Primary Care of the Psychiatric Mental Health Client II

Pediatric Case Study Video Transcript

Carl is a 13-year-old boy who lives in a residential group home and attends an alternative school program. He does not engage or interact with fellow students, teachers, or family members. He prefers to do activities alone. He hits his head on walls, furniture, or the floor when the environment is too noisy or when he wants to be alone. Carl engages in a ritual of using his shoestrings and pieces of material to tie his feet together.

He was described by his family as a distant child who would not participate in family activities with his five adoptive siblings. He can use words and phrases to communicate his needs and desires and uses some American Sign Language. He also has good receptive skills for verbal information. Carl hesitates and pauses to speak when spoken to and repeats exactly what was said to him before responding. He has never been seen having a casual conversation. He rarely initiates conversation with others.

He prefers individual activities, including looking at magazines and doing math puzzles and problems. Although he has superior ability in mathematics, Carl’s IQ places him in the low range of intelligence. Carl is healthy and has no medical problems. But he does need assistance with activities of daily living. He has always been large for his age. His current height is 5’10” and weight is 165 pounds.

Carl was adopted from an orphanage in an Eastern European country at the age of two years. His adoptive parents have little knowledge of his birth parents, although he may have been exposed to alcohol in utero. Carl’s self-injurious behavior became too much for his family to handle, and he was placed in this residential school at the age of 12 after he banged his head so hard on the floor that he fractured his skull.

The residential school is now looking for a psychiatric consult to help them address escalating risky behaviors such as running outdoors and self-injurious rituals. A previous drug trial with fluoxetine proved unsuccessful and resulted in worsening of behaviors. His adoptive parents have been resistant to using antipsychotic medications.