Healthcare Check-up

 


Charlie is an 8-year-old boy who is having difficulty making friends and sitting still in class. When he goes to school, his teacher complains that he can't sit still. He will sit for 3 minutes, but soon afterwards, he starts bouncing his legs, and then he begins tapping his pencil. Shortly thereafter, he starts rapping lyrics under his breath. He is performing well in school, but his behavior is distracting to others.

Charlie isn't hyperactive like this at home, but his mother is concerned. His mother wants you to prescribe him Xanax for anxiety and Adderall for Attention deficit hyperactivity disorder (ADHD). After you do an extensive interview with Charlie, you realize that he is just bored in his U.S. History class and would rather be playing basketball in P.E. However, Charlie's mother insists that you write a few prescriptions. Research suggests that medical professionals (Doctors, Nurse Practitioners, Physician Assistants, etc.) are often pressured to write prescriptions even when they don't believe that it is the best thing to do for the patient.

Your investigation has led you to believe that Charlie just needs more physical exercise. But his mother continues to insist that Charlie needs medication. How would you explain to his mother what you plan to do? Use your investigation skills and present your facts to her.

 

 

Sample Answer

 

 

 

 

 

 

In this scenario, as an Advanced Practice Nurse, the goal is to practice beneficence (acting in the child’s best interest) while maintaining a therapeutic relationship with the mother through shared decision-making.

Addressing the pressure to over-prescribe requires a combination of clinical evidence, empathetic communication, and a clear diagnostic rationale. Here is how I would present the facts to Charlie’s mother.

The Clinical Assessment: Differentiating Boredom from ADHD

The first step is to explain why Charlie does not meet the clinical criteria for an ADHD diagnosis according to the DSM-5-TR.

The "Two-Setting" Rule: For an ADHD diagnosis, symptoms must be present in two or more settings (e.g., at home and at school). Since Charlie is not hyperactive at home, his behavior is likely "situational" rather than "neurological."