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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Kylie does not attend this appointment. Please take a history from her mother, Ilana, and make suggestions for management. You are required to focus on the presenting complaint only.

Scenario

Kylie Chong is an 8-year-old girl who has seen you a few times for minor illnesses in childhood. Kylie’s mum, Ilana, has booked to see you today because ‘Kylie is out of control and won’t do what she is told’. Ilana wants you to prescribe the drug that is used in attention deficit hyperactivity disorder (ADHD).

INSTRUCTIONS FOR KYLIE’S MOTHER, ILANA CHONG

You have three children and work part-time as a cleaner. You were brought up in Australia and so was your husband. His family migrated to Australia from China. Your husband and his family consider child rearing to be the mother’s main responsibility. You are keen to have support and will be open to any suggestions from the doctor if you feel respected not blamed.

You had a normal pregnancy and birth. Kylie reached all her milestones.

Kylie is the middle child of the family. From the beginning she has been the most challenging but recently you feel things are out of your control. She is doing OK at school but her behaviour is very disruptive at home. It is so frustrating that the teachers report her to be good, while at home Kylie is disobedient and refuses to join in with the family. Getting her up to go to school in the mornings is a nightmare and at weekends all she does is watch TV and eat junk food. You have tried a strict diet free from preservatives but that made no difference. A recent hearing check was normal.

You have come to the doctor today because you have heard there is a drug for attention deficit hyperactivity disorder (ADHD) and you think it might be the answer for Kylie.

If the doctor asks about the three main symptoms of ADHD of inattention, hyperactivity and impulsiveness, you are to answer that Kylie does NOT have these symptoms.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open-ended questions to explore Kylie’s mum’s ideas, concerns and expectations.

Specific questions

Kylie’s behaviour—define the issues

Pregnancy, birth and developmental history

Interests

Friendships

Relationship with siblings and family

Sleep

School performance, reports from teachers

General health, appetite, mood

Test against criteria expected in ADHD

  • — Inattention

  • — Hyperactivity

  • — Impulsiveness.

Most likely diagnosis

Outline that ADHD doesn’t seem likely

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