CPAN Case of the Month – June 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

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

Explanation of the Case and Outcome of the Call:

4yo male with ADHD and paternal family history of Bipolar disorder continued to have aggression and hyperactivity despite brief sequential trials of Focalin IR, Clonidine and Guanfacine IR.  At this point Risperdal 0.25 mg BID was started and then increased to 0.5 MG BID with less aggression but continued hyperactivity.  

The consultation focused on two main points: recommended medical management of ADHD with preschool youth and diagnostic clarification. Preschool youth can be more sensitive overall to medications, however, the best recommendation is for a trial of both stimulant classes prior to initiating other psychotropic medications. Additionally, the DEXmethlyphendiate (Focalin) may be less efficacious and recommended to start with low dosage Ritalin to help target ADHD and minimize side effects. If not tolerated, a trial of an amphetamine-based stimulant would be a great next step. Finally, if the patient does not respond well to a stimulant prior to initiating an antipsychotic medication, it may be helpful to have a one-time direct consultation via CPAN to help with diagnostic clarification. Aggression and hyperactivity symptoms may be evidence of other disorders such as trauma and anxiety which would necessitate a change in treatment approach.