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DSM-IV-TR Casebook and
Treatment Guide for

Child
Mental Health

EDITED BY
CATHR YN A. GALANTER, M.D.
PETER S. JENSEN, M.D.

Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical stan-
dards, and that information concerning drug dosages, schedules, and routes of admin-
istration is accurate at the time of publication and consistent with standards set by the
U.S. Food and Drug Administration and the general medical community. As medical
research and practice continue to advance, however, therapeutic standards may
change. Moreover, specific situations may require a specific therapeutic response not
included in this book. For these reasons and because human and mechanical errors
sometimes occur, we recommend that readers follow the advice of physicians directly
involved in their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views and
opinions of the individual authors and do not necessarily represent the policies and
opinions of APPI or the American Psychiatric Association.
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Copyright © 2009 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
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First Edition
Typeset in Adobe Electra and ITC Highlander.
American Psychiatric Publishing, Inc.
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Library of Congress Cataloging-in-Publication Data
DSM-IV-TR casebook and treatment guide for child mental health / edited by
Cathryn A. Galanter, Peter S. Jensen. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-310-5 (alk. paper)
1. Child psychiatry—Case studies. I. Galanter, Cathryn A., 1968– II. Jensen, Peter S.
III. Diagnostic and statistical manual of mental disorders.
[DNLM: 1. Diagnostic and statistical manual of mental disorders. 4th ed., text
revision. 2. Mental Disorders—diagnosis—Case Reports. 3. Adolescent.
4. Child. 5. Diagnosis, Differential—Case Reports. 6. Mental Disorders—therapy—
Case Reports. WS 350 D811 2009]
RJ499.D758 2009
618.92′89—dc22
2008044429
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
 Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxi
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxiii
Cathryn A. Galanter, M.D.
Peter S. Jensen, M.D.
Introduction: Our Conceptualization of the Cases . . . . xxxvii
Peter S. Jensen, M.D.
Cathryn A. Galanter, M.D.

Part I: Classic Cases

Introduction to Classic Cases . . . . . . . . . . . . . . . . . . . . . . . 3

Peter S. Jensen, M.D.
Cathryn A. Galanter, M.D.

0
1 Trouble Paying Attention: Attention-Deficit/

Hyperactivity Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Stephen P. Hinshaw, Ph.D.
Psychotherapeutic Perspective . . . . . . . . .12
William E. Pelham, Jr., Ph.D., A.B.P.P.
James Waxmonsky, M.D.
Psychopharmacologic Perspective. . . . . . .15
Laurence L. Greenhill, M.D.
Integrative Perspective . . . . . . . . . . . . . . .18
Stephen P. Hinshaw, Ph.D.
0
2 Trouble With Transitions: Does My Child Have Autism?. . . . 25
Susan Bacalman, M.S.W.
Robert L. Hendren, D.O.
Psychotherapeutic Perspective . . . . . . . . 29
Laura Schreibman, Ph.D.
Psychopharmacologic Perspective . . . . . . 32
Lawrence Scahill, M.S.N., Ph.D.
Integrative Perspective . . . . . . . . . . . . . . . 36
Susan Bacalman, M.S.W.
Robert L. Hendren, D.O.

0
3 Living in Her Parents’ Shadow:

Separation Anxiety Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Andrea M. Victor, Ph.D.
Gail A. Bernstein, M.D.
Psychotherapeutic Perspective . . . . . . . . 46
Jami M. Furr, M.A.
Sarah A. Crawley, M.A.
Philip C. Kendall, Ph.D., A.B.P.P.
Psychopharmacologic Perspective . . . . . . 49
Rachel G. Klein, Ph.D.
Integrative Perspective . . . . . . . . . . . . . . . 53
Andrea M. Victor, Ph.D.
Gail A. Bernstein, M.D.

0
4 Chatterbox at Home: Selective Mutism . . . . . . . . . . . . . . . . 59

Bruce Black, M.D.
Psychotherapeutic Perspective . . . . . . . . 62
Anne Marie Albano, Ph.D., A.B.P.P.
Psychopharmacologic Perspective . . . . . . 67
Courtney Pierce Keeton, Ph.D.
John T. Walkup, M.D.
Integrative Perspective . . . . . . . . . . . . . . . 70
Bruce Black, M.D.

