Case Study: Symptoms of ADHD and Potential Medications

The Patient's Symptoms

[Off camera]: So, you told your supervisor you were having difficulty with concentration, and then it was your supervisor who set up this appointment, right, is it?

[Harold]: Yeah, I, I work at this large architectural engineering firm and it’s all great. Except, they’ve accelerated the deadlines now and it just puts a lot of pressure on. And I, I just can’t concentrate. I mean, everyone else is, doesn’t have a problem with it. But, but I just, I just can’t seem to be able to do the same job they’re doing.

[Off camera]: Okay, tell me about your problem with concentration.

[Harold]: Well, um, you know it’s just… Perfect example is, is they wanted me to design um, air ducts.

[Off camera]: Right.

[Harold]: Air ducts, simple. But I designed them through solid wall, a fire wall, and a supporting wall and I didn’t even realize what I was doing.

[Off camera]: Uh-huh.

[Harold]: You know, I mean, um, I’m making silly mistakes like that because, another time we had these windows, we already bought them, design, beautiful, they’re going to be in this entire building.

[Off camera]: Right.

[Harold]: Every floor. Well, I drew the window opening way too small. Now, I mean, if that would have gone ahead, it would have cost millions. I just, it’s, it’s just silly things like that.

[Off camera]: Uh-huh, is this a new kind of problem for you?

[Harold]: Well, I mean, I didn’t seem to have a problem when everything was relaxed, and the deadlines were normal.

[Off camera]: Right.

[Harold]: I could do the job. Everything was fine. But now we’re on these, these ridiculously tight deadlines and, and I just, can’t seem to do it. Everyone else can. It’s, there’s not a problem for them. And I end up like I’m not pulling my weight.

[Off camera]: Uh-huh.

[Harold]: And they think that and it’s true, I’m not.

[Off camera]: Now did you have these, uh, similar kind of problems back in school?

[Harold]: Well, yeah, I mean, in school everyone would go to the library to cram for big exams, so, I mean.

[Off camera]: Right.

[Harold]: That was a normal thing. And, yeah, I’d go but I’d end up looking out the window. Look it’s snowing, oh, it’s spring time. I’ll go for a walk. And, and if someone is whispering in a library well, I have to go to the other side. All my friends could study anywhere.

Possible Causes of Symptoms

[Off camera]: Uh-huh, but, what other kind of difficulties do you seem to have?

[Harold]: Well, at the job we have, these uh, lectures, you know.

[Off camera]: Right.

[Harold]: We’d get together, it’s groups. This is the lectures by the chief of the department gets together with all the architects and engineers and he talks about the mission of the day. What we’re trying to work for, our goals.

[Off camera]: Right.

[Harold]: Do I listen? I’m thinking, maybe, my dog needs a bath. Or what am I going to have for lunch? Or, you know, anything other than what he’s saying.

[Off camera]: Mm-hmm.

[Harold]: And because of that, you know, it’s not a good idea.

[Off camera]: So, so, is it difficult to sit and listen?

[Harold]: Yeah, I mean, okay, we were supposed to be designing this other, on top of this penthouse, this, kind of, a patio, party area.

[Off camera]: Right.

[Harold]: And the gutters around it just to make sure everything was very comfortable for everyone. Well, I got up there and I’m designing and the gutters are here, and no, wait a minute, there’s Italian, tile floor. Doesn’t look like it’s tilted the correct way. So I started studying that and there were already two people assigned to study that. To fix that problem, not me.

[Off camera]: Mm-hmm.

[Harold]: I got in a lot of trouble for that one.

[Off camera]: Do you have any problems organizing?

[Harold]: At home or the office?

[Off camera]: Uh, either.

[Harold]: I’m a bit of a mess. I mean, and I’m messy. I will forget my shoes, my socks, my phone, my jacket, I, I can’t find them. I’m not that organized. And I have a calendar. One of my coworkers, actually bought me a calendar to motivate me.

[Off camera]: Yeah.

[Harold]: To get more organized. So, I started writing down all the important dates and events, but then do I ever look at that calendar? No, I don’t. So, it’s a complete waste of time.

[Off camera]: What about problems paying bills?

[Harold]: Bills, I mean, yeah they get paid. After two or three times of the threatening calls or letters. And then I have to pay the penalties.

[Off camera]: Hmm, what about hyperactivity?

[Harold]: You know, I mean, I’m, sometimes I’m a little more uncomfortable in a chair or you know. But I don’t think that’s that big a deal. I mean, I used to be a lot worse. I mean, uh, there was a time when I was in school, I would get marked down for citizenship because I never raised my hand and I talked out of class and, and I just, couldn’t seem to stay focused. But I’m a lot better now.

[Off camera]: Mm-hmm, were you ever um, treated with medications or behavioral therapies for ADHD?

[Harold]: No, no. My mother threatened that one time, but I was never evaluated. Never went, uh, I’m kind of amazed she never just dragged me into a doctor’s office, but she never did.

[Off camera]: Do you drink any caffeinated drinks?

[Harold]: Coffee, soda, you know, once in a while. But when I was a kid, my mother said no caffeine, no sugar, cause you’ll climb the walls. I was already doing it anyway and so she, I uh, once and a while I’ll have a little caffeine now and it kind of helps me focus a little but, sugar, I stay away from that. It’s just not a good idea.

Read the above case Study (Harold Case Study Video ) and Answer the following questions and post to this discussion forum:

1) What symptoms of ADHD does your patient present with?

2) What are other possible causes of his symptoms?

3) What further information, if any, would you like about this case?

4) With the assumption that the patient does have ADHD, what 2 medication would think you prescribe (list 2 names and dose)?

5) Why?

6) List any relevant safety information and screening (labs, etc) related to your medication choice.

7) What are the common side effect of these medications?

8) Modifying the contraindication of these medications?

9) What is the role of Wellbutrin and ADD and when you will choose to use this medicine?

10) What are the advantages and disadvantages of each?

11) Is there any difference in medication and treatment for ADD with different age group?