‘How I Treat’ Pediatric ADHD | Fine-Tuning a Case of Pediatric ADHD Case Presentation

Michael is an 8-year-old male who comes to our outpatient clinic due to ongoing concerns with his behavior at school (he frequently makes jokes and talks in class) and with academic concerns (he forgets to turn in homework, and teachers consistently say he could do better academically than he does). At home, Michael often fights with his younger siblings, argues with his parents about completing chores and doing homework. Otherwise, his parents see him as bright, good at soccer, and generally happy.

 Several months ago, he was screened by his pediatrician for attention-deficit/hyperactivity disorder (ADHD) using the Vanderbilt ADHD Diagnostic Parent Rating Scale and was started on Ritalin 10 mg daily to help manage symptoms of hyperactivity and attention.  His parents are not sure Ritalin has done much to help him at school. They do not see any difference at school and are worried that with school starting again soon, he will struggle like he did last school year.  In addition, Michael’s mother shares that she was also recently diagnosed with ADHD, and she worries about how her own disorganization impacts their evenings where they all procrastinate on Michael’s homework completion, resulting in tough evenings.  While they love their pediatrician, they wonder if there is more to be done to support Michael and manage the impact of his ADHD on his school day and their home life.

Michael sleeps well at night and has tolerated the Ritalin well.  He is an active 8-year-old that weighs 64 lbs and has many school and neighborhood friends.  His parents are also concerned that some of his “good friends” have started to step back from him a bit due to his trouble at school with talking out of turn or making jokes.  They want him to keep his friends and feel better about school, as he started to complain about going to school at the end of the last school year.  Michael is generally happy and active throughout the evaluation and says he wants to stop getting into trouble at home and school and to do better than last year.  He and his parents communicate well in the evaluation, even about the conflicts at home.

Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. A clinical professor of psychiatry and nursing at the University of Illinois Chicago and the director of the Pediatric Mood Disorder Clinic, she has been practicing as a Psychiatric Nurse Practitioner for over 35 years.

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