Week 9: Therapy for Clients with ADHDTyler, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Tyler, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Tyler was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).ADHD is a prevalent disorder for clients across the lifespan, as more than 6 million children (CDC, 2016) and 8 million adults (ADAA, 2016) have been diagnosed with the disorder. Like Tyler, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, clients often respond well to therapies and have positive health outcomes.This week, as you study ADHD therapies, you examine the assessment and treatment of clients with ADHD. You also explore ethical and legal implications of these therapies.Photo Credit: [kristian sekulic]/[E+]/Getty ImagesDiscussion: Presentations of ADHDAlthough ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.Learning ObjectivesStudents will:Assess client factors and history to develop personalized therapy plans for clients with ADHDAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHDEvaluate efficacy of treatment plansApply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapyLearning ResourcesNote: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.Required ReadingsNote: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab. Chapter 4, “ADHD Treatments”Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.Review the following medications:For ADHD armodafinilamphetamine (d)amphetamine (d,l)atomoxetinebupropionchlorpromazineclonidineguanfacinehaloperidollisdexamfetaminemethylphenidate (d)methylphenidate (d,l)modafinilreboxetineAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Note: Retrieved from Walden Library databases.Optional ResourcesHodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. doi:10.2165/11599630-000000000-00000Psychiatric Times. (2016). A 5-question quiz on ADHD. Retrieved from http://www.psychiatrictimes.com/adhd/5-question-qu...Assignment: Assessing and Treating Clients With ADHDNot only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.Learning ObjectivesStudents will:Assess client factors and history to develop personalized therapy plans for clients with ADHDAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHDEvaluate efficacy of treatment plansEvaluate ethical and legal implications related to prescribing therapy for clients with ADHDLearning ResourcesNote: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.Required ReadingsNote: Review all materials from the Discussion.Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.Note: Retrieved from Walden Library databases.Required MediaLaureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: AuthorNote: This case study will serve as the foundation for this week’s Assignment.To prepare for this Assignment:This case study will serve as the foundation for this week’s Assignment.The AssignmentExamine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:Decision #1Which decision did you select?Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?Decision #2Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Decision #3Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Also include how ethical considerations might impact your treatment plan and communication with clients.Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requiremeAttention Deficit Hyperactivity Disorder A Young Girl With ADHDBACKGROUNDKatie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father. SUBJECTIVEKatie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. MENTAL STATUS EXAMThe client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation RESOURCES§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291. Decision Point OneSelect what the PMHNP should do:Begin Wellbutrin (bupropion) XL 150 mg orally dailyBegin Intuniv extended release 1 mg orally at BEDTIMEBegin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNINGRESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minuteDecision Point TwoChange to Ritalin LA 20 mg orally daily in the MORNINGRESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visitDecision Point ThreeSelect what the PMHNP should do next:Maintain current dose of Ritalin LA and reevaluate in 4 weeksIncrease Ritalin LA to 30 mg orally dailyObtain EKG based on current heart rateRESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visitDecision Point ThreeMaintain current dose of Ritalin LA and reevaluate in 4 weeksGuidance to StudentAt this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.

Instructions:Target Corporation describes itself as “an upscale discounter that provides high-quality, on-trend merchandise at attractive prices in clean, spacious and guest-friendly stores.” Target has over 350,000 employees and operates over 1,700 stores in the United States. The firm recently opened stores in Canada, and—like Walmart (see chapter 14 in your text)—it has an online business component. Target also offers branded proprietary credit and debit cards. Part A Target Corporation: ROIC For the fiscal year ending January 31, 2012, Target’s EBIT was $5,322,* and its tax rate was 34.3 percent. Its short-term borrowings were $3,786, and its long-term debt was $13,697. In addition, the firm’s book value of equity was $15,821. 1.Estimate Target’s return on invested capital or ROIC. 2.Compare it with Walmart’s. Are you surprised at the difference? * All amounts related to Target are in millions of dollars, unless otherwise noted. Part B Target Corporation: ROE For the fiscal year ending January 31, 2012 (2011), Target had total revenues of (in millions) $69,865 ($67,390) and net earnings of $2,929 ($2,920). Its total assets were $46,630 ($43,705) and its equity was $15,821 ($15,487). 1.Estimate Target’s return on equity (ROE) for each of these two years, using the DuPont decomposition to indicate the profit margin, the asset turnover, and the firm’s financial leverage. 2.Why has the ROE changed? 3.How would you compare the ROE drivers for Walmart and Target? Part C Target Corporation: Cost of Capital According to its annual report, as of January 31, 2012, Target’s borrowing costs averaged 4.6 percent, and its tax rate was 34.27 percent. A research report estimated Target’s cost of capital at 10.5 percent. The firm had interest-bearing debt of $17,483. Moreover, Target’s stock was trading at $50.81 per share, and there were 679.1 million shares outstanding. Now, let’s assume Target’s amount of debt is also a market value estimate of the debt. Let’s also assume the current debt and equity values are at Target’s optimal capital structure. 1.Based on market value estimates, what is Target’s cost of capital? 2.How does it compare to Walmart’s, and what explains the difference? Part D Target Corporation: EVA Earlier, you were provided with the information necessary to estimate Target’s operating profit (EBIT) after-tax, also known as NOPAT; invested capital (the book value of equity plus interest-bearing debt); cost of capital; and market value of equity. Based on this information, 1.Estimate Target’s EVA for the year that ended on January 31, 2012. 2.Was Target adding value? 3.Did Target have a positive market value added or MVA? 4.How did Target’s EVA and MVA compare with Walmart’s EVA and MVA? Part E Target Corporation: EV/EBITDA Analysis Let’s suppose you forecast Target’s EBIT for the year ending January 31, 2013, to be $5,352, and you forecast Target’s depreciation and amortization to be $2,361. A research analyst determines that an appropriate forward-looking EV/EBITDA multiple for Target is 6.9 times. Based on this information, 1.Estimate Target’s enterprise value, or EV. 2.Next, incorporating the value of Target’s debt, estimate the firm’s value of equity. 3.Finally, based on 679.1 million shares outstanding, estimate the intrinsic value per share and compare it with Target’s stock price on January 31, 2012, of $50.81. 4.Based on this analysis, is Target’s stock overvalued or undervalued?

Post a 300- to 500-word response in which you address the following:Provide the full DSM-5 diagnosis for O. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention).Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services.Explain how you would use the client’s family to support recovery. Include specific behavioral examples.Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan.Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder.