Transitions, Suicidality, and Underappreciated Autism Spectrum Disorder in a High School Student

CASE: Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change. He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation. His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide, as well as anxiety, alcoholism, depression, and attention-deficit/hyperactivity disorder (ADHD) in the extended family. Alex has had multiple psychiatric diagnoses by sequential providers. He was diagnosed with generalized anxiety disorder and ADHD by 5 years of age, major depressive disorder by 11 years of age, persistent depressive disorder by 12 years of age, and ultimately disruptive mood dysregulation disorder because of severe and persistent temper outbursts associated with negative mood and behavioral dysregulation, leading to recurrent crisis evaluations. He has been psychiatrically hospitalized twice, in the fifth and seventh grade, for suicidal ideation (SI) and elopement from home, respectively. He recently completed a 2-week acute residential placement, during which no medication changes were made. Current medications include escitalopram 20 m...
Source: Journal of Developmental and Behavioral Pediatrics - Category: Child Development Tags: Challenging Case Source Type: research