Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.

To prepare for this Discussion:

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty

The Case: 8-year-old girl who was naughty The Question: Do girls get ADHD? The Psych pharm Dilemma: How do you treat ADHD with oppositional symptoms? Pretest Self-Assessment Question (answer at the end of the case) what is true about oppositional symptoms in patients with ADHD A. They can be part of the diagnostic criteria for ADHD in children B. They can be confused with impulsive symptoms of ADHD C. They can be part of oppositional defiant disorder (ODD) which can be comorbid with ADHD D. They can be part of conduct disorder (CD) which can be comorbid with ADHD Patient Intake • 8-year-old girl brought to her pediatrician by her 26-year-old mother • Chief complaint: fever and sore throat Psychiatric History • While evaluating the patient for an upper respiratory infection, the pediatrician asks if school is going well • The patient responds “yes” but in the background the mother shakes her head “no” • The mother states that her daughter is negative and defiant at home and she has similar reports, mostly of disobedience, from her teacher at school • The patient has had temper tantrums since age 5 but these have decreased over the past 3 years, especially the past year • Still angry and resentful since her little sister was born 6 years ago • Academic problems • Fights with other children, mostly arguments and harsh words with other girls at school Social and Personal History • Goes to public school • Has a younger sister age 6 • Does not see her father much, lives in a nearby city • Not many friends • Spends most of her time with her sister and either her mother or her maternal grandmother who helps with after school supervision and baby sitting

Medical History • None Family History • None known for medical or psychiatric disorders other than the father who drinks a bit too much and his father (paternal grandfather) who some think might be an alcoholic • Mother was adopted and no family history known Pediatrician’s Notes: Initial Evaluation • Not enough time to do any more evaluation • Instead, the mother is given the parent and teacher version of the Conners ADHD rating scale and is instructed to bring the completed forms to the follow-up visit • A variety of rating scales are available, some without charge (see http://www.neurotransmitter.net/adhdscales.html). • The Connors scale charges a fee but other rating scales available at this link, or listed in the Two-Minute Tute below are free. Pediatrician’s Notes: Follow-up Visit Week 3 • At the follow-up visit, the mother admits to having been too busy to fill out the parent form • Also admits to having forgotten to send the rating form to the teacher • Mother acknowledges being more disorganized since her second child started school this year • Since then it has also been extremely difficult to keep the patient organized and focused on school • The mother is on the verge of tears • “Two children are too much for a single mother” • The pediatrician offers to send the teacher form to the school and gives the mother tips on how to remember to fill out her own form • When the teacher form is sent back to the pediatrician’s office the mother will be contacted for a follow-up visit Pediatrician’s Notes: Follow-up Visit Week 6 • At the follow-up visit, the mother comes alone • Teacher’s ADHD rating scale responses state that the patient has significant problems with – Talking excessively – Sustaining attention – Being organized – Being distracted – Being forgetful

– Following instructions – Making careless errors (except when it comes to her homework) • The teacher also complains of the patient being more argumentative and disobedient than the other children in her class • The mother’s responses on the ADHD rating scales are similar to the teacher’s but she endorses only five symptoms as significantly impairing • Checked “severe” for ability to listen (rated only mild by the teacher) • Upon further questioning by the pediatrician, it becomes clear that the mother is compensating for her daughter by – Double checking her homework – Making sure homework is in her backpack – Helping the patient be organized • Eventually, symptoms that were originally determined to be “mild” by the mother are changed to “significantly impairing” • Mother confirm that the patient argues a lot with her, especially when the mother is trying to oversee her work, and that the patient still occasionally has temper tantrums similar to when she was five years old, but milder Based on just what you have been told so far about this patient’s history what do you think is her diagnosis? • ADHD • ODD (oppositional defiant disorder) • CD (conduct disorder) • ADHD comorbid with ODD • ADHD comorbid with CD • A child acting out again her mother’s divorce and against having to share her mother with her sister • Other Pediatrician’s Mental Notes: Follow-up Visit, Week 6, Continued • The patient is diagnosed with ADHD, mostly inattentive type, comorbid with symptoms of oppositional defiant disorder – ADHD symptoms include inattention but not hyperactivity – Some of her impulsive symptoms such as being argumentative and disobedient overlap with her ODD symptoms but the ODD symptoms seem to be willful and on purpose rather than truly thoughtlessly impulsive • To be diagnosed with conduct disorder, the patient would need to exhibit symptoms similar to ODD plus have aggression towards animals, destruction of property, deceitfulness or theft, and serious violations of rules, symptoms of a type and severity that neither the teacher nor the mother brought up

1. Think of an idea you would like to see implemented in your job (e.g. a way to increase productivity, improve service, increase business, or improve working conditions). Write a routine miscellaneous memo requesting action and persuading your audience that your idea is worthwhile.

