PMHNP Care Across the Lifespan I
The assigned disorder is ADHD
The Assignment (1–2 pages)
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
Explain the risk assessment you would use to inform your treatment decision-making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
Attention-Deficit/ Hyperactivity Disorder (ADHD): Treatment in Children and Adolescents
Attention-deficit/ hyperactivity disorder is a neurodevelopmental disorder that affects children but can progress into adulthood if not treated early. Affected children have a reduced attention span and may in addition show hyperactivity or not (APA, 2013; Sadock et al., 2015).
Treatment in Children and Adolescents
One FDA-approved drug for treating ADHD in children and adolescents is atomoxetine (Strattera). It is a selective norepinephrine reuptake inhibitor (Stahl, 2017). There are also other medications that are not FDA-approved but used off-label to treat the condition. One of them is bupropion (Wellbutrin). It is a norepinephrine dopamine reuptake inhibitor (Stahl, 2017). A study by Braüner et al. (2016) found that about 32.3% of all psychiatric prescriptions for children and adolescents are off-label. The nonpharmacological interventions that are evidence-based include psychosocial treatments such as parent training, cognitive behavioral therapy (CBT), and neurofeedback amongst others (Shrestha et al., 2020).
Risk Assessment to be Performed for Treatment Decision
The risk assessment that would be performed to inform the treatment decision would involve finding out the safety profile of especially the non-FDA approved medication. Also, extensive consultations with more experienced colleagues who have used it before will need to be done. For the FDA-approved one, the risk assessment will involve evaluating the possibility of adverse reactions. The benefit of the FDA-approved drug is that it is proven to be efficacious in treating the condition. The risk is that of sedation and reduced appetite (Stahl, 2017). The benefit for the off-label drug is also that it has been shown to reduce ADHD symptoms by anecdotal evidence. The risks however include insomnia, weight loss, and agitation (Stahl, 2017).
Clinical Practice Guidelines
There are indeed clinical practice guidelines for use in guiding the treatment of ADHD in children and adolescents (Wolraich et al., 2019). The guidelines advocate for the use of nonpharmacological interventions as a first step. If results are not achieved, then pharmacological measures are to be added. Off-label prescriptions can be tried if the PMHNP thinks that the characteristics of the child favor a better clinical outcome.
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
Braüner, J.V., Johansen, L.M., Roesbjerg, T., & Pagsberg, A.K. (2016). Off-label prescription of psychopharmacological drugs in child and adolescent psychiatry. Journal of Clinical Psychopharmacology, 36(5), 500–507. https://doi.org/10.1097/jcp.0000000000000559
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: A review. Translational Pediatrics, 9(S1), S114–S124. https://doi.org/10.21037/tp.2019.10.01
Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6th ed. Cambridge University Press.
Wolraich, M.L., Hagan, J.F., Allan, C., Chan, E., Davison, D., … Earls, M. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528