Disorders of

Childhood/Adolescence
PLM

CarolNati,MD,MS
MichaelOglesby,Ph.D.
 An8yearoldchildhasbeenbroughttoyour
officebecausehisweighthasbeguntodrop.
Hesaysthatheisnothungry.Hehasa
historyofasthma(treatedwithbudesonide
andalbuterol),eczema(treatedwitha
topicalcorticosteroidplusdiphenhydramine
foritching)andADHD(treatedwith
methylphenidatebeginning2monthsago).
 Follow up question:

Thispatientdoesnotliketakingmedication
inschoolandhasbeenrefusingtogotothe
schoolnurseforhislunchtimedoseof
methylphenidate.Hisgradesinhis
afternoonclassesaresuffering.
 A9yearoldboyisdiagnosedwithADHDand
startedonamixtureofamphetaminesalts
(Adderall).
 A6yearoldchilddiagnosedwithmental
retardationhassymptomsthatinclude
impulsivityandhyperactivity.Herparents
areconcernedthatthisishamperingher
abilitytolearn.Herteacherconcurs.The
parentswishtostartamedicationfor
ADHDbutshecannotswallowpills,nor
willshechewpills.
 Youarewalkingthroughamallandyousee
achildwhoisstaringatthewaterfall.
Unlikeotherchildren,hisgazeisfixedonit
andhedoesntseemtonoticetheother
childrenplayingaroundhim.Whenhis
motherstandsinfrontofhimandspeaks,he
respondswithwordsthatyoucannot
understand.Heseemstobeabout8yearsof
age.
 Theparentsofa14yearoldaskyouwhetheror
nottheyshouldbeconcernedabouttheir
daughter.Whathasprecipitatedthisvisitisthe
mostrecentconfrontationwhenthechildcame
downstairsinastringbikini,saidshewasheaded
toherfriendshousetositinahottubandthen
wasgoingtogoouttoeatafterwardswithher
boyfriend.Herboyfriendis21,andtheyrelate
thatheseemstobeaniceguy,but.
 A9yearoldchildisbroughttothe
emergencyroomafterhermotherhasbeen
takentojail.Hermotherwasacrackaddict
andthetwoofthemhadbeenlivinginacar
foralongperiodoftime.Thechildisvery
brightandhadlearnedtopanhandleoffof
strangersinordertofeedherselfandher
mother.
What is the childs most likely diagnosis?

1. Nonesheprobablyhasverystrong
copingskills.
2. SeparationAnxietyDisorder
3. CocaineDependence
4. ReactiveAttachmentDisorder
Disinhibitedtype
5. ReactiveAttachmentDisorderInhibited
type
Follow up question: Assuming that the child
is taken into foster care, what is her
prognosis?

1. Verygoodshewillbenefitfromastable
home.
2. Poorthereislittlehopeforher.
3. Guardedbutimprovedifshegets
therapyquickly
4. Itisimpossibletopredict.
 Averybright12yearoldboywhois
fascinatedwithcomputersisnotinterested
ingoingtohisfirstschooldance.Hehas
neverhadabestfriendandpreferstositand
developvideogamesinhisroom.He
speakswithverylargewordsandseemsa
bitdifferentfromtheotherboysinhisclass.
 A15yearoldgirlisdoingpoorlyinschool.
Shehasneverbeenhyperactivebutshehas
oftencomplainedofhavingapoorattention
span.Shesitsbythewindowinschooland
lovestostareoutthewindow.Sheisanice
kidwhoseemsparticularlyinterestedinstill
wantingtopleaseherparents.