ADHD Case Study: Larry Wen, Diagnosis, Neurotransmitters, Stimulants and Methylphenidate (Concerta) Patient Education

Case Study: Larry Wen, 10-year-old with inattention and disorganization

Larry Wen, a 10-year-old cisgender Asian American boy, struggles to maintain focus and complete schoolwork and homework. He is easily distracted by noises and peers, talks excessively and has been moved to the front of the class. At home, he is disorganized, makes careless errors in homework and frequently misplaces items such as toys, the TV remote and his sports bottles.

Part I questions (use them as headings; APA format; at least five peer-reviewed North American sources from 2021 to 2026):

• What diagnosis best describes what may be happening to Larry?
• What neurotransmitters are involved with his current symptoms?
• What classification of medications would best treat his symptoms?
• For one medication in that class: FDA approvals, mechanism of action, time frame for results, common side effects, life-threatening side effects, starting dose and common labs and baseline vitals, with reasoning.

Part II: record yourself providing patient education on the medication, speaking to the patient with care and without medical jargon.

Original example for study purposes (about 1,100 words). Medication information follows the FDA label; confirm dosing and monitoring with current prescribing information.

What diagnosis best describes what may be happening to Larry?

Larry’s presentation is most consistent with attention-deficit/hyperactivity disorder (ADHD), likely the predominantly inattentive presentation or the combined presentation if additional hyperactive-impulsive symptoms are confirmed. He shows several DSM-5-TR inattentive symptoms: difficulty sustaining attention, failing to finish schoolwork, careless mistakes, disorganization, losing things, distractibility by external stimuli and forgetfulness in daily activities. His excessive talking is a hyperactive-impulsive symptom. A diagnosis requires at least six symptoms in a domain for children, persisting for at least six months, present before age 12, occurring in two or more settings and causing functional impairment (American Psychiatric Association, 2022; Eiland & Gildon, 2024). Larry’s symptoms appear at school and at home, supporting the cross-setting requirement. A full evaluation should include standardized rating scales from parents and teachers and rule out other explanations such as learning disorders, anxiety, sleep problems, vision or hearing problems and stressors at home. ADHD is common; in 2022, an estimated 11.4% of U.S. children aged 3 to 17 had ever been diagnosed (Danielson et al., 2024).

What neurotransmitters are involved with his current symptoms?

ADHD is associated with dysregulation of dopamine and norepinephrine in brain networks that support attention, motivation and executive function, particularly the prefrontal cortex and its connections with the striatum. Dopamine supports reward processing, motivation and sustained attention, while norepinephrine supports alertness, working memory and filtering distractions. Reduced signaling in these pathways helps explain Larry’s difficulty focusing, organizing and resisting distractions. ADHD medications act by increasing the availability of these neurotransmitters (Eiland & Gildon, 2024).

What classification of medications would best treat his symptoms?

Central nervous system (CNS) stimulants, methylphenidate or amphetamine products, are first-line medications for school-age children with ADHD, ideally combined with behavioral interventions such as parent training and classroom supports (Eiland & Gildon, 2024). A systematic review found that medications have the strongest evidence base among ADHD treatments for improving core symptoms (Peterson et al., 2024). Nonstimulants such as atomoxetine, viloxazine and extended-release guanfacine or clonidine are alternatives when stimulants are ineffective, poorly tolerated or contraindicated.

Selected Medication: Methylphenidate Extended-Release (Concerta)

FDA approvals. Concerta is FDA-approved for the treatment of ADHD in patients 6 to 65 years old and is not recommended for children under 6 (U.S. Food and Drug Administration [FDA], 2026).

Mechanism of action. Methylphenidate is a CNS stimulant that blocks the reuptake of dopamine and norepinephrine into presynaptic neurons and increases their release into the synapse, strengthening signaling in attention and executive function circuits (FDA, 2026). The osmotic extended-release design delivers medication through the school day with one morning dose.

Time frame for results. Stimulants begin working within about an hour of the first dose, so families and teachers may notice improved focus on the first day. Optimal benefit is usually reached over several weeks as the dose is titrated in 18 mg steps at weekly intervals (FDA, 2026).

Common side effects. Decreased appetite, weight loss, trouble sleeping, stomachache (upper abdominal pain was the most common adverse reaction in children), headache, irritability, nervousness, dizziness and modest increases in heart rate and blood pressure (FDA, 2026).

