How I Treat: Pediatric ADHD With Dr Childress Case Presentation

The patient is a 13-year-old Asian female who presented for an evaluation of anxiety and depression. She was an 8th grader at a public middle school.  She had been in a private school but transferred because it was too hard.

The patient reported felling overwhelmed and that it was hard for her to talk in front of the class.  It was also difficult for her to make friends. She worried about grades, especially math and felt panicked when she talked about her grades. She had multiple missing assignments.

When depressed, she was only sad for part of the day and had no difficulty sleep or eating.  She felt guilty and it was harder to concentrate. Starting at about age 10, she had thoughts about hurting herself and did some superficial cutting a couple of months prior to the visit.  She denied suicidal ideations at the visit.

Most of the depressive and anxious symptoms stemmed from conflict with her parents because of her school performance and missing assignments.  She reported making careless mistakes, having trouble staying focused, having to re-read assignments frequently, being easily distracted and forgetting or misplacing her soccer gear frequently.  Additionally, her mother reported that the patient was very disorganized and that it was difficult for her to complete tasks, especially chores.  She also avoided difficult work.

The patient was fidgety in my office and reported that she bites her nails and taps her foot frequently.  She denied other hyperactive and impulsive symptoms.

So, what should the clinician do at this point?