CPAN Case of the Month – March 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: Seven-year-old patient

Reason for CPAN Consultation: To receive support with a diagnosis and treatment plan

Explanation of the Case and Outcome of the Call:

A pediatrician called for consultation for a seven-year-old patient with a recent placement in foster care with their grandmother.  The patient was on Adderall XR 20 mg for ADHD. The grandmother noted persistent disruptive behaviors at home but not at school and hoped for an increase in dosage.  We discussed the possibility of co-occurring disorders given the stressors for both the patient and grandparent. Trauma reactions can appear like unmanaged attentional problems.  We discussed stimulant dosing, alternatives and adjuncts to the Adderall, and potential side effects if the stimulant dosage was too high.  Diagnostic considerations and interventions for these were discussed.  The pediatrician planned to provide education to the family and share the various treatment strategies for shared decision-making.