Life-threatening side effects. The boxed warning describes a high potential for abuse and misuse, which can lead to substance use disorder, overdose and death; in 2023, the FDA required updated boxed warnings for all prescription stimulants to emphasize these risks and the danger of sharing medication (FDA, 2023). Other serious risks include sudden death in patients with structural heart abnormalities or serious heart disease, stroke and myocardial infarction (rare), new or worsening psychosis or mania, priapism and peripheral vasculopathy such as Raynaud’s phenomenon (FDA, 2026). Long-term use of ADHD medications has also been associated with an increased risk of hypertension and arterial disease, which supports ongoing cardiovascular monitoring (Zhang et al., 2024).

Starting dose. For children 6 to 12 who have not taken methylphenidate before, the recommended starting dose is 18 mg once daily in the morning, increased by 18 mg at weekly intervals as needed, to a maximum of 54 mg per day for this age group (FDA, 2026). The tablet must be swallowed whole, not chewed or crushed.

Common labs and baseline vitals, with reasoning.

• Blood pressure and heart rate at baseline and each visit, because stimulants can raise both.
• Height, weight and BMI, plotted on growth charts, because stimulants can suppress appetite and growth.
• Cardiac history and family history of sudden death, arrhythmias, cardiomyopathy or fainting with exercise; an ECG and cardiology referral are indicated only if history or exam suggests heart disease.
• Psychiatric history, including tics, psychosis, bipolar disorder and substance use in the patient or household, because stimulants can worsen these conditions and carry misuse risk.
• Routine laboratory tests are not required before starting methylphenidate in a healthy child, but labs such as a CBC or thyroid tests may be ordered if the history suggests another cause of symptoms.

Part II: Patient Education Script (for the Recording)

“Hi, Larry, and hi, Mr. and Mrs. Wen. Thank you for coming in today. We talked about how it can be really hard for you to pay attention in class and keep track of your things, and that’s not your fault. Your brain just needs a little extra help with focus. The medicine we’re going to try is called Concerta. You’ll take one pill every morning with breakfast, and you need to swallow it whole, without chewing or breaking it. It starts working in about an hour and lasts through the school day, so it can help you focus in class and finish your homework.

Some kids feel less hungry at lunch, have a stomachache or headache, or have trouble falling asleep. Eating a good breakfast and a snack after school can help, and taking it early in the morning helps with sleep. Please let us know right away if Larry has chest pain, fainting, a very fast heartbeat, sees or hears things that aren’t there, or seems very sad or upset. This medicine is just for Larry; please keep it in a safe place and never share it with anyone, because it can be harmful to others. We’ll check his blood pressure, heart rate, height and weight at every visit and adjust the dose if needed. Medicine works best together with routines at home and support at school, like a homework checklist and a quiet place to work. What questions do you have for me?”

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD prevalence among U.S. children and adolescents in 2022: Diagnosis, severity, co-occurring disorders, and treatment. Journal of Clinical Child & Adolescent Psychology, 53(3), 343–360. https://doi.org/10.1080/15374416.2024.2335625

Eiland, L. S., & Gildon, B. L. (2024). Diagnosis and treatment of ADHD in the pediatric population. The Journal of Pediatric Pharmacology and Therapeutics, 29(2), 107–118. https://doi.org/10.5863/1551-6776-29.2.107

Peterson, B. S., Trampush, J., Maglione, M., Bolshakova, M., Rozelle, M., Miles, J., Pakdaman, S., Brown, M., Yagyu, S., Motala, A., & Hempel, S. (2024). Treatments for ADHD in children and adolescents: A systematic review. Pediatrics, 153(4), e2024065787. https://doi.org/10.1542/peds.2024-065787

U.S. Food and Drug Administration. (2023, May 11). FDA updating warnings to improve safe use of prescription stimulants used to treat ADHD and other conditions. https://www.fda.gov/drugs/drug-safety-and-availability/fda-updating-warnings-improve-safe-use-prescription-stimulants-used-treat-adhd-and-other-conditions

U.S. Food and Drug Administration. (2026). Concerta (methylphenidate HCl) extended-release tablets: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/021121s34s40s45lbl.pdf

Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D’Onofrio, B. M., Brikell, I., Kuja-Halkola, R., Lichtenstein, P., Johnell, K., Larsson, H., & Chang, Z. (2024). Attention-deficit/hyperactivity disorder medications and long-term risk of cardiovascular diseases. JAMA Psychiatry, 81(2), 178–187. https://doi.org/10.1001/jamapsychiatry.2023.4294

More model assignments posted today

• DNP project implementation results
• Trichomoniasis case analysis
• AKI and CKD case study
• HRM 200 orientation presentation
• Pricing tactics assignment
• Disruptive innovation examples
• MAN 4301 HR strategy presentation
• Housing First community psychology paper
• Schizophrenia study guide and Gestalt therapy