ADHD: Clinical Assessment, Diagnosis, Treatment, and Patient Education

This report presents a comprehensive analysis of a case study involving a 7-year-old boy diagnosed with ADHD, providing a detailed overview of the diagnostic and treatment process. It begins with an abstract summarizing the key aspects of the case, followed by an introduction to ADHD, its symptoms, and the DSM-V diagnostic criteria. The report details the initial clinical assessment, including the child's behavioral issues at school and home, and a review of his medical and psychiatric history. A mental status examination (MSE) is described, along with specific interview questions used to gather relevant information. The report then explains the DSM diagnosis for ADHD, focusing on the categories of inattention and hyperactivity, and discusses the length of treatment, including the use of behavioral management and medication. It also covers dosage titration schedules, factors affecting medication effectiveness, and the importance of patient education. The report emphasizes the need for necessary tests and the role of parents and teachers in supporting the child's treatment, providing a holistic approach to managing ADHD.

Running head: SIGNATURE ASSIGNMENT
ATTENTION DEFICIT HYPERACTIVITY DISORDER
Name of the Student
Name of the University
Author note

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Abstract
This is a signature assignment on ADHD or attention deficit hyperactivity disorder. The
diagnosis is done depending on the guidelines set my DSM (Diagnostic and Statistical Manual of
Mental Disorders). A case study is provided that explains that a 7-year boy is suffering from
ADHD and is brought to clinic by mother. The whole paper explains about the clinical
assessment done at the initial stage, the noting down of complains, medical and psychiatric
history along examination of mental status. This paper also discusses about the interview that
was asked by the physician for making a decision regarding the treatment. It discusses about the
length of the trails, level of dosage and duration of medication along with several potential side
effects. It discusses about the necessary tests required and the importance of educating the
parents of the patient about the disease.

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DSM diagnosis algorithm for ADHD (Attention-deficit/hyperactivity disorder)
ADHD or attention deficit hyperactivity disorder is a medical illness where a person losses their
ability for proper brain development, henceforth the brain activity gets affected further putting an
impact on the attention, self-control and on the ability to be still (Bowling & Nettleton, 2020).
The symptoms of ADHD are impulsivity, hyperactivity and inattentiveness. Researches have
shown that both adult as well as children can get affected with the disorder however the
symptoms begin during childhood (Bunford, Evans & Wymbs, 2015). The child faces difficulty
in schools for learning and education. The adult suffering from ADHD faces difficulty in
coordinating time, setting objectives, organisational skills and hence it affects their jobs. The aim
of this paper is to provide a synopsis of the real scenario of a patient suffering from ADHD and
discuss guideline based evidence on the DSM diagnosis that would be provided.
Overview of Initial Physical Clinical Assessment
A seven years old boy was brought to the doctor’s office as he was suffering from
academic difficulty at schools and he was also having some behavioural problems. The problem
was first noticed when he was in his pre-school and his teachers was worried about the impulsive
behaviour that he was showing imprudent aggression. The kids mother reported even at home he
is impatient and runs all day round, she had to ask him numerous time to do a particular work
such as picking up his toys. She also informed that her son, sits quietly only for few seconds and
then again turns hyperactive. His teacher even complained that he distracts his classmates, cuts
the lines and also loses homework assignments however the kid is bright. He finishes his work
quickly when given under individual supervision. The child’s mother is highly concerned as his
classmates are teasing him as he seems stupid to others. She even reported that her child is
motivated and sweet and does not talk back to the adults or teachers and never bully’s anyone.

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When his mother takes her to her office, he always jumps up and down and never listens to his
mother. Mother also confirmed that his 15 years old sibling was also hyperactive when he was of
his age, also had academic problem.
Patient History
Patient history stated that his older brother who is 15 years old now also had same kind of
symptoms. He was also impatient, hyperactive and had difficulty in learning. The boy is only
seven years old and is facing academic learning problems. However, he is a bright child and can
perform assignments properly if asked to do alone. It had been noticed that he mainly becomes
hyperactive, impatient when surrounded by crowd. Even patient’s mother informed that her kid
is bright, however she is confused with his nature in schools and for that reason this seven-year-
old boy is getting teased by his friends at school.
Mental Status Exam (MSE)
After listening to mothers complain the physician need to conduct mental state
examination (MSE). It is defined as the analogue for physical examination. The physician would
conduct a series of examination and observation. As the child is only 7 years old, the physician
need to be gentle and soft towards the patient. The question and observation reveals some
pathological or normal findings. The observations done was in context of an interview that might
vary from one patient to another. Every child has different way of thinking, cognition and
emotion; hence to paint a clear observatory picture child’s emotion and state of mind is highly
important to be noted (Kaiser, Schoemaker, Albaret & Geuze, 2015). The data obtained from
MSE was then combined with the kid’s family history where his older sibling also had similar

