Julia, a 19-year-old female college student, came to a school clinic for help with academic problems. Since starting college six months earlier, she had done poorly on tests and could not manage her study schedule. Her worries about flunking out of college were causing her poor sleep, poor focus and lost hope. After a week of low grades, she returned home and told her family she should drop out of college. Her mother brought her to the clinic where she and her older brother had been treated for ADHD when they were younger. She wondered if his ADHD might be causing his problems, or whether he had outgrown it.
Julia had been to the clinic when she was 9 years old and had been diagnosed with ADHD. Notes from that evaluation showed Julia had been in trouble at school for getting out of her seat, losing things, not following instructions, not completing homework and not listening.
A psychologist also confirmed reading problems during the evaluation. Because Julia’s problems did not meet the standard for a learning disability diagnosis, she could not receive special education services. Julia’s primary care doctor had proposed medication, but her mother refused. Instead, she hired a tutor to help her daughter “with concentration and reading.”
Since starting college, Julia said he often had trouble staying focused while reading and listening to lectures. Because of his stress at school, she had trouble falling asleep, had poor energy and didn’t “have fun” like his peers.
Julia’s older brother had ADHD. Her father, who died when Julia was seven, had dyslexia (a reading disorder). Her father had dropped out of community college after one semester.
Julia was referred to a psychologist for more testing, and the doctor diagnosed her with ADHD. The report stated that Julia had certain problems with reading fluency and comprehension (reading quickly and know the correct meaning), as well as spelling and writing. When she was first assessed at age 9, the standards for ADHD required six of nine symptoms. She had been diagnosed with the combined type of ADHD, because the specialty clinic had found at least six symptoms in inattention and hyperactivity/impulsivity. With DSM-5, only five symptoms are needed for people age 17 and older. At age 19, Julia met the standards for ADHD and for a specific learning disorder. With the correct diagnosis, he was able to receive services for academic support for her college studies.
American Psychiatric Association. (2021). ADHD patient stories. Understanding Mental Disorders: Your Guide to DSM5. American Psychiatric Publishing, Inc.
What is your diagnosis and treatment plan for this case? Include the following:
Pharmacological tx
Non-pharmacological to
Patient Education
Referral to other providers
Based on the information provided, the diagnosis for Julia is ADHD (combined type) and a specific learning disorder, particularly in reading fluency, comprehension, spelling, and writing.
Treatment Plan:
- Pharmacological Treatment: Since Julia’s mother refused medication in the past, it is important to respect her decision. However, if Julia is open to considering medication, it may be beneficial to discuss with a psychiatrist or primary care doctor experienced in treating ADHD. Stimulant medications like methylphenidate or amphetamines are commonly prescribed for ADHD symptoms. The decision to pursue medication should be made after a thorough discussion of the potential benefits, side effects, and individual considerations.
- Non-pharmacological Treatment: a. Educational Accommodations: Julia should be provided with academic support and accommodations to address her learning difficulties. This can include extended time for exams, preferential seating, note-taking assistance, and access to assistive technology. b. Cognitive Behavioral Therapy (CBT): CBT can help Julia develop strategies to manage her ADHD symptoms, improve time management and organization skills, enhance study techniques, and address any associated anxiety or depression. c. Tutoring and Study Skills Training: Continue with the tutoring support Julia’s mother has already arranged to improve her concentration, reading skills, and overall academic performance. d. Lifestyle Modifications: Encourage Julia to adopt healthy lifestyle habits, such as regular exercise, proper sleep hygiene, and a balanced diet. These can have a positive impact on her overall well-being and may help mitigate ADHD symptoms.
- Patient Education: Provide Julia and her family with education about ADHD, its symptoms, and its impact on academic performance. Help them understand the importance of early intervention and the available treatment options. Share resources and support groups where they can find additional information and connect with others facing similar challenges.
- Referral to Other Providers: Julia has already been referred to a psychologist for further testing and evaluation. It is important to involve a multidisciplinary team to provide comprehensive care. Consider additional referrals to specialists such as an educational psychologist, neuropsychologist, or speech therapist, depending on Julia’s specific needs.
The treatment plan should be tailored to Julia’s individual circumstances and preferences. Regular follow-up appointments with the healthcare providers involved will be crucial to assess progress, make any necessary adjustments, and ensure ongoing support.