NR 606 Week 4 Extended Vise Overview; Pediatric Parent Call Scenarios

* γ PARENT CALL SCENARIOS (BY CONDITION) ç' C ADHD – “Medication not working” Scenario: “My child is still not focusing and is more irritable on Adderall.” Key thinking: Subtherapeutic dose vs wrong stimulant class Irritability → possible rebound vs overstimulation Response approach: Assess timing (wear-off vs all-day symptoms) If rebound → add afternoon dose or long-acting If persistent irritability → switch stimulant class (amphetamine → methylphenidate) 909637-223544●m=● MDD – “Activation / suicidality” Scenario: “Since starting fluoxetine, my child is more restless and talking fast.” Key thinking: Activation vs emerging bipolar Response: Mild activation → reduce dose, slower titration Severe (↓ sleep, grandiosity) → STOP SSRI, evaluate for bipolar 909637-222520m”●^●. Anxiety (GAD/OCD) – “Not improving” Scenario: “She’s still anxious after 2 weeks on sertraline.” Key thinking: SSRIs take 4–6 weeks minimum Response: Normalize timeline Optimize dose before switching Ensure CBT is in place 909637-223812 *< Autism – “Aggression worsening” Scenario: “He’s more aggressive even on risperidone.” Key thinking: Dose vs environmental trigger vs side effect Response: Assess triggers first (routine changes) If med-related → adjust dose or switch to aripiprazole Monitor metabolic effects 909637-222137L*◆+ Bipolar – “Sleeping less, more energy” Scenario: “He only sleeps 3 hours and is very energetic.” Key thinking: Mania until proven otherwise Response: Urgent evaluation Start/optimize mood stabilizer or antipsychotic Avoid antidepressants 909637-220920ç' C Schizophrenia – “Hearing voices” Scenario: “My teen says voices are telling him things.” Key thinking: Rule out substances + medical causes Response: Immediate safety assessment Start antipsychotic Consider hospitalization if command hallucinations 909637-222421 'Cç Tourette – “Tics worsening” Scenario: “Tics are worse after starting stimulant.” Key thinking: Stimulants can unmask/exacerbate tics Response: If mild → continue + monitor If severe → switch to guanfacine or clonidine 909637-222650PTSD – “Nightmares and avoidance” Scenario: “My child won’t sleep and avoids school after trauma.” Key thinking: Trauma response, not ADHD/anxiety alone Response: Trauma-focused CBT first-line Avoid jumping to meds unless severe 909637-221796)f ODD – “Defiance getting worse” Scenario: “He refuses everything and argues constantly.” Key thinking: Often comorbid ADHD Response: Treat underlying ADHD if present Parent management training is key 909637-223946'Cç MEDICATION SELECTION ALGORITHMS ADHD Start stimulant (methylphenidate OR amphetamine) If ineffective → switch class If intolerable → atomoxetine or alpha-2 agonist Add alpha-2 if: Sleep issues Tics Aggression 909637-223779Depression (MDD) Fluoxetine first-line If no response → optimize dose (4–6 weeks) Then → switch to escitalopram Always combine with therapy If activation → reassess for bipolar 909637-222825Anxiety/OCD CBT first-line (always) Add SSRI if moderate–severe Optimize dose before switching OCD often needs higher SSRI doses 909637-222467Bipolar Lithium or SGA first-line If severe → SGA + lithium Avoid antidepressant monotherapy Add therapy after stabilization 909637-221982Schizophrenia Start second-generation antipsychotic Monitor response 4–6 weeks Switch if ineffective Consider clozapine if refractory 909637-221878Autism Irritability Behavioral therapy first If severe aggression → risperidone or aripiprazole Monitor metabolic effects closely 909637-222663Tics Mild → behavioral therapy Moderate → guanfacine/clonidine Severe → antipsychotic (aripiprazole) 909637-220965 ị HIGH-YIELD TRICK QUESTIONS f˛µ 1. “Child with depression + decreased need for sleep” )yS Answer: Bipolar until proven