Evidence-Based Practice

Introduction

It is universally acknowledged that evidence is very important especially in cases where there can be misconception or misunderstanding. Most people usually need proof to accept a given claim or a process presented to them. It also has to involve them directly in one way or another. In a way it is a precautionary measure that is a part of being rational. Insisting on proof is simply normal. The paper provides a review of a case study involving Jonathan, who has been diagnosed with attention-deficit/hyperactivity disorder, also known as ADHD (mixed type) as well as mild to moderate oppositional defiant disorder (ODD). This case study is accompanied by an evaluation of ethical, legal, and cultural implications of decisions that are always made for practices that require evidence. It is therefore a requirement to make sound decisions using evidence-based practices in order to be effective in the decisions made.

Jonathan, the subject of this case study, is an eight-year-old boy suffering from ADHD and oppositional defiant disorder (ODD) as diagnosed by their school psychologists (Norcoss, 2008). He has, therefore, been recommended to receive psychotropic medication that his father adamantly refuses to give him. His parents have been supportive whenever they could, but due to their job and their frequent breakups their presence for Jonathan is limited and therefore not as effective as required (Norcoss, 2008).

According to Sasser, Kalvin, and Bierman (2016), the condition of ADHD is a biologically based as well as a heterogeneous disorder, and it has a range of negative outcomes for the sick. The researchers further state that, based on regulatory systems, biological dysfunction influences ADHD condition’s stability and precedes it with socialization experiences that affect the development of self-regulatory compensatory skills as well as capacities thereby altering the condition and its outcome (Sasser, Kalvin, & Bierman, 2016). The risk factors of the conditions are concurrent aggression, emotional difficulties, social isolation and family adversity. These factors are capable of affecting the development of ADHD indirectly through decreasing or increasing child exposure to supportive socialization experiences that are associated with self-control development (Sasser, Kalvin, & Bierman, 2016).

According to Sasser et al. (2016), inattention and hyperactivity in childhood is a sign of ADHD occurring later in adolescence stage. On the other hand, acute inattention may cause a drop in the school performance of a learner (Halldorsdottir & Ollendick, 2016). High levels of hyperactivity are associated with rebellion against parents, peers and teachers, hence, increasing social alienation and fueling emotional reactivity. As a result, children with ADHD are under threat of the condition affecting their socialization experiences and consequently reducing the capacity of developing of self-regulation skills (Sasser, Kalvin, & Bierman, 2016).

Aggression caused by ADHD has been linked to high temperamental reactivity in early years of schooling, thus acting as direct liabilities that are biologically based (Sasser, Kalvin, & Bierman, 2016). Another effect of the condition is the cognitive disengagement that makes those with the condition lose key developmental opportunities in academics and positive interactions with peers and teachers. It means that children suffering from this condition have less development as far as competencies are concerned and that can cause difficulties in their later years (Sasser, Kalvin, & Bierman, 2016). All these perils were facing Jonathan after he has been diagnosed with the ADHD condition by their school psychologist.

Jonathan’s condition requires an intervention bigger than simply medicating him, because clinicians have to decide on factoring in all the variables. In his case, there are two possibilities regarding the decision because he has ADHD (mixed type) as well as mild to moderate oppositional defiant disorder (ODD). There are six steps that can be used to guide the decision making in the cases like Jonathan’s (University of Saint Mary, 2015). First, it is necessary to pose clinical guiding questions. In this step, a PICO(T) format is required where P is population, patient or problem of interest, I is the intervention factor being considered, O is the outcome measured, and T is the timeline (University of Saint Mary, 2015). For this case, our patient is Jonathan, who has ADHD (mixed type) as well as mild to moderate oppositional defiant disorder (ODD). The intervention measures are to find out how to assist Jonathan with his condition. The outcome and the time frame are yet to be determined by the decision to be made. The second step is searching for the best evidence. A clinician can search for the suitable evidence to base their decision on in a database or with other resources (University of Saint Mary, 2015). In the case of Jonathan, the clinician can check other previous cases like his in the hospital database and the way such similar cases were dealt with and hence come up with a sound decision on the course of action. The third step is to critically appraise the evidence found. In this case, a supportive study or findings should be used. At the same time evaluation of the strengths and weaknesses of the evidence should be done (University of Saint Mary, 2015). Successful cases from the hospital’s database can be used to add weight to the type of decision that has been made. The fourth is the integration of the evidence with one’s clinical expertise as well as with the preferences of the patient. Other factors have to be put into consideration in this case, like socioeconomic and biologic factors (University of Saint Mary, 2015). In the process of decision making, the clinician has to take into account the wish of Jonathan’s father for his son not to be given psychotropic medication. In this case, the clinician has to consult relevant sources to make this happen. The fifth is the evaluation of the outcomes of the evidence-based practice decision by asking whether the expected outcome was achieved with reasons of why and why not (University of Saint Mary, 2015). This comes after the decision on Jonathan’s condition has been made and action taken. Evaluation of the consequence of the decision is then done to see how effective it was for Jonathan. The sixth and the last step is the dissemination of the outcome of the decision to colleagues and beyond (University of Saint Mary, 2015).

Legal Considerations

The government health care policy should be taken into account when deciding on the case of Jonathan. By doing so, it seals all the loopholes that the decision can be faulted with by law and the accepted rules and regulations (Osborne, 2016).

Ethical Consideration

The clinicians have to put in consideration the rights and wrongs that are possible in the decisions concerning Jonathan’s condition such as prescribing the right medication at the right time (Gurbutt, 2006). This will facilitate Jonathan’s recovery as well as the duration of time taken.

Cultural Implications

If Jonathan’s condition is treated entirely through the decisions made by the clinicians, it will have a positive effect on the general public as more trust and hope will be there for individuals having a similar condition as Jonathan (Osborne, 2016).

Conclusion

The case study above shows that the ADHD condition, when dealt with at an early stage, can result in avoidance of complications in the victim’s future. Jonathan, as the subject of the case study, needs quick intervention since his malady is worsening with every passing day. Jonathan’s case has been discussed in detail and legal, ethical, and cultural implications have been considered. As can be seen, sound decisions require evidence-based practices that will give more weight to the type of decision made.

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