CPAN Case of the Month – October 2023
Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a PCP during this consultation.
Patient: adolescent male
Reason for CPAN consultation: reviewing a previous diagnosis and updating a care and medication plan
Explanation of the case and outcome of the call:
A pediatrician recently worked with an 8-year-old male patient previously diagnosed with Autism and ADHD and taking Focalin XR 30 mg, Intuniv 2 mg and Risperdal 0.5 mg. He was experiencing worsening aggression usually in the context of school settings and being told no and was not self-stimulating but was hitting teachers and peers. He was medically stable except for constipation and weight gain of more than 20 pounds with initiation of Risperdal 6 months ago. He had previously tried Daytrana, Quivillant, Dyanavel which were ineffective.
The pediatrician connected with CPAN and reviewed the core features of Autism and the limited role medications have in improving symptoms. CPAN and the pediatrician reviewed that although Risperdal is FDA approved for irritability the significant weight gain was an issue. They reviewed that the Intuniv was not at a maximum dosage, and it was recommended to have a weekly taper with monitoring of symptoms and side effects of low blood pressure and dizziness. They also reviewed that constipation and other physical ailments can worsen behavior so at minimum developing some additional plans to address the constipation may assist somewhat in improving overall functioning. CPAN and the pediatrician encouraged the family to seek out Applied Behavioral Analysis therapy as this is an evidence-based approach to improving functionality for individuals with Autism. It was also recommended that the family explore additional psychological assessments to better match skills to the work required in school.
Additionally, it was shared with the family that if they encounter challenges working on an IEP at the school, CPAN can help find advocacy resources for them.