Alex, a 10-year-old male third grader, is irritable, “moody,” and prone to fighting with peers at school and in after-school care. He is frequently aggressive toward his three siblings and half-siblings. His family’s dogs avoid him, as Alex tends to “play rough” with them and has harmed them in the past. Alex was brought to the outpatient clinic on an emergent basis because earlier in the day his mother was asked to pick him up from school after he had turned over many desks and chairs resulting in the destruction of the classroom. Alex claimed he did this because his teacher had made him angry when she asked him about some missing assignments. Alex performs poorly in school, receives speech therapy for difficulties with word pronunciation, and has been diagnosed with a reading disorder per psychoeducational testing that he received through his school.
Alex is in basic good physical health, but does have some motor tics, including tendencies to blink his eyes and make repetitive lip-smacking and arm flinching movements; particularly when he is under stress. He still tends to wet the bed at night, so it is “awkward” for him to visit overnight with friends. Alex’s parents are divorced, and his mother struggles to balance employment and taking care of her kids. Alex’s father, who provides little financial support for Alex and his older brother, lives 800 miles away and has not talked to Alex in over a year. His father is a high school dropout, has been diagnosed with BPD, and has an extensive history of substance abuse, including marijuana, methamphetamines, and alcohol. He had been diagnosed with ADHD as a child and had motor and vocal tics. Alex’s mother is currently receiving pharmacotherapy for depression and anxiety. She reported childhood symptoms consistent with ADHD as a child, although she was never diagnosed with ADHD. She also reported difficulties with bedwetting until she was 12 years old. Alex’s extensive maternal and paternal family history of mental health concerns includes mood and anxiety disorders, substance abuse, ADHD, and learning difficulties. Alex is reported to have not been physically or sexually abused, but he did domestic violence on multiple occasions as a young child. His parents grew up in a poor neighborhood, met, and married as teenagers. Alex’s two younger siblings are a product of a nonmarital relationship that his mother had with a man who also physically abused her in Alex’s presence.
For your case study include the following:
Any differential diagnoses (Include a short line indicating why each one should be considered for the case)
Your diagnosis and reasoning. Defend your diagnosis with specific criteria from the DSM 5.
Any additional questions you would have asked for clarification and insight.
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent. What additional considerations should be given when dosing medications for children and why? What could be given for the “tics”? What is the BEERS Criteria? What specific screening should be done before giving a child a stimulant?
Any labs and why they may be indicated (Including any to rule out organic causes of behavioral presentations)
Screener scales or diagnostic tools that may be beneficial for this patient.
Additional resources to give (Therapy modalities, support groups, activities, etc.) Do not forget to include a hotline and support group for the patient.
APA format with at least 2 references
