NURS 6640: Psychotherapy With Individuals

NURS 6640: Psychotherapy With Individuals

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NURS 6640: Psychotherapy With Individuals

Initial post

The client that has been selected for the purpose of this discussion is the hyperactive child. The client is an African-American girl who seems to be between the age of 12 and 15. During the sessions, she seems to focus only on other things other than the session. She seems to find it hard to settle in one place and she talks very fast. In fact, it is hard to tell what exactly he is talking about. She does not give the listener a chance to respond to her questions. She asks a series of questions at a time and this makes it hard to have a conversation with her. Indeed, this looks mostly like a case of ADHD. To be specific, this is a case of hyperactivity and impulsivity considering that ADHD may be manifested as hyperactivity, impulsivity and/or inattention (Krull, 2019).

According to the DSM 5, there are a number of criteria that must be met in order to diagnose a client with hyperactivity and impulsivity. First, it is important to note that the symptoms should not be mainly the manifestation of failing to understand instructions, hostility, defiance or oppositional behavior (APA, 2013).  This is not the case. In fact, this child does not seem to have any symptoms suggesting the above-mentioned list. Secondly, the child should show at least 6 of the listed symptoms in at least 6 months. In this particular client, there are various symptoms that come out very clearly. She is always fidgeting; she leaves the seat where she is required to remain seated like in this case where she is expected to be seated during the session. She seems to find it hard to engage in activities in a quiet manner. She seems to be on the go and others may find it hard to keep up with her. She talks excessively, she blurts answers before a question is completed and she seems to find it hard to wait for her turn to speak, meaning that she often interrupts others. It is important to be specific whether or not there is a combination of inattention and hyperactivity/impulsivity or just a case of hyperactivity and impulsivity (APA, 2013). In the case of the current client, the diagnosis is only that of hyperactivity and impulsivity.

Treatment of ADHD can be done using stimulants as well as non-stimulants. Notably, stimulants are either methylphenidates or amphetamines.  Stimulants always work by blocking dopamine both at the postsynaptic as well as presynaptic membrane. The most common treatment for ADHD remains to be stimulants because they are up to 70% effective (Magnus, Nazir, Anikumar & Shaban, 2019). In this case, the stimulant that shall be used is methylphenidate. This is because this is a stimulant that has been documented as having significant efficacy in treating ADHD. There is also evidence showing that there are specific cognitive processes that are involved when stimulants are used with a view of mediating clinical improvement (Hawk et al., 2018). It is expected that with the medication, the client shall have better control of her thoughts and behavior. There will be less impulsivity and hyperactivity and she will behave normally for her age. Cognitive behavioral therapy can also be used to help her improve her thinking as well as social interaction. In a study that utilized cognitive behavioral therapy in adolescents with ADHD, it was concluded that the intervention was effective in mediating better clinical outcomes and the adolescents also tolerated the intervention (Sprich, Burbridge, Lerner & Safren, 2015). A combination of drugs and CBT shall therefore be effective in this case.

References

Hawk Jr, L. W., Fosco, W. D., Colder, C. R., Waxmonsky, J. G., Pelham Jr, W. E., & Rosch, K. S. (2018). How do stimulant treatments for ADHD work? Evidence for mediation by improved cognition. Journal of Child Psychology and Psychiatry, 59(12), 1271-1281

Krull, K. R. (2019). Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. Agustyn M, Torchia MM (Eds), UpToDate, Waltham MA. Accessed on April, 29

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2019). Attention deficit hyperactivity disorder (ADHD). In StatPearls [Internet]. StatPearls Publishing

Sprich, S. E., Burbridge, J., Lerner, J. A., & Safren, S. A. (2015). Cognitive-behavioral therapy for ADHD in adolescents: Clinical considerations and a case series. Cognitive and behavioral practice, 22(2), 116-126