Case 1: School refusal during COVID-19
An 8-year-old girl who was previously doing well with mild anxiety has stated that she wants to continue online learning instead of returning to in-person education this fall. She has said that she is worried about getting COVID and feels uncertain that people will respect masking rules. She also states that she feels nervous about being among friends again after such a long period of not being in school.
Primary question for the group:
- Should this girl be referred for counseling and what type of counseling is recommended?
- Are there recommended accommodations for school re-entry?
- Are other clinicians seeing this type of anxiety in previously well-functioning children?
Case 2: 13-year-old male with Autism Spectrum Disorder starting the transition care process
A 13-year-old male with autism spectrum disorder, macrocephaly, and a relative weakness in his nonverbal/adaptive skills compared to his acquisition of speech and language skills along with significant difficulty in mathematics consistent with a learning disability in that area presents for social skills training and discussion regarding future expectations.
Primary question for the group:
- Does your practice have a transition process in place?
- Does the process include discussing puberty, self-care, and future vocation/independent living at certain ages?
How do you provide culturally competent transition care for children with Autism and/or intellectual disability?
Case 3: Rapid Metabolizer?
A 9-year-old boy with ADHD and mild learning difficulties presents with concerns about decreasing efficacy of ADHD medication over time. He has been on multiple stimulant medications and alpha-agonist medication. He has frequently seemed to need high doses of stimulant medication to achieve symptom control, which work for a period of time and then lose efficacy. When switched to a new stimulant, the pattern repeats. Alpha agonists have not provided much help even at high doses.
Primary question for the group:
- How do you assess for and treat children with ADHD who appear to be “rapid metabolizers”?
- How do issues of potential “tolerance” to ADHD medications?
- Is there a role for pharmacogenomics?
Case 4: Diagnosing and Managing Internet Addiction in an Adolescent.
A 15-year-old female child currently in 9th, presents with irritability, sleep deprivation and her parents report intense social media use and being online late into the night. This has been a source of many arguments in the home over setting media use limits. Her parents have noticed a marked drop in self-care, such as bathing once a week, needing multiple reminders to eat/drink, often missing first few hours of online school and a significant decline in academic performance over last 6 months with mood changes notable in 3 months. The teen reports that some of her online usage is for make-up tutorials at school.
Primary question for the group:
- When does internet use become problematic?
- What are comorbid conditions that should be explored that may exacerbate the misuse
- What treatment recommendations should be given to the teen/parents?