Reference no: EM133560346

Josh is a 16-year-old male who presents to clinic with his mom. You have treated Josh off and on for ADHD that was diagnosed when he was 7 years old. When Josh was 7, the diagnosis seemed straight forward. Josh's teacher sent in a Vanderbilt ADHD rating scale that indicated both problems with focus/concentration and hyperactivity/impulse control. Josh was bright but his grades were poor and he was too distracted to get work done in the time allowed. Josh was adequately treated with Adderall XR 10mg in am and things improved. When Josh was 10, his father passed away suddenly in a work accident and everything changed. Josh was angry, getting into fights at school, disrespectful toward his mom and running away. He stopped coming in for his ADHD medications and refused recommended therapy. Today, Josh presents with his mom. He is angry and refuses to talk, unless his mom says something that makes him angry, at which time he yells at her requiring redirection from you. Josh's mom tells you that he is out of control, skipping school and she doesn't know where he is. He was recently picked up by police and accused of throwing rocks through a church window. Josh denies this and blames the broken windows on another kid who also skipped school. Josh isn't exactly interested in taking medications but reports "I'll take the Adderall." Josh's mom reports concern about what Josh could do with the Adderall as he has been smoking cigarettes and she thinks he is smoking marijuana. (This statement from Mom starts yet another argument in your office.)

1. Discuss your observations.

2. What are your possible differential diagnoses for this case?

3. Are there any lab tests you would like to have or would order?

4. What is the plan for treatment?

5. What is the secondary plan for treatment?