Brief Answer:
My presumptive diagnosis is transient mood disorder

Detailed Answer:
Hello

Thanks for the query

Advair contains steroid and long acting bronchodilator.In the given dosage it is a very good medication to control the recurrence of asthma.
Proventil contains albuterol a short acting bronchodilator.It is not advised on a regular basis and should be given if there is aggravation of symptoms.
Singulair is a mast cell stabiliser when given along with Advair and Proventil it increases the efficacy of medication and thus better control of symptoms.
The asthma and its medication is not related to her behavioral abnormality.

I want to know if this behavior is limited to the school only or it remains same at home too.
On the basis of described symptoms my presumptive diagnosis is transient mood disorder.
The differential diagnosis are
1)Attention deficit hyperkinetic disorder(ADHD)-It is unlikely as this is uncommon after 7 years of age,should be present for more than 4 months and in 2 different situations like school and home.
2)Seperation anxiety disorder or school refusal.Here the child due to her separation from care taker(particularly in school) shows abnormal behavior.
Chances are less likely due to the age of onset.
3)Conduct disorder - It is also unlikely as the child should have in addition aggressive or antisocial behavior.
4)Learning disorder is another less likely possibility.

The behavioral disorder are mainly diagnosed on the basis of history and the presence of symptoms.For example for diagnosis of ADHD, 1)
the symptoms should persist for longer duration(4 months),
2)symptoms should include hyperactivity,inattention,impulsiveness,
3)Onset less than 7 years of age
4) In two different situation

So my presumptive diagnosis is transient mood disorder as her symptoms do not fit into any of the above diagnosis.
I suggest you to monitor her behavior at home,ask in detail about her behavior in school and get her evaluated by a pediatrician/psychiatrist if needed.

I hope this helps.
Do ask if you have any more doubts,
Regards

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Brief Answer:
A definite diagnosis can not be labelled at this stage

Detailed Answer:
Thanks for follow up

I can understand what is going in your mind.Although the symptoms are suggestive of ADHD,one can not label her with this diagnosis unless she met all the criteria(unless it is so severe that it is causing personal and social problem).

You are right it may be an early symptom of ADHD. But the diagnosis can be made in follow up only. This is the reason I used the term transient,as in many of the children the symptoms don't last for a long time and improves on its own while few may develop other symptoms(like symptoms of depression or conduct disorder) over a period of time.

I would like to keep her in follow up of counceller/psychiatrist and behavioral therapy as needed.The medication for any specific disorder can be started only after fulfilling the criteria or when the symptoms worsened rapidly.

If you have any more query I shall be glad to answer that.
Regards

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Brief Answer:
I prescribe Methylphenidate sustained release tablet once a day

Detailed Answer:
If the diagnosis of ADHD is confirmed I prescribe Methylphenidate sustained release tablet 10 mg once a day in morning before breakfast and refer the child to a pediatric psychiatrist for behavioral therapy.

The advantage of sustained release tablet is that compliance is better and we can avoid multiple dosage.

My diagnosis is usually based on DSM (Diagnostic and statistical manual of mental disorders) criteria and I don't recommend any investigation for diagnosis or before starting the therapy.

I usually ask about the history of Glaucoma, seizure disorder as this drug should not be given in these conditions.

I hope this helps.
Regards

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Brief Answer:
You will get better idea from a child psychiatrist

Detailed Answer:
Non pharmacological treatment should be started simultaneously along with the pharmacological treatment.
There are several methodologies of non pharmacological behavioral therapy for autistic disorder.
As I am not specialized in child psychiatry after confirming the diagnosis and initial medical treatment I refer the child to a specialized child psychiatrist for further management.

I request you to close the discussion and put your queries to a psychiatrist on healthcaremagic platform so that he/she better able to help you out.

If you have any query regarding the general pediatrics I shall be glad to answer.

Regards

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