Hyperactive Child

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The hyperactive child is an adolescent, African American, Female client.  Her speech is rapid, pressured, and tangential.  Her thought process is disorganized with flights of ideas.  She appears impulsive with poor boundaries as evidenced by grabbing items that do not belong to her.  She presents with psychomotor agitation evidenced by constant fidgeting in her seat, grabbing objects, and manipulating them continuously in her hands.  The client expresses an aversion to doing homework and reports that her parents are always “on my back about video games” (Laureate Education, 2013).  While this video file does not provide the ability to ask important follow-up questions for determining diagnostic criteria, the data that can be extrapolated is highly suggestive of ADHD.  The client’s observed behaviors are consistent with the following DSM criteria for ADHD: Distracted by external stimuli, frequent fidgeting, constantly on the go, talking excessively, and frequent intrusive or interruptive behavior. Follow-up questions regarding her dislike for homework might meet DSM criteria for inattention to detail in homework, difficulty organizing tasks, and reluctance to engage in activities requiring prolonged mental effort.  Together, these inattentive, impulsive, and hyperactive symptoms exceed the six required for a diagnosis of ADHD (American Psychiatric Association, 2013).

The client would be initiated on Methylphenidate SR 18 mg each morning. Stimulant medications are first-line pharmacologic agents for the treatment of ADHD in adolescents, as they display the highest efficacy for both impulsive and inattentive symptoms and improve long term outcomes in those with ADHD (Stahl, 2013).  The most evidenced therapy for ADHD is behavioral therapy, in which the therapist works with parents to modify the child’s environment and help improve behaviors.  This is done via behavioral parent training in which strategies such as operant conditioning are taught in order to modify dysfunctional behaviors and reinforce positive behaviors (Nathan & Gorman, 2015). The intended outcome for both pharmacologic and nonpharmacologic interventions is to reduce symptoms in order to improve goal-directed behavior.  This will ultimately result in improved scholastic achievement, better interpersonal relationships, and will thereby improve long-term functioning overall.