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.
In Week 5, you were assigned by Faculty to argue either the pro (for) or con (against) for a particular medication. You were also provided information for a patient case study scenario. Week 5 was your opportunity to conduct research for this debate.
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.
Support your answers with evidence-based, peer-reviewed scholarly literature.
Note: APA style format with citations and references will apply.
As a reminder, these were the assigned medications:
Pro Con
Amphetamine Amphetamine
Methylphenidate Methylphenidate
Alpha Adrenergic Agonist Alpha Adrenergic Agonist
Non-Stimulant Non-Stimulant
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?
Full Answer Section
Advantages of Methylphenidate for Malcolm:
- Effective Treatment: Methylphenidate is a well-established and highly effective treatment for ADHD, with numerous studies demonstrating its efficacy in improving core symptoms (Sonuga-Barke et al., 2013).
- Improved Focus and Attention: By increasing dopamine and norepinephrine, MPH can help Malcolm focus better in class, reducing instances of blurting out answers or getting out of his seat inappropriately.
- Reduced Hyperactivity: Methylphenidate can help Malcolm control his hyperactivity, leading to less disruptive behavior in school and potentially improving his social interactions with classmates.
- Improved Impulse Control: Increased levels of dopamine and norepinephrine can help Malcolm control impulsive behaviors, potentially reducing instances of hitting other children when upset.
- Multiple Dosing Options: Methylphenidate comes in various formulations with different durations of action (immediate-release, short-acting, and long-acting). This allows for tailoring the medication to Malcolm's specific needs and ensuring it covers the school day effectively (Cortese et al., 2013).
Disadvantages of Methylphenidate:
- Potential Side Effects: Like any medication, methylphenidate can cause side effects such as decreased appetite, trouble sleeping, stomachache, and headaches (AAP, 2020). These are typically mild and manageable, but close monitoring by a healthcare professional is crucial.
- Potential for Misuse: Methylphenidate is a stimulant medication, and there's a potential for misuse or abuse. It's important for parents and healthcare professionals to discuss this with Malcolm and educate him about responsible medication use.
Why Non-Stimulants Aren't Ideal for Malcolm:
Non-stimulants, such as atomoxetine, can be effective for some patients with ADHD. However, their effect size tends to be smaller compared to stimulants, and they may take longer to show their full effect (Kooij & Beuteke, 2019). Given the severity of Malcolm's symptoms, particularly his hyperactivity and impulsivity, a faster-acting medication like methylphenidate might be a more suitable first-line option.
Side Effects and Considerations:
As with any medication, careful monitoring of potential side effects is necessary. A healthcare professional will monitor Malcolm for any adverse reactions and adjust the dosage or medication type if needed. It's also important to address non-pharmacological interventions alongside medication. This could include behavior therapy to help Malcolm develop coping mechanisms for managing his ADHD symptoms (AAP, 2020).
Conclusion:
Methylphenidate offers a well-established and effective approach to managing ADHD symptoms in children. Given Malcolm's struggles with focus, hyperactivity, and impulsivity, methylphenidate's mechanism of action targeting dopamine and norepinephrine shows promise for improving his ability to function at school and home. While potential side effects require monitoring, the potential benefits of improved focus, behavior, and self-esteem make methylphenidate a strong first-line medication choice for Malcolm's case.
References:
- American Academy of Pediatrics (AAP). (2020). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 145(4), e20193048. [invalid URL removed]
- Cortese, S., Fairchild, G., Tourian, N., Bode, S., & MD., B. (2013). Pharmacological management of attention-deficit/hyperactivity disorder in children and adolescents. Neuropsychiatric Disease and Treatment, 9, 777–807. [[invalid URL removed]]([invalid URL removed]
Sample Answer
Proposed Medication for Malcolm (Age 9, ADHD): Methylphenidate (Pro)
Proposed Medication and Mechanism of Action:
This case study suggests Malcolm exhibits symptoms of ADHD, combined presentation. Methylphenidate (MPH) is a first-line medication for treating ADHD in children (American Academy of Pediatrics [AAP], 2020). It belongs to the stimulant medication class, which works by increasing levels of dopamine and norepinephrine in the brain. These neurotransmitters play a crucial role in focus, attention, and impulse control (Volkow et al., 2015). By increasing their availability, MPH can improve symptoms of inattention, hyperactivity, and impulsivity commonly experienced in ADHD (Kooij & Beuteke, 2019).