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symptoms. A psychiatric review of system data base containing the psychiatric data was
designed.
Interview Questions
Interview question would help in diagnosing ADHD. The question that would help are-
How may I help you? Why are you here today? How old are your kid and in which grade he is?
Is there any previous family history with similar symptom? Since, when your child is showing
hyperactivity? Does he do the same in school? Do you ever see your child to be patient and
performing assignment quietly? Are your child stresses of getting teased in school? Is he is
worried about not performing well in schools? Are the teachers in school cooperative towards
your child’s problem? Did your older son also have same symptoms? Did he overcome it or still
facing the same? Have you visited any other physician before? (If so) Can you tell me the
treatment the physician underwent? Was your child ever under medication? (if so) Can you
provided me with the names?
Hello kid, can you please solve the puzzle? (If not), Did you find it difficult? Are you
bored? Do you want to play? Do you like going to school? Do you have friends? Why your
friends tease you?
Diagnosis of ADHD
DSM diagnosis is used as a treatment method for ADHD. DSM-V treatment is used in
treating hyperactivity symptoms that are observed before 12 years of age. In the case study
provided the kid is only 7 years old hence DSM-V is preferred for him. The symptoms of ADHD
fall under two main categories such as hyperactivity and inattention (Sayal, Prasad, Daley, Ford
& Coghill, 2018). The inattention symptoms include less attention span, lacking response

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towards gestural and verbal activities. On other hand, hyperactivity symptoms include display of
excess motoric active energy, fidgeting and rapid speech. The person feels difficulty in being
seated. The impulsive actions demonstrate a disconnection among actions and functions. Co-
morbid disorders often are linked with ADHD that includes spectrum disorder along with many
other anxiety and mood disorder (Sciberras et al., 2016). In the following case study, the patient
is a 7 years old boy undergoing hyperactivity and learning disorder. He has a family history
where his older brother also had undergone through same scenario in school. He has been
brought to the clinic his mother for diagnosis.
Length of treatment in trial/ initiation period
Children of age 7 or below require parents help in different purpose. Therefore, the
treatment recommends training of parents for behavioural management as first line of treatment.
However, if the behavioural management fails then medication is provided along with parents
training (Patros et al., 2016). This parents training policy and medication are provided till age 12
and then different types of training and behavioural therapy are provided to the adolescent.
Schools and class room interventions has an important role in this. DSM-5 explains the crucial
nature of ADHD as an obstinate outline of inattention and hyperactivity impulsivity, which
impedes with operation or enlargement (Reale et al., 2017). DSM-5 can determine the level of
treatment depending on the age and level of hyperactivity. ADHD medication are considered to
be the stimulant which comes under first line therapy and are highly effective during treatment.
The stimulants present show similar efficacy however differs on dosage, duration of activity.
Therefore, there is also variation in effectivity from one patient to other. DSM diagnosis for
ADHD adds particular level of therapy in order to enhance their everyday functioning. However,
if it is not treated, then the ability of the kid to process information would decrease that would

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increase with time and would be present during his adolescent (Pelsser, Frankena, Toorman &
Rodrigues Pereira, 2017).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) have suggested that
behavioural therapy is commonly used for helping people suffering from ADHD (Fernández de
la Cruz et al., 2015). The therapy helps in the improvement in the functioning throughout social-
interpersonal domains. It suggests that everyone needs to learn the way to deal with ADHD
patient. As it is mentioned in the case study that the kid is getting teased by his classmates, which
is affecting him more. This therapy states that behavioural education in schools, teachers and
parents would help the ADHD patient to feel comfortable among others (Mikami & Normand,
2015).
Dosage titration schedule and duration of medication
The main goal for titration is to find the dose of medicine that can controls child's
symptoms of ADHD with very less side effects. The impact of ADHD drug varies from child to
child (Bigorra, Garolera, Guijarro & Hervás, 2015). It takes time to get adjusted in the child’s
body however once the adjustment is done then the effectivity is really good. Generally, the dose
of medicine is increased slightly after every 2-3 weeks. The medication continues until the child
is free from ADHD symptoms (Barkley, 2016). The doctor provides the child with lower dose of
medication in the beginning, even though the child is showing any medication it needs to be
noted. Many times it happened that the medication gets adjusted over time.
Duration of medication for the 7-year-old child will be short acting formulas such as 4
hours. However, if the child is having school then long-acting stimulant of 10-12 hours is chosen
so that they can focus on their homework as well as after school activities (Burch & Tort, 2018).

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Factors affecting medication effectiveness
Factors that plays an important role in ineffectiveness of ADHD medication are improper
dosage. If the child is not provided with the dosage as prescribed by the doctor, the child faces
other difficulties. Parents education has an important role for a child with ADHD, they must not
be neglecting or ignoring their child’s difficulty (Parents as Friendship Coaches for Children
With ADHD, 2019). the child need to feel comfortable in every situation. Sometimes drug
interaction also plays an important role. It has been seen that every person is not adjustable to
every drugs that are prescribed. Depending on the body’s capability drug must be prescribed.
Genetic factors as well as medical issues also hinders the activity of the medication provided for
ADHD patient (Mitchison & Njardvik, 2015). The most crucial and important factor that affects
drug’s efficacy are psychological and physical dependence. These needs to be taken under
consideration before application of drug to the 7 years old child.
Necessary labs and test
The patient in the case study is a 7 years old child, suffering from ADHD. There is
numerous test to diagnose ADHD. Doctors rely on several points such as interviewing parents,
watching the child personally, setting of questionnaires and performing psychological tests. The
doctor observes the ways a person’s symptoms affects the behaviour and daily mood of the
person (Sweeney et al., 2018). Even tests for hearing and eye sight, blood tests such as thyroid
tests, electrical activity of the brain as well as MRI (Magnetic image resonance) or CT scan are
recommended in order to check brain abnormalities. Laboratory summary comprises thyroid
function, electrolytes, blood purity (Hall et al., 2015). Doctor before prescribing any medicine or
lab test must notice three types of disorder such as inattentive, impulsive type and combined
type. They rate the scales for evaluating and track ADHD such as CAP (Child Attention Profile)

