CPAN Case of the Month – December 2023

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

Patient: 9-year-old male

Reason for CPAN Consultation: To get advice on potential new medication options

Explanation of the Case and Outcome of the Call:

A 9-year-old male with moderate ASD and ADHD was having physical outbursts primarily at his mother’s home rather than his father’s home or at school. Reportedly, medications for outbursts had not helped previously. The child would get aggressive multiple times a week, break things, and his mother is unsure of how to calm him when this occurs. The physician was curious if a new medication would be helpful in these instances. 

Given that the behaviors appeared to be specific to his mother and their home, the psychiatrist posited that a therapy focused on that relationship would likely be the most efficacious treatment. Parent Management Training (PMT) or Parent Child Interactional Therapy (PCIT) are the most recommended forms of therapy for this type of concern. The outcomes of that therapy would ideally also inform how the child’s father and the team at school work with the child so that there is consistency. A trial of the antipsychotic Risperdal M tab 0.25 mg could be considered after baseline lipid, HbA1C and weight are obtained and followed, to target the specific outbursts on a prn basis whilst starting the appropriate behavioral therapy. Recommended the parents read the Explosive Child book and possibly join the community based on that book to help support the mother and father.