How I Treat: Pediatric ADHD With Dr Julie Carbary Case Presentation

Susan is a 15-year-old adolescent who is seen within our outpatient clinic due to reports of suicidal ideas she expressed to her mother. She is currently a freshman in high school and asks that she not be interviewed in the same room with her mother, whom she does not get along with. Susan feels that her mother dismisses her feelings and is slow to respond to her emotional concerns, and that for a long time she has been trying to tell her parents that she needs help with her schoolwork and is struggling. Since elementary school she has always struggled with school, taking longer than her peers to get work done and squeaking by with D and C grades that have not improved with more time spent on the material. She has different classes than her friends and has had to stay after school to complete missing work.  She reports she has been frustrated and down the past several months since the start of school, and “said those things to my mom” about thinking about taking her life because she was fed up with school.    

Her Patient Health Questionnaire-9 (PHQ9) is mildly elevated apart from concerns about concentration and mother completes a Vanderbilt, which finds her elevated on attention-deficient/hyperactivity disorder (ADHD) markers of inattention, hyperactivity, and distractibility, and her mother reports that Susan’s twin brother has been treated for ADHD for many years. Her mother reports “she can be happy when she is with her friends but not when she needs to get her work done.” This has been the largest challenge between Susan and her mother, that she struggles with school but not when with friends.

References

Barbaresi WJ, Campbell L, Diekriger EA, et al.  Society for developmental and behavioral pediatrics clinical practice guideline for the assessment and treatment of children and adolescents with complex attention deficit/hyperactivity disorder. J Dev Behav Pediatr. 2020;41(2):535-557.

Coxe S, Sibley MH, Becker, SP. Presenting problem profiles for adolescents with ADHD: differences by sex, age, race, and family adversity. Child Adolesc Ment Health. 2021;26(3):228-237.

Faraone SV, Banaschewski T, Coghill D, et al. The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789-818.

Shapero BG, Gibb BE, Archibald A, Wilens TE, Fava M, Hirschfeld-Becker DR. Risk factors for depression in adolescents with ADHD: The impact of cognitive biases and stress. J Atten Disord. 2021:25(3):340-354.