How I Treat: Pediatric ADHD Case Presentation

Caleb and his mother arrived for an initial counseling appointment. Caleb is a 9-year-old Caucasian male. When asked why he was here to meet with a counselor, Caleb replied, “Well, I get in trouble for talking a lot. My mind jumps around like little bunnies.”

The counselor asked to speak with the mother individually and asked about her concerns. Caleb’s mother reported the following issues: interrupting others often despite numerous warnings, yelling at inappropriate times, and maintaining eye contact but often asking for repeated directions. She noted that these actions were present at home and school. He has a younger brother, Jake (6). Caleb plays rough with Jake; he quickly punches Jake if there is only a slight provocation.

Caleb was asked to rejoin the counseling session and constantly moved while on the office couch. At one point, he placed his hands underneath his bottom so he “wouldn’t be tempted to touch things.” Caleb spoke quickly and trailed off in the middle of sentences on a few occasions. He jumped from topic to topic and diverted to expressing his thoughts and feelings about objects he noticed or sounds he heard in the counselor’s office.

Caleb’s father did not attend the initial session. The counselor asked about family history to which the mother noted “Caleb’s dad has had trouble concentrating since he was a kid.” Furthermore, Caleb’s father has received disciplinary action at work for moving onto a new project before the current one is completed. Caleb’s cousin has an Individualized Education Plan due to difficulties in concentration and comprehension.

At the end of the initial appointment, Caleb said, “I really want to be good, but I just can’t keep my thinking straight in my head”. He was almost in tears. His mother added, “I would like to know how to help Caleb because I know he is a really great kid."