2. Write a memo as the sales director of a company to both in-house sales department employees and the sales representatives. Announce and describe a new dress code policy and diplomatically explain why the policy is more strict for the sales reps. Remember to keep the tone informal but professional, to format the memo properly, and to provide adequate information regarding the new dress code.

Pay attention to the standard parts of a memo listed on pages 327-328 ( Note: I will send you those pages on chat)

Please see below.

Please address the fact pattern. Discuss any possible causes of action as well as relevant defenses. Only discuss relevant issues!  I am not as interested in your outcome (who will end up winning) as I am in how you use the law to support your points. Base your answer only on facts given. If additional information is needed, tell me that. 

1)

Bart was employed as assistant manager to Sav-On Drugs. He was accused of theft and embezzlement, which he admitted to, and was fired. The following day at company headquarters, he signed a contract promising to repay the company $2000. Bart made a payment of $741 and then stopped. Sav-On sued for the balance. Bart argues he signed the agreement under duress. Result?

2)

Sonny, an inexperienced businessman, bought equipment and chinchillas from Division West Chinchilla in order to start a chinchilla ranch. Sonny got into the business because Division West told him that the chinchilla ranching was “an easy undertaking and no special skills were required.” Sonny lost money operating the ranch. He sued, claiming fraud. Result?

Please use in-text citations and references.

Chapter 6

http://www.saylor.org/site/textbooks/The%20Legal%20and%20Ethical%20Environment%20of%20Business.pdf

 1. Southern Sporting Good Company makes basketballs and footballs.
Each product is produced from two resources rubber and leather. Each
basketball produced results in a profit of $11 and each football earns
$15 in profit. The resource requirements for each product and the total
resources available are as follows: 
Product 
Resource Requirements per Unit Rubber (lb.) Leather (ft2) Basketball 2.8 3.7 Football 1.5 5.2 Total resources available 600 900

a. Find the optimal solution.

b. What would be the effect on the optimal solution if the profit for the basketball changed from $11 to $12?

c.
What would be the effect on optimal solution if 400 additional pounds
of rubber could be obtained? What would be the effect if 600 additional
square feet of leather could be obtained?

2. A company produces
two products, A and B, which have profits of $9 and $7, respectively.
Each unit of product must be processed on two assembly lines, where the
required production times are as follows: 
Product 
Resource Requirements per Unit Line 1 Line 2 A 11 5 B 6 9 Total Hours 65 40

a. Formulate a linear programming model to determine the optimal product mix that will maximize profit.

b. What are the sensitivity ranges for the objective function coefficients?

c.
Determine the shadow prices for additional hours of production time on
line 1 and line 2 and indicate whether the company would prefer
additional line 1 or line 2 hours.

3. Formulate and solve the model for the following problem: 
Irwin
Textile Mills produces two types of cotton cloth denim and corduroy.
Corduroy is a heavier grade of cotton cloth and, as such, requires 8
pounds of raw cotton per yard, whereas denim requires 6 pounds of raw
cotton per yard. A yard of corduroy requires 4 hours of processing time;
a yard od denim requires 3.0 hours. Although the demand for denim is
practically unlimited, the maximum demand for corduroy is 510 yards per
month. The manufacturer has 6,500 pounds of cotton and 3,000 hours of
processing time available each month. The manufacturer makes a profit of
$2.5 per yards of denim and $3.25 per yard of corduroy. The
manufacturer wants to know how many yards of each type of cloth to
produce to maximize profit. Formulate the model and put it into standard
form. Solve it 

a. How much extra cotton and processing time are left over at the optimal solution? Is the demand for corduroy met?

b.
If Irwin Mills can obtain additional cotton or processing time, but not
both, which should it select? How much? Explain your answer.

4.
The Bradley family owns 410 acres of farmland in North Carolina on which
they grow corn and tobacco. Each acre of corn costs $105 to plant,
cultivate, and harvest; each acre of tobacco costs $210. The Bradleys’
have a budget of $52,500 for next year. The government limits the number
of acres of tobacco that can be planted to 100. The profit from each
acre of corn is $300; the profit from each acre of tobacco is $520. The
Bradleys’ want to know how many acres of each crop to plant in order to
maximize their profit.

a. Formulate the linear programming model for the problem and solve.

b.
How many acres of farmland will not be cultivated at the optimal
solution? Do the Bradleys use the entire 100-acre tobacco allotment?

c.
The Bradleys’ have an opportunity to lease some extra land from a
neighbor. The neighbor is offering the land to them for $110 per acre.
Should the Bradleys’ lease the land at that price? What is the maximum
price the Bradleys’ should pay their neighbor for the land, and how much
land should they lease at that price?

d. The Bradleys’ are
considering taking out a loan to increase their budget. For each dollar
they borrow, how much additional profit would they make? If they
borrowed an additional $1,000, would the number of acres of corn and
tobacco they plant change?

1483717693.xlsx