Question

The 8-year-old girl who was naughty.

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 defi ant 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

• List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.

Answer 1

Physical examination include ;

Initial assessment

• Standard history and physical examination
• child's developmental history, confirmation of normal hearing and vision
• Review of the family history for ADHD, learning difficulties or psychiatric illness.
• inattention and impulsivity include learning disabilities
• fetal alcohol syndrome (high levels of exposure to alcohol while in the womb)
• depression; anxiety; vision or hearing problems; and, chronic abuse or neglect

Diagnostic test

• Thyroid hormone test (these symptoms may occur due to variation of thyroid hormone)
• DSM criteria
• ADHD rating scales

Diagnosis

• Defensive coping related to feelings of inadequacy and need for acceptance from others.
• Impaired social interaction related to developmental disabilities (hyperactivity).
• Altered thought processes related to personality disorders.
• Risk for parental role conflict related to children with attention deficit hyperactivity disorder.
• Risk for injury related to psychological

Drug choice

Most often, the doctor will start your child on a low dose of a stimulant, such as an

• amphetamine
• methylphenidate (