychotherapy for depressed preadolescents: Examining efficacy and potential
treatment mechanisms. Journal of the American Academy of Child & Adolescent
Psychiatry, 54(3), 191-199.
Ding, Y. S., Naganawa, M., Gallezot, J. D., Nabulsi, N., Lin, S. F., Ropchan, J., ... &
Laruelle, M. (2014). Clinical doses of atomoxetine significantly occupy both
norepinephrine and serotonin transports: Implications on treatment of depression and
ADHD. Neuroimage, 86, 164-171.
Doernberg, E., & Hollander, E. (2016). Neurodevelopmental Disorders (ASD and ADHD):
DSM-5, ICD-10, and ICD-11. CNS spectrums, 21(4), 295-299.
O’Mahony, N., Florentino-Liano, B., Carballo, J. J., Baca-García, E., & Rodríguez, A. A.
(2014). Objective diagnosis of ADHD using IMUs. Medical engineering &
physics, 36(7), 922-926.
Plichta, M. M., & Scheres, A. (2014). Ventral–striatal responsiveness during reward
anticipation in ADHD and its relation to trait impulsivity in the healthy population: A
meta-analytic review of the fMRI literature. Neuroscience & Biobehavioral
Reviews, 38, 125-134.
Qureshi, M. N. I., Min, B., Jo, H. J., & Lee, B. (2016). Multiclass classification for the
differential diagnosis on the ADHD subtypes using recursive feature elimination and
hierarchical extreme learning machine: structural MRI study. PloS one, 11(8),
e0160697.

5CASE STUDY
Sharma, A., & Couture, J. (2014). A review of the pathophysiology, etiology, and treatment
of attention-deficit hyperactivity disorder (ADHD). Annals of
Pharmacotherapy, 48(2), 209-225.
Storebø, O. J., Ramstad, E., Krogh, H. B., Nilausen, T. D., Skoog, M., Holmskov, M., ... &
Gillies, D. (2015). Methylphenidate for children and adolescents with attention deficit
hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews, (11).