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which are filled by teachers to track ADHD. BASC (Behaviours Assessment system for children)
looks for anxiety and depression and most important test conducted is CBCL (Child behaviour
checklist/Teacher report form) that shows physical aggressiveness and withdrawal. The doctor
might also prescribe Brain wave test to the child, to recognise the brain waves (Cuffe et al.,
2015). As the patient is a child in this case behavioural therapy is preferred, however if there is
no improvement then the doctor ask for medication.
The medication dosage varies for child with ADHD. The medication of ADHD for child
are Adderall XR, Concerta, Focalin XR, Desoxyn and Metadate CD. The medications are
categorized as stimulant and non-stimulant. Children are supplied with medication because it
helps in improving attention and diminishes impulsivity and hyperactivity (Grassmann, Alves,
Santos-Galduróz & Galduróz, 2016). This helps the child to enhance their ability to learn and do
their work.
However, the child in the mentioned case study is only 7 years old, for him evidence
based behavior therapy is suggested. Nevertheless, medication is recommended if there is no
improvement only. Methylphenidate is indorsed over amphetamines or non-stimulants. Stimulant
is commended over atomoxetine, clonidine and guanfacine. This kid is recommended with a
stimulant medication of amphetamine due to his symptoms of hyperactivity and impulsivity
(Feldman, 2017).
Patients education
Patients education is required for treatment. As in this case study the patient is a child of
7 years old so his parents need to be educated. The child is suffering from ADHD and hence
getting teased by his classmates. It would affect the child more. Initially the parent must know

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how to deal with kids with this kind of disorder. They must know specific ways of treatment at
home. It is mandatory that kid suffering from ADHD must not feel insecure that would cause
greater impulsion and hyperactivity. Moreover, the school teacher would also be cooperative
towards the kid and hence they must have a knowledge towards dealing with the child in this
specific scenario.
However, an individual in their adolescent suffering from this disease must know to deal
with the situation they face in college and work places (Benzing, Chang & Schmidt, 2018). The
person need to know proper medication and therapy that is necessary for keeping the disorder
under control. Must visit the doctor at regular intervals. Hence, education of patient and their
family towards this disease plays a crucial role in treatment process.
Side effects and reasoning towards making the decision
ADHD medication reduces, ADHD symptoms in kids. Sometimes it causes side effects.
The side effects are cause by both stimulant and non-stimulant medication. Side effects for
ADHD medicines are headaches, stomach upset. These two slowly goes away after child’s body
gets adjusted with medicine. The child also undergoes other side effects such as reduction in
appetite, it mainly depends on the kids. Sometimes the kids become uncomfortable with the side
effects and it can be adjusted by change in the dosage or by changing the medicine from one
form to the other. The common side effects for stimulant and non-stimulant medication also
affects a person health (Mikami & Normand, 2015). Stimulant medicines such as
methylphenidates and amphetamines have side effects such as sleep problem, weight loss,
dizziness, headaches, nervousness and mood swings. The non-stimulant medications such as
Tenex, kapvay and intinuv have side effects such as drowsiness, fatigue and decrease in appetite.

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Change of amphetamine is recommended as the child is only 7 years and goes to school.
Feeling of dizziness, weight loss and headaches would make the child impatient and more
nervous (Bunford, Evans & Wymbs, 2015). As the patient is a child prescription of medicine and
the dosage must be kept into consideration. The medication would also lead to mood swings. The
child with ADHD already reported to be suffering from hyperactivity and impulsivity. So, in his
case increase in the mood swings would lead to the enhancement of the disorder. So, immediate
measures need to be taken to change the medication. Sometimes change of medicine or change in
dosage causes in the control of the disorder.

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References
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Benzing, V., Chang, Y., & Schmidt, M. (2018). Acute Physical Activity Enhances Executive
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30067-8
Bigorra, A., Garolera, M., Guijarro, S., & Hervás, A. (2015). Long-term far-transfer effects of
working memory training in children with ADHD: a randomized controlled trial.
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0804-3
Bowling, Z., & Nettleton, A. (2020). The diagnosis and management of ADHD (Attention
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Children and Adolescents. Clinical Child And Family Psychology Review, 18(3), 185-
217. doi: 10.1007/s10567-015-0187-5
Burch, J., & Tort, S. (2018). What adverse events are associated with methylphenidate in
children and adolescents with attention deficit hyperactivity disorder (ADHD)?.
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