A 7-year-Old Boy with ADHD

Abstract

A 7-year-old white boy had been diagnosed with attention-deficit/hyperactivity disorder (ADHD), inattentive type, 1 year before. He also had a reading disorder with verbal comprehension impairment. He was brought into the emergency room for agitation and self-injurious behavior while at a day camp. He had barricaded himself with stacked chairs and was banging his head repeatedly into the fi le cabinet after an altercation with his friends.After unsuccessful attempts to calm him, and out of fear for the safety of the other children, the day camp counselor called the mother and police. The patient continued to entrap himself, make animal sounds, sing, and repeat single words while the police brought him into the emergency room for psychiatric evaluation.There was no history of depressive or manic symptoms, no changes in sleep, appetite, or weight, and no history of suicidal or homicidal ideation. The patient had a history of a regulatory sensory processing disorder, which was diagnosed a few months before. He has been enrolled in an individualized education program (IEP) for a few months.The mother reported a sudden dramatic change in her son's behavior 1 month after the IEP was initiated. There was sequential development of symptoms not previously seen in the patient, starting with increased aggression and irritability, and he became physically assaultive toward his brother by trying to choke him. He had showed impulsive behavior and was nearly hit by a dump truck after running into the street when his mother refused to buy him ice cream. A few days after that, he exhibited symptoms of social withdrawal and refused to go to school. When in school, he would hide under desks or in closets.His mother said there were newly developed food preferences, and he began to refuse certain foods based on their texture, such as gravy or mashed potatoes. During a visit with a child neurologist, the patient started rocking back and forth and was banging his head repeatedly against the wall. He displayed rapid, non-rhythmic movements of hands, repeated vocalizations of single words, and choreiform head movements. He had no eye contact. His behavior was temporarily controlled by verbal intervention by the neurologist.A recommendation was made for psychiatric evaluation and an appointment was made. However, his symptoms then escalated to the point that he had to be brought to the ER because of extreme agitation and aggressive behavior during the day camp visit.