Reference no: EM133656285

Jason is a 8-year-old male Grade 1 student who lives in Toronto with his parents. He is the only child to two parents, both of whom have completed post-graduate education. There is an extended family history of Attention Deficit/Hyperactivity Disorder (ADHD), mental health concerns as well as academic excellence. Jason is an intelligent and caring young boy who presents with significant potential to excel academically. In his spare time, Jason enjoys spending time with his friends, and participating in physical activities such as swimming, running and skating. He also enjoys participating in social events, and is often invited to play dates and birthday parties. It is noteworthy that he did not know his address or home phone number, could not print his surname, and recognized only a few pre-primer words. While Jason interacts well with peers his own age, his parents note that he can be easily led and influenced by others. They also report that Jason gets upset when he does not receive recognition or feels that he has been ignored. His teacher notes that he sometimes acts 'socially immature', and that he often demonstrates attention-seeking behavior. Jason describes difficulties with focusing and sitting still in class. He recognizes that he is able to 'hyper focus' on some activities of interest, however he often has difficulty sustaining his attention at school. His parents and teacher indicate that Jason is restless, and often requires reminders to help him stay on task. He is described as "constantly running around" and presenting with difficulties listening and following instructions. Jason teacher indicates that he often blurts out answers and interrupts other students in the classroom. Jason recognizes this tendency in himself but says that he 'can't stop' in spite of his best intentions. Jason has always had challenges falling asleep, and sometimes finds that he wakes up in the middle of the night. When he wakes up, he finds that he has a difficult time getting back to sleep - sometimes staying awake for as long as an hour and a half. His mother reports difficulties at home with following routines and remembering instructions. His parents describe emotional reactivity as well as confrontational behaviors demonstrated both at home and at school. His teacher notes that Jason is very defiant towards listening to instructions, but generally interacts well with his peers. He is easily frustrated and emotionally impulsive - Jason has had several incidents of hitting, crying outbursts, and inappropriate behavior. Behavioral concerns with aggression, lying, arguments, and disruptive behavior were noted in pre-school program at age 4. He does not have any allergy to medications.

1. What are the differential diagnoses for this patient?

2. What diagnostic tests would you complete?

3. What is the appropriate treatment plan for this patient? Who should be included in this multidisciplinary team?

4. What should be discussed with Jason's guardians? What other externalizing conditions is Jason exhibiting? What special circumstances should be considered in this case? at school? in the home? in the community?

5. Include treatment plan, follow-up, referrals, and prescriptions that you would prescribe to this patient and provide rationales for each.