title: Trauma and hyperactivity: differentiating symptoms and cause.
abstract: Quintin is a 7-and-a-half-year-old male who presents to you with his long-term foster parents stating that the school "wants to put him in a special behavior class." You have cared for the child since he went into the foster parents/biological aunt and uncle's care at 14 months of age.Quintin has been healthy and is on no medication; he has no chronic diseases or other medical problems. He has never had physical trauma, but when you first met him at 14 months of age, his aunt and uncle could give no history about his infancy. The aunt's sister who is the biological mother is currently incarcerated for drug trafficking, and his biological father is an unknown.His toddler years were fairly uneventful. The aunt and uncle have 2 children of their own who are currently 12 and 15 years of age-at the time Quintin joined the family they were 5 and 8 years of age and so the initial adjustment was stressful for the family. The aunt worked full time throughout Quintin's toddlerhood and often in childcare he would have difficulty with drop-off.When he began at head start, he was often described as "too busy" and "trouble on the playground," but he was highly verbal and intellectually curious, had many friends, and did well. Kindergarten was fairly uneventful in a full-day program, although he began to be more provocative at home, often getting into his cousins video games and once breaking his cousin's smart phone.He did well academically at the beginning of first grade. He was a solid reader by January of the year, but his activity and oppositionality were increasing. He was suspended 4 times between January and March for "unsafe behavior" including bolting from the playground during recess following the dare of an older student. His aunt and uncle present at primary care at their wits end. They state that at home he is increasingly angry. He responds much better to his uncle but can be very provocative with his aunt stating "I don't have to listen to you because you are not my mother." His aunt expressed concern when she was told by his teacher that "Either he starts medication or he needs to go to a special classroom." Where do you go from there?
authors.affiliation: Phramongkutklao Hospital, Bangkok, Thailand.
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Arunyanart
authors.forename: Carol
authors.initials: C
authors.lastname: Weitzman
authors.forename: Betsy
authors.initials: B
authors.lastname: Groves
authors.forename: Marilyn
authors.initials: M
authors.lastname: Augustyn
mesh_terms: D000293:Adolescent; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000209:etiology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D005260:Female; D005581:Foster Home Care / Q000523:psychology; D006801:Humans; D008297:Male; D009035:Mothers; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology* / Q000523:psychology*