Reference no: EM133879345

Question

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most commonly missed neurodevelopmental disorders in girls, as their differences in presentation, with inattention being the primary symptom when compared to boys who typically present as hyperactive, may contribute to missing the diagnosis until adulthood (Hinshaw et al., 2021). These girls grow up to be women who are left without treatment and, as adults, have additional stressors like work, childrearing, and family responsibilities and find themselves turning to drugs, alcohol, and food to cope (Babinski & Libsack, 2024).

My case study, Jessica, is a 32-year-old woman who is newly diagnosed with ADHD and has lifelong struggles with school, work performance, and interpersonal relationships. As Robberect et al. (2020) report, roughly 5% of adults have ADHD. Prescribing Jessica with medication to treat her symptoms, such as a stimulant like methylphenidate (MPH), could improve her symptoms, and a fair medication trial is warranted to promote an improved quality of life. Her medication treatment may not end with MPH as 20-40% of people with ADHD are treatment-resistant and unable to see an improvement in symptoms with medication management (Hsu et al., 2019). Those adults may continue to struggle with educational and career goals, difficulties at work, relationship struggles, and legal problems, as ADHD often has an unstable course, similar to Jessica's struggles.

A meta-analysis concluded that half of the studies that received funding from pharmaceutical companies showed that MPH was effective for adults with ADHD (Cândido et al., 2021). Jessica has never been treated and has the potential to benefit from medication management with MPH.

Once a medication is tried, it is crucial to complete a measurable self-reported tool showing the benefit of MPH, such as the Barrett Impulsiveness Scale (Crisp & Grant, 2024). In addition, at follow-up visits, completing urine drug screens is a common practice for clinics that prescribe controlled medications, including stimulants, to ensure that the patient is taking her medication and not selling their medication, as 8.9% of patients surveyed in the United States on MPH endorse a history of diversion (Chamakalayil et al., 2021). Besides these legal and ethical concerns, a stigma exists in society about people being treated for ADHD, including prescribers unwilling to accept newly diagnosed adults as patients (Babinski and Libsack, 2024).

An advantage to prescribing a stimulant is that the Food and Drug Administration.

(FDA) approves them for adults with ADHD. In addition to drug diversion, misuse is a disadvantage to prescribing stimulants, as a recent prospective cohort study reported that 22% of patients endorsed misusing their methylphenidate at least once (Chamakalayil et al., 2021).

Stimulants can be used long-term into older adulthood, as MPH did not make the Beers Criteria list of potentially inappropriate medications (The 2023 American Geriatrics Society Beers Criteria® Update Expert Panel, 2023). Additionally, MPH is used as monotherapy or as an adjunct for treating late-life depression in patients over 60 years old (Siddarth et al., 2020).

Studies are available comparing stimulant to non-stimulant treatment for ADHD. Wilens et al. (2024) show in their review that MPH outperformed atomoxetine in improving executive function (EF). Viloxazine, a selective norepinephrine reuptake inhibitor, showed mixed results when studied for improving EF.

With MPH, it is essential to have a thorough health history before prescribing, as there is a risk of cardiovascular disease, including sudden cardiac death, when taking stimulant medications (Goldin, 2022). Other vital risks to discuss include the risk of suicide, as stimulants have a black box warning related to suicide risks. Some additional side effects include constipation, anorexia, nervousness, and insomnia(Goldin, 2022).

MPH works as a dopamine and norepinephrine reuptake inhibitor, leaving a substantial store of dopamine in the presynaptic cleft (Grevet et al., 2022; Jaeschke et al., 2021). Besides targeting the striatal region, it also targets the prefrontal cortex, where it promotes wakefulness, improves performance, and decreases the need for sleep (Yoo et al., 2020).