Developing a client recovery focused treatment plan for a JamesWatson, a 15-year old male patient with ADHD.
James Watson is a 15-year-old boy living with his parents, and heattends a local high school in their neighborhood. Watson has beenstruggling in his subjects and has fallen significantly behind inmany subjects. He has also been facing difficulties in friendshipgroups, and he has been reported to be arguing during playtime. On apositive note, Watson is doing well in sports. Further, Watson hasbecome more disorganized in the past one year. Watson has lost manyof his school equipment and is often late leaving the house forschool and social events. Watson is usually restless and experiencesdifficulty in concentrating even on things he finds enjoyable. Theparents remember that Watson experienced this issues when he wasyoung and they are worried about his condition.
The safety of the Watson in the evaluation of ADHD will be based onthe possibility of him causing harm to himself due to hyperactivityand partaking unwanted risks. Irritability and mood changes mightcause Watson to harm those people around him. A careful andsystematic assessment of the entire lifetime history of symptoms andimpairments of Watson will also be done. Diagnosis will not be basedon a single clinical impression rather, the presence of symptomsimpairment and symptoms in not less than two domains (work, home,school and interpersonal contacts) will be assessed (Garfield et al.,2012).
According to the Diagnostic and Statistical Manual of MentalDisorders criteria for ADHD, impairment in the symptoms is agedependent since there is a reduction in the symptom threshold foradults when compared to children. Therefore, the pattern of thesymptoms shown by Watson will be recorded. Patterns of comorbidity tobe assessed will comprise of personality disorders, mood, sleep andsubstance use disorder. Full medication history of both somatic andpsychiatric treatments will be taken. Moreover, a family history ofpsychiatric and neurological conditions will be evaluated since thereis a high heritability instance of the disease among family members.Assessment will be done on the childhood onset and the currentsymptoms of ADHD. In the treatment plan, the educational needs ofJames Watson are essential. James Watson and his family will beeducated about the disorder and its treatment options as it may helpbring them to comfort. This process will help Watson and his familyunderstand the past behavior of the Watson, and it might help himjoin a self-help group which will be beneficial too.
Diagnostic and Screening Tools
There are quite a number of tools used for screening and diagnosticpurposes. ADHD rating scale that is based on the DSM-1V criteria andADHD Self-Report Scale (ASRS) are the most commonly used tools. Inthe diagnosis of James Watson condition the ADHD Self-Report Scale(ASRS) will be utilized. ASRS is a six item World Health Organizationadult checklist that is available online without limitations. Itincludes queries for each of the DMS-1V items, and it was selectedbased on sequential logic regression to adjust concordance withclinical classification. ASRS has a 97.9% classification accuracy,99.5% specificity and 68.7% sensitivity (NIH, 2015).
In the diagnostic assessment, self-report questionnaires areavailable. Brown ADD Scale Diagnostic Form (BADDS) which measuresonly the behaviors that relate to inattention and executivefunctioning will be used. The scores obtained from these levels willbe utilized in the screening of ADHD and evaluation of the treatmentoutcomes which will be appropriate for James Watson. WHODAS simplescoring method will also be used in assessing the disability of theADHD client. The scores are assigned from none (1) to extreme (5) anddepending on the score obtained from Watson’s evaluation theappropriate treatment procedure will be determined.
It’s vital in the diagnosis of ADHD, correct treatment targets, andin the identification of comorbid conditions. James Watson is maybeexperiencing symptoms that can be confused with bipolar andborderline personality disorders, dysthymia and cyclothymia. Suchsymptoms include low self-esteem and mood, irritability and affectiveliability. Daily mood changes in ADHD are prevalent and representessential standard mood ranges which are poorly regulated rather thanmore severe lengths of depression and elation observed in bipolardisorder (NIH, 2015). Therefore, if Watson will be experiencingchronic mood instability, it will be considered a key syndrome in hisADHD diagnosis.
Border personality disorder and ADHD share impulsivity, feelings ofboredom, anger outbursts and affective instability. Anger andimpulsivity in ADHD patients are thoughtless and short-lived ratherthan being driven. Further, feelings of abandonment, identitydisturbances and self-mutilation are less intense in ADHD than inborderline personality disorders. However, the disparities may not beclear enough as both conditions signs are chronic and trait-like.Therefore, in Watson’s differential diagnosis, the intensity of thesymptoms will be used in differentiating whether he has borderlinedisorder or ADHD. Finally, in Watson’s differential diagnosisevaluation of the comorbid disorders is vital for ADHD assessmentsince the order of therapy will rely on the presence ofco-morbidities and their severity.
