The following is a case of an adolescent girl who has been more argumentative recently, despite ongoing therapy for ADHD and anxiety. You, the clinician, wonder if her mother’s recent job loss and history of substance abuse may be contributing factors to her daughter’s behavior, and you decide to meet with your patient’s mother alone.
Questions to consider after reading the case
• You normally meet with your patient alone or with the patient and her mother together. How would you present to your patient and her mother the change in appointment structure to meet with the mother alone?
• What questions would you ask the mother to assist her in disclosing alcohol use or substance use if she is using substances?
Katie, age 13 years, entered treatment 2 years ago for ADHD and general anxiety disorder. She presents for a routine psychopharmacologic appointment. Katie’s mother, Laura, reports that things have been particularly stressful at home recently. She states that she recently lost her job and her daughter has been more confrontational than usual and spends too much time on the computer late at night. The mother has a psychiatric history significant for marijuana dependence and you wonder what else might be going on at home.
Normally you meet with Katie alone and then with Laura and Katie together. Today you wish to speak with the mother privately to discuss her substance abuse and to further assess home stressors.
You discover that Laura is worried about the family’s finances since she lost her job. Katie’s father found extra part-time employment and has been at home less frequently to help with parenting Katie and her younger brother. Laura says she has been considering using cannabis again to “help her relax.” Instead, she tries to unwind by drinking 2 to 3 glasses of wine over the course of the evening.
You continue to screen for problematic alcohol use by asking Laura if she ever has more than 4 drinks at a time. You also ask about other risky behaviors, including driving under the influence, which she denies. Her answers give you reason to believe that Laura has been drinking heavily and that she would benefit from further evaluation.
Katie’s behavior patterns in the evenings raise your concern that stressors at home may be exacerbating her ADHD and anxiety symptoms. Because ADHD is a risk factor for adolescent substance use disorder, close monitoring of ADHD symptoms and monitoring for signs and symptoms of substance use is suggested.
1. Wilens TE, Martelon M, Joshi G, et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry. 2011;50:543-553.