It seems sound to recommend that Adam stop taking Concerta, because it might aggravate underlying bipolar symptoms.
Strattera not stimulating, but it can have side effects, like prolonged erections, and it is also a fairly new drug. It should be prescribed with caution. It is still uncertain whether Adam's conduct disorders are due to his unstable home environment, and not due to any biological factors. Prescribing Strattera seems like a normal course of therapeutic action, but should not be regarded as a panacea.
Question
If you were the clinician, counselor, or therapist, what would be the primary issue you would want to address?
To be diagnosed with ADHD, the individual should exhibit the symptoms in two environments, and Adam's behavior seems to primarily assert itself in the home. With support, he seems functional in school, and he is substantially less functional at home than at school or with his peers. The first question that should be addressed is what is the most appropriate environment for Adam -- a foster setting, or remaining at home.
Question
Are there any discrepancies, contradictions, or concerns that stand out for you?
In terms of evaluating Adam's personal strengths, to say that "Adam is a very personable young man," seems contradictory, given Adam's manipulative behavior and his sexually inappropriate displays via the young woman he met on the Internet. Also, to say that "Adam's family...
His mother is also observed to be very physically demonstrative with her child, and says that she loves him frequently. This is not in and of itself unusual were it not for the fact that she says Adam's sexuality makes her uncomfortable and the fact that she characterized it as 'molestation.'
One great concern is if Adam has been or is being sexually abused by his mother or another adult. When Adam was eleven and accused his mother of sexual abuse he was placed in a half-way house. Apparently, it was eventually concluded that his allegations were baseless, because he was once again released to his family. His mother has claimed that Adam, not she, is the initiator of the sexual displays, although it is characteristic of children who are sexually molested to show sexual behavior that is inappropriate for their age -- and it is even possible that Adam's mother is making such an allegation as a cover for her own behavior. Adam's mother has problems with her memory, which makes her an unreliable source of information about what may have happened to Adam in the past. Further investigation into possible abuse is required.
