Case #1
A young girl with difficulties in school

A Young Girl With ADHD

 

Decision Point One


 299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

RESULTS OF DECISION POINT ONE

Decision Point Two
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Based on your diagnosis and the parents’ concerns, you decided to begin Risperal 0.5 mg po BID

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon her return to the clinic in 4 weeks, Katie’s parents feel that Katie is calmer, but no changes in her school performance have been noted. Additionally, her parents have noticed that she seems more “tired” than usual, and report that she seems to ‘space out’ more often. They further report that she has been falling asleep during her usual television shows.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Risperdal to 1 mg po BID
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Risperdal is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her a other side effects, and did nothing to treat the primary presenting problems of inattention.

While CBT has evidence of efficacy in both autism spectrum disorder and social anxiety disorder, and while video modeling and video-self modeling therapy has some evidence for efficacy in ASD, these therapies will not, in and of themselves, help Katie as she does not have ASD with co-occurring social anxiety disorder.


Augment current dose of Risperdal with Cognitive-Behavioral Therapy and Video Modeling/self-modeling therapy
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Risperdal is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her a other side effects, and did nothing to treat the primary presenting problems of inattention.

While CBT has evidence of efficacy in both autism spectrum disorder and social anxiety disorder, and while video modeling and video-self modeling therapy has some evidence for efficacy in ASD, these therapies will not, in and of themselves, help Katie as she does not have ASD with co-occurring social anxiety disorder.


Reconsider diagnosis
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Risperdal is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her a other side effects, and did nothing to treat the primary presenting problems of inattention.

While CBT has evidence of efficacy in both autism spectrum disorder and social anxiety disorder, and while video modeling and video-self modeling therapy has some evidence for efficacy in ASD, these therapies will not, in and of themselves, help Katie as she does not have ASD with co-occurring social anxiety disorder.


Based on your diagnosis and the parents’ concerns, you decided to begin Celexa 20 mg po daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Katie’s parents feel that Katie is no calmer, and that there have been no changes in her school performance. Her parents are also concerned that Katie has been asking them “odd” questions such as “where do you go when you die?” and “when you die, do you get to see your pets that have died?” Her parents indicated that she had never had such questions before.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Celexa to 40 mg PO daily
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Celexa is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antidepressants may be considered if the child has co-occurring depression and/or anxiety disorder, but only after careful consideration of risk/benefits associated with antidepressant therapy in a child. The Celexa did nothing to alter Katie’s behavior, and in fact, Katie developed what appeared to be some morbid thoughts, possibly suggesting a fascination with death. While there is insufficient information to suggest that she was entertaining suicidal ideation, her parents clearly indicated that she was not having these thoughts before the antidepressant therapy was initiated.

While CBT has some evidence for efficacy in ASD and social anxiety disorder, it will not help Katie as she does not have either of these diagnoses.


Augment with CBT
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Celexa is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antidepressants may be considered if the child has co-occurring depression and/or anxiety disorder, but only after careful consideration of risk/benefits associated with antidepressant therapy in a child. The Celexa did nothing to alter Katie’s behavior, and in fact, Katie developed what appeared to be some morbid thoughts, possibly suggesting a fascination with death. While there is insufficient information to suggest that she was entertaining suicidal ideation, her parents clearly indicated that she was not having these thoughts before the antidepressant therapy was initiated.

While CBT has some evidence for efficacy in ASD and social anxiety disorder, it will not help Katie as she does not have either of these diagnoses.


Reconsider Diagnosis
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Celexa is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antidepressants may be considered if the child has co-occurring depression and/or anxiety disorder, but only after careful consideration of risk/benefits associated with antidepressant therapy in a child. The Celexa did nothing to alter Katie’s behavior, and in fact, Katie developed what appeared to be some morbid thoughts, possibly suggesting a fascination with death. While there is insufficient information to suggest that she was entertaining suicidal ideation, her parents clearly indicated that she was not having these thoughts before the antidepressant therapy was initiated.

While CBT has some evidence for efficacy in ASD and social anxiety disorder, it will not help Katie as she does not have either of these diagnoses.


Based on your diagnosis and the parents’ concerns, you decided to begin Olanzapine 5 mg po daily.

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Katie’s parents feel that Katie is calmer, but no changes in her school performance have been noted. Additionally, her parents have noticed that she seems more “tired” than usual, and report that she seems to ‘space out’ more often. They further report that she has been falling asleep during her usual television shows.
  • Katie’s parents have also noticed that Katie has gained about 3 pounds since beginning the Olanzapine.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Olanzapine to 7.5 mg at bedtime
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Olanzapine is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her other side effects, including weight gain- and did nothing to treat the primary presenting problems of inattention.

While Social Skills Training and Parent Training can help with Autism Spectrum Disorder, they are not indicated in the treatment of Social Anxiety Disorder. Regardless, neither of these therapies would be helpful as Katie does not have ASD with co-occurring social anxiety disorder.


Augment Olanzapine dose with a combination of Social Skills Training and Parent training
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Olanzapine is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her other side effects, including weight gain- and did nothing to treat the primary presenting problems of inattention.

While Social Skills Training and Parent Training can help with Autism Spectrum Disorder, they are not indicated in the treatment of Social Anxiety Disorder. Regardless, neither of these therapies would be helpful as Katie does not have ASD with co-occurring social anxiety disorder.


Reconsider Diagnosis
Guidance to Student

The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Olanzapine is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her other side effects, including weight gain- and did nothing to treat the primary presenting problems of inattention.

While Social Skills Training and Parent Training can help with Autism Spectrum Disorder, they are not indicated in the treatment of Social Anxiety Disorder. Regardless, neither of these therapies would be helpful as Katie does not have ASD with co-occurring social anxiety disorder.