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CPAN Case of the Month – December 2024

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

Patient: 7-year-old male

Reason for CPAN Consultation: Support with clarity of diagnosis

Explanation of the Case and Outcome of the Call:

A 7-year-old male with concerning behaviors but with conflicting levels of agreement amongst the adults at home and at school leave a PCP stymied. The PCP screened appropriately with Vanderbilts with the following results: both parents rated inattention and hyperactivity high. Teacher A, with the most contact rated him high on inattention, hyperactive and oppositional/conduct behaviors. Teacher B with less contact had no positive scores in any domain, but commented on how disruptive his behavior was in class. As the results were not consistent the PCP wondered what the diagnosis was. 

There is often not complete agreement amongst individuals when rating behaviors. This can be for a multitude of reasons, stigma, dislike, lack of understanding about the form or the diagnosis. However, in this scenario three adults that interact closely with the young person note challenges with inattention and hyperactivity in two different locations. If the young person does not have any other symptoms that might indicate another diagnosis, then the PCP can proceed to diagnosis and treat ADHD combine type. Remember inattention and hyperactivity can be found within Depression, Anxiety, Trauma and/or Learning differences. It is important to rule out other mental health conditions prior to proceeding with diagnosis.  

Additionally, ODD and ADHD are often co-morbid. Frequently ODD symptoms will improve by virtue of treating ADHD. Emotion dysregulation is seen in both ADHD and ODD disorders. Treat ADHD first and completely. Stimulants are the recommended first-line treatment for moderate to severe ADHD. Once the ADHD is well controlled, if ODD symptoms persist, a trial of parent management training therapy may be indicated. Provide the family with psychoeducation on ADHD and how best to parent and collaborate with the school system and teachers to strive for the best outcome for their child.