Incorporating Developmental Principles Into Clinical Care.

An 8-year-old is being treated for attention-deficit hyperactivity disorder (ADHD), with a positive response to medication and behavioral management. Although the child’s academic performance has improved, the parents are concerned that the child does not appear to fully understand the importance of doing well at school, despite their parental explanations about college and careers. School assignments are done adequately, but the child spends no extra time on academic activities and refuses to participate in educationally related recreational activities, preferring to dress up and engage in imaginary play, often related to the child’s favorite movies. The scenarios are often quite involved and take considerable planning. The child often plays alone (although there is some playtime with two peers) and is uninterested in playing a team sport. Life at home has improved, with the child being less irritable and reactive. The parents state that the child has always been moody and has difficulty adjusting to change. Over the years, this has improved. The child generally seeks out the parents when distressed and responds positively to their suggestions. The parents are wondering whether the child’s ADHD is being adequately treated. They ask the psychiatrist whether there are additional treatment interventions to improve the child’s motivation and academic performance. The psychiatrist brings this case up in peer supervision for suggestions about how to respond.