CPAN Case of the Month – August 2024

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Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a pediatrician during this consultation.

Patient: 4-year-old male

Reason for CPAN Consultation: To receive support with medication and treatment

Explanation of the Case and Outcome of the Call:

A 4-year-old male with ADHD continued to struggle with hyperactivity, aggression and behavioral issues. They were first tried on Focalin IR which increased irritability. Then Clonidine 0.1 mg which was too sedating and Guanfacine IR with no effect. A family history of bipolar prompted the clinician to start Risperdal at escalating dosages with mixed effect.   

Young children may have more pronounced negative affect with stimulant medications. However, prior to escalating to antipsychotic medications the recommendations for treatment of ADHD were reviewed. First, consider a dextroamphetamine stimulant as most individuals respond positively to one of the two stimulant classes. Alternatively, instead of Dexmethylphenidate consider using or Methylphenidate. Alpha agonists can be beneficial for hyperactivity, but the dosage may have been too high at 0.1mg and slower titration may have been necessary. Behavioral therapy, such as parent management training, is considered a best practice for youth with the described behaviors if ADHD is still considered the most likely diagnosis. In combination with a stimulant, it offers the most robust chance for improvement. Finally, if the above options are not sufficient, the young person may need an evaluation to ascertain if another diagnosis(es) is present such as learning disorders, anxiety and or trauma that will not be responsive to the above treatments.