Endocrinology & Metabolic Syndrome
Open Access

10-years-old Boy With ADHD

The patient presented to the psychiatric clinic for evaluation when he was in third grade due to behavioral and attention difficulties in school. He was unable to sit still, would not wait his turn, made inappropriate outbursts during class, and did not properly complete his work. He could not stay focused even in one-to-one conversation, and daydreamed frequently. Additionally, he often got into fights with his peers, leading to both school detentions and multiple suspensions. The mother reports that many of these symptoms had been present at a very early age.Birth, medical, developmental and family history were unremarkable. There is no history of anxiety, depression, psychosis or suicide attempts, and no previous psychiatric hospitalizations.

Birth, medical, developmental and family history were unremarkable. There is no history of anxiety, depression, psychosis or suicide attempts, and no previous psychiatric hospitalizations.

The diagnosis of attention deficit/hyperactivity disorder (ADHD) was made and he was started on medication treatment. He failed trials of both amphetamines (Adderall XR, DuraMed) (up to 20 mg) and methylphenidate (Concerta, Janssen) (18 mg). On methylphenidate, he developed suicidal ideations and would get very irritable stating “kids were teasing [him] a lot.” He was started on dexmethylphenidate hydrochloride (Focalin XR, Novartis), which was well tolerated. The dose was titrated up to 20 mg over a period of 8 months and an afternoon dose of dexmethylphenidate hydrochloride 5 mg was added in response to residual afternoon symptoms