Case Study, Chapter 30, Mental Health Disorders of
Childhood and Adolescence
1. Read the case study and answer the learning objectives.
2. Assignments will be 2 to 3 pages double spaced.
3. Cite your source(s). Using the textbook is recommended.
A mother brings her 9-year-old daughter, Jane, into the pediatrician’s office for a follow-up
appointment. Jane had been diagnosed with attention-deficit hyperactivity disorder (ADHD) last
year while repeating second grade. She has been taking methylphenidate 10 mg twice a day for 7
months now. Initially, she had been started on methylphenidate 10 mg three times a day, but
complaints of headache and insomnia resulted in a series of changes. Initially, the last dose of the
day was dropped from 10 to 5 mg at dinner time, but later, the parents stopped giving the third
dose altogether, citing concerns about dependency and their desire to use a more conservative
medication approach for managing the patient’s ADHD. A behavioral plan with school supports
has also been in place for the past year.
Although Jane had been demonstrating good progress, today the mother reports that the
Jane’s grades are beginning to plummet again. Earlier this school year, she had been earning
marks of “Satisfactory (S)” and “Satisfactory Plus (S+),” but now she is getting “Satisfactory
Minus (S−)” and “Needs Improvement (NI).” The mother describes the Jane as being more
restless and “antsy” with difficulty completing her homework and reading assignments. In
reviewing the Janes’ family and home environment, you discover that Janes’ father has recently
left the family because of the unexpected additional stress of the mother’s two teenage nephews
moving in with the family in the past 6 weeks after their mother was arrested on drug charges.
Janes’ tells you that the two boys tease and threaten her, and she says that she is fearful of them.
The mother admits that the addition of the two teenage boys to the family has been problematic
because the boys have been “unruly and disrespectful.” She admits to feeling somewhat trapped
and overwhelmed; however, she says the boys have “nowhere else to go,” and family should look
out for family.
Objectives
1.
How would you communicate with Jane, a 9-year-old child diagnosed with attention
deficit hyperactivity disorder (ADHD) who is restless and “antsy”? What
communication techniques would be effective and why?
2. Jane is diagnosed with attention-deficit hyperactivity disorder (ADHD)? Enumerate
the signs and symptoms to support this diagnosis.
3. What other areas of assessment are important to explore today with the patient and
her mother?
4.
What are the non-pharmacological interventions would you use to reduce the clients
level of stress and why?
5.
What are the psycho-pharmacological interventions for Jane’s diagnosis (ADHD),
write the indication, side effects, adverse effects and nursing consideration.
6.
Given the patient’s current signs and symptoms, do you believe
there is a need for medication adjustment?