Safety and legal concerns: The plan will work towards theinterests of James Watson. Ethical practice will be ensured throughethical considerations that govern the practice and lead to legalpractice. Confidentiality and consent of Watson will be taken care ofto avoid litigation claims.
Genomic considerations: ADHD is a family disorder that is highinheritable indicating that the genomic component influences the riskof the disease. Furthermore, the continuity of the symptoms acrossthe individual’s lifespan is due to shared genetic effects(Pingault et al., 2015). Therefore, in both the diagnosis andtreatment, the family history of Watson will be evaluated todetermine if his condition is genetic or was caused by environmentalconditions.
Psychotherapy: Due to the impairment in the life of JamesWatson, efficient organization, and problem-solving skills will behelpful to him. A coaching program for Watson by a psychotherapistwill include acceptance of the disorder, learning to deal with timemanagement and limiting activities to one objective at a given time.Further, learning to start and complete tasks and comprehendingemotional responses associate with the disorder will be included inthe therapy. Watson’s family will provide positive and negativefeedbacks for particular actions and aid in establishing a routinethat might help him.
Pharmacotherapy: The first choice of treatment Watson’s ADHDwill be stimulants such as methylphenidate and dexamphetamine.Stimulants have been reported to be effective in more than 70% of thecases (Garfield et al., 2012). Stimulants are expected to improve thesymptoms, impair Watson’s behaviors and related problems such asanger outbursts and cognitive problems. Mild side effects such asreduced appetite and dry mouth are expected too.
Complementary and Alternative Treatments: if Watson does notrespond to the stimulants, atomoxetine is recommended as analternative. It’s indicated in patients with comorbid SUD, socialanxiety, and emotional dysregulation (Garfield et al., 2012).Antidepressants and mood stabilizers will be used to complement thefirst line treatment in case of comorbid complicated issues.
Community interventions: Stigma associated with ADHD in thecommunity is caused by lack of awareness and lack of understandingthe available data on the disorder. Knowledge about the conditionshould, therefore, be increased to both the family and those aroundJames Watson. Further, accurate information about ADHD in the form ofbrochures will be given to Watson and his family. The communityaround Watson should accept him and avoid abandoning him.
Primary, Secondary, and Tertiary Prevention:Primaryprevention hinder the emergence of the disorder and include programsthat enhance maternal health during pregnancy and initiatives todecrease environmental toxins. They lower the incidence rates butdon’t eradicate ADHD. Secondary prevention methods detect ADHD atits earliest stages when it can be treated its progression slowed orits future complications minimized. They include early detectionusing screening tools before the onset of serious complications, andit leads to the implementation of intervention programs. Head startis an early intervention program for children. Tertiary programs usetreatment strategies that will mitigate the complications but areunlikely to cure the disorder (Halperin et al., 2012). In Watson’scondition, psychostimulants and parental training will be implementedto reduce the severity of the symptoms and the complications.
ADHD persists in persons with high comorbidity rates and significantpsychosocial impairments. Extensive psychiatric work will be doneduring diagnosis, and it will include developmental history, currentsymptoms, impairments and the associated co-morbidities. Externalinformation will be collected from the family to avoidunderreporting. The treatment model will accommodate Watson’s bestinterests. Differential diagnosis will help in identification ofcomorbid conditions and the right treatment plan. A multi-modal formof therapy is recommended, and it will comprise of psychoeducation,pharmacotherapy, and psychotherapy. Family and close friends ofWatson are critical in his treatment and recovery process too.
Garfield, C. F., Dorsey, E. R., Zhu, S., Huskamp, H. A., Conti, R.,Dusetzina, S. B. … Alexander, G. C. (2012). TRENDS IN ATTENTIONDEFICIT HYPERACTIVITY DISORDER (ADHD) AMBULATORY DIAGNOSIS ANDMEDICAL TREATMENT IN THE UNITED STATES, 2000-2010. AcademicPediatrics, 12(2), 110–116.http://doi.org/10.1016/j.acap.2012.01.003
Halperin, J. M., Bédard, A.-C. V., & Curchack-Lichtin, J. T.(2012). Preventive Interventions for ADHD: A NeurodevelopmentalPerspective. Neurotherapeutics, 9(3), 531–541.http://doi.org/10.1007/s13311-012-0123-z
NIH (2015). Attention deficit hyperactivity disorder (NIHPublication). Available from NIMH Public Inquiries.
Pingault, J. B., Viding, E., Galéra, C., Greven, C. U., Zheng, Y.,Plomin, R., & Rijsdijk, F. (2015). Genetic and environmentalinfluences on the developmental course ofattention-deficit/hyperactivity disorder symptoms from childhood toadolescence. JAMA Psychiatry, 72(7), 651-658.