5 Everything Bothers Her: Major Depressive Disorder. . . . . . . 77
John S. March, M.D., M.P.H.
Psychotherapeutic Perspective . . . . . . . . .80
Greg Clarke, Ph.D.
Psychopharmacologic Perspective. . . . . . .83
Graham J. Emslie, M.D.
Integrative Perspective . . . . . . . . . . . . . . .87
John S. March, M.D., M.P.H.

0
6 Excessively Silly: Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . 97

Mary Kay Gill, R.N., M.S.N., J.D.
Boris Birmaher, M.D.
Psychotherapeutic Perspective . . . . . . . .101
Mary A. Fristad, Ph.D., A.B.P.P.
Psychopharmacologic Perspective. . . . . .104
Robert A. Kowatch, M.D., Ph.D.
Integrative Perspective . . . . . . . . . . . . . . 108
Mary Kay Gill, R.N., M.S.N., J.D.
Boris Birmaher, M.D.

0
7 Life of the Party: Chronic Marijuana Use . . . . . . . . . . . . . 115

Paula Riggs, M.D.
Psychotherapeutic Perspective . . . . . . . .118
Yifrah Kaminer, M.D., M.B.A.
Psychopharmacologic Perspective. . . . . .122
Oscar G. Bukstein, M.D., M.P.H.
Integrative Perspective . . . . . . . . . . . . . . 126
Paula Riggs, M.D.

0
8 My Mind Is Breaking: Psychosis. . . . . . . . . . . . . . . . . . . . . . 129

Julia W. Tossell, M.D.
Judith L. Rapoport, M.D.
Psychopharmacologic Perspective. . . . . .133
Sanjiv Kumra, M.D., M.S.
Kathryn R. Cullen, M.D.
Integrative Perspective . . . . . . . . . . . . . . 136
Julia W. Tossell, M.D.
Judith L. Rapoport, M.D.
0
9 She Just Won’t Eat a Thing: Anorexia Nervosa . . . . . . . . . . 143
E. Blake Finkelson, B.A.
B. Timothy Walsh, M.D.
Psychotherapeutic Perspective . . . . . . . 147
Daniel le Grange, Ph.D.
Psychopharmacologic Perspective . . . . . 151
Angela S. Guarda, M.D.
Integrative Perspective . . . . . . . . . . . . . . 156
B. Timothy Walsh, M.D.
E. Blake Finkelson, B.A.

10 The Blinker: Tourette’s Disorder . . . . . . . . . . . . . . . . . . . . . . 163

Daniel A. Gorman, M.D., F.R.C.P.C.
Bradley S. Peterson, M.D.
Psychotherapeutic Perspective . . . . . . . 167
Douglas W. Woods, Ph.D.
Christine A. Conelea, M.S.
Psychopharmacologic Perspective . . . . . 170
Barbara J. Coffey, M.D., M.S.
Integrative Perspective . . . . . . . . . . . . . . 174
Daniel A. Gorman, M.D., F.R.C.P.C.
Bradley S. Peterson, M.D.

11 She Never Falls Asleep: Disordered Sleep in

an Adolescent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Ronald E. Dahl, M.D.
Allison G. Harvey, Ph.D.
Psychotherapeutic Perspective . . . . . . . 184
Jodi A. Mindell, Ph.D., C.B.S.M.
Psychopharmacologic Perspective . . . . . 187
Judith A. Owens, M.D., M.P.H., D’A.B.S.M.
Integrative Perspective . . . . . . . . . . . . . . 190
Ronald E. Dahl, M.D
Allison G. Harvey, Ph.D.

12 The World Is a Very Dirty Place:
Obsessive-Compulsive Disorder . . . . . . . . . . . . . . . . . . . . . . . 197
Susan E. Swedo, M.D.
Psychotherapeutic Perspective . . . . . . . .200
John Piacentini, Ph.D., A.B.P.P.
Psychopharmacologic Perspective. . . . . .204
Mark A. Riddle, M.D.
Integrative Perspective . . . . . . . . . . . . . . 207
Susan E. Swedo, M.D.

Part II: Comorbid Complexity

Introduction to Comorbid Complexity . . . . . . . . . . . . . