Assessing and Treating a Child with ADHD: Case Study
This paper presents a clinical case study of an African-American child aged 8–12 exhibiting symptoms consistent with ADHD, predominantly hyperactive presentation (DSM-5 code 314.01/F90.1). The paper covers the initial client assessment, formal diagnosis, and a therapeutic approach combining behavioral interventions with pharmacotherapy. Behavioral strategies discussed include parental training, classroom interventions, and positive reinforcement techniques. Pharmacological recommendations center on methylphenidate stimulants, specifically Concerta, as a first-line treatment. The paper concludes with expected treatment outcomes, including symptom reduction and improved academic and behavioral functioning.
- Client Assessment: Behavioral observation and DSM-5 symptom review
- Diagnosis: Formal ADHD hyperactive-presentation diagnosis assigned
- Therapeutic Approach: Combined behavioral and pharmacological treatment plan
- Pharmacotherapy Recommendations: Stimulant medication selection and dosing rationale
- Expected Treatment Outcomes: Anticipated symptom reduction and functional gains
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What makes this paper effective
- The paper grounds its clinical reasoning directly in DSM-5 criteria, linking observed behaviors to specific diagnostic thresholds before assigning a formal diagnosis — a disciplined move that prevents over-diagnosis.
- It integrates both pharmacological and behavioral dimensions of treatment rather than treating them in isolation, reflecting current evidence-based practice for pediatric ADHD.
- The case formulation section clearly maps the ABC (antecedent–behavior–consequence) logic, making the therapeutic rationale transparent and easy to follow.
Key academic technique demonstrated
The paper demonstrates evidence-based clinical reasoning: each treatment recommendation is tied to a cited empirical source (e.g., Kolar et al., 2008 for medication efficacy ranges; Abikoff, 1997 for combination therapy superiority). This technique shows readers how to move from observation to diagnosis to intervention using a literature-supported chain of reasoning, which is the core skill in applied psychiatric nursing practice.
Structure breakdown
The paper follows a standard clinical case-study format: (1) behavioral observation and symptom inventory in the assessment section; (2) a formal DSM-5 diagnosis with its numerical code; (3) a case formulation and combined therapy plan covering both behavioral and pharmacological interventions; (4) medication selection rationale with dosing specifics; and (5) expected outcomes tied to measurable functional improvements. Each section builds logically on the last, mirroring real-world clinical documentation practice.
Client Assessment
The client is an African-American child aged between 8 and 12. Her identifying symptom is the inability to remain calm when the situation requires it — for example, during counseling sessions, where she repeatedly nags the counselor to play (APA, 2013). She also talks excessively during sessions, displays intrusive behavior such as using the counselor's belongings without permission, and seeks to play in situations where play is inappropriate (APA, 2013). She displays a tendency to blurt out answers without reflection — for instance, calling the counselor "stupid" for leaving his things within reach. She also appears to be constantly "on the go," as if anxiously waiting for the session to end so she can play, and she handles a toy throughout the session, signifying poor concentration.
The client also displays some symptoms of inattention (APA, 2013). She expresses a strong dislike for homework and wishes she could make it disappear. She is easily distracted by toys in the counselor's office and immediately begins to play with them. However, she does not meet the DSM-5 criteria for inattentiveness, which requires an individual to present with at least six symptoms in Category A.
Diagnosis
ADHD, predominantly hyperactive presentation — 314.01 (F90.1)
Therapeutic Approach
The client wishes she could disappear and that her parents would leave her alone. She resents the fact that her parents will not let her play video games, likely because she is unable to manage her time and complete her homework or other chores on schedule. The client's case can be formulated as follows: she finds homework boring (prompting event) and chooses to play video games instead, but her parents refuse to accommodate this preference (problem thought). They prevent her from playing, leading to sadness, anger, boredom, and frustration that make her want to disappear (target behavior) (Wheeler, 2014).
Given this formulation, the PMHNP needs to initiate combined therapy incorporating both pharmacotherapy and behavioral therapy. Studies have shown that combination therapy is more effective than either pharmacotherapy or behavioral therapy alone (Abikoff, 1997). Behavioral interventions could include behavioral parental training, behavioral interventions in the classroom, response-cost contingencies, and positive reinforcement. Wheeler (2014) emphasizes the need to empower parents and involve them as partners in their children's treatment.
Parental training could involve educating the client's parents about ADHD and the most appropriate strategies for managing the child's hyperactivity. For instance, parents could be guided to spend more time with their child, assist her with homework, and use positive reinforcements — such as compliments and rewards — to encourage her to take on more challenging tasks. The client's teachers could also be trained on how to make homework more engaging given her situation, constituting the behavioral classroom intervention component.
References
Abikoff, K. H. (1997). Behavior therapy and methylphenidate in the treatment of children with ADHD. Journal of Attention Disorders, 2(2), 89–114.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389–403.
Loe, I. M., & Feldman, H. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32(6), 643–654.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer Publishing Company.
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