Southern Jamaica Plain Health Center, Boston, Massachusetts, USA.
J Dev Behav Pediatr. 2010 Nov-Dec;31(9):720-2. doi: 10.1097/DBP.0b013e3181fa6b17.
Brian is a 15-year-old boy who has been just changed to your practice because of a change in insurance plans. When taking the social history, his parents note that he has "the hardest time relating to other kids." Sometimes he will be in the middle of a conversation with a friend and then discuss tangential topics. His father reports that Brian "...has always been an easy target. He has always been sort of bigger than other kids, but being bigger than other kids, he has a hard time standing up for himself." He seems to expect to be picked on in any new social situation. When Brian likes something, he really goes after it with a passion; for example, he is very interested in knowing all about the dynasties in China. His interests are dinosaurs and anime. He is described as "An all-or-nothing type kid" when it comes to his interests. If his father tries to explain to Brian why he would like something done in a particular way, Brian will explode, and at times, he has even tried to shove his father. He does not really have any friends. His mother finds it hard knowing that Brian cannot make friends because he "is the sweetest kid you will ever meet." Brian sometimes thinks he needs to master things right away. He is not very good at abstract thinking, and "he can't think outside of the box." Eye contact has always been something that has been difficult for Brian as well. He can sit in front of the TV watching a show and repeat the entire series word for word. His parents initially had concerns about Brian, when he was 3 or 4 years old. After a specialty evaluation, he was diagnosed with sensory integration disorder and attention-deficit hyperactivity disorder. He is currently starting the 10th grade this year. Brian was born at 9 months, weighing 7 pounds 10 ounces. There were no complications. He was treated with stimulants for attention-deficit hyperactivity disorder in the past, and he is currently on a long-acting amphetamine with equivocal efficacy. The parents are primarily here to refill his medication, but you wonder about their understanding about Brian's condition and where to head next during this visit.
布莱恩是一个 15 岁的男孩，由于保险计划的变更，他刚刚转到你的诊所。在进行社会历史记录时，他的父母注意到他“与其他孩子交往最困难”。有时他会在和朋友交谈时突然谈论一些不相关的话题。他的父亲报告说，布莱恩“……一直是个容易被欺负的目标。他一直比其他孩子高大，但因为比其他孩子高大，他很难为自己挺身而出。”他似乎期望在任何新的社交场合都被欺负。当布莱恩喜欢某样东西时，他会非常热情地追求它；例如，他非常想了解中国的所有朝代。他的兴趣是恐龙和动漫。当谈到他的兴趣时，他被描述为“一个全有或全无的孩子”。如果他的父亲试图向布莱恩解释为什么他希望以某种特定的方式做某事，布莱恩会大发雷霆，有时甚至试图推搡他的父亲。他真的没有任何朋友。他的母亲发现很难理解为什么布莱恩不能交朋友，因为“他是你见过的最可爱的孩子”。布莱恩有时认为他需要马上掌握某些东西。他不擅长抽象思维，“他不能跳出框框思考”。眼神交流对布莱恩来说一直是一件困难的事情。他可以坐在电视机前看一个节目，并逐字逐句地重复整个系列。他的父母在他 3 或 4 岁时就开始对布莱恩的状况表示担忧。经过专业评估，他被诊断患有感觉统合障碍和注意力缺陷多动障碍。他今年刚上 10 年级。布莱恩 9 个月大时出生，体重 7 磅 10 盎司，没有并发症。他过去曾因注意力缺陷多动障碍接受过兴奋剂治疗，目前正在服用长效安非他命，疗效不确定。父母这次来主要是为了给他配药，但你想了解一下他们对布莱恩病情的理解，以及这次就诊后下一步该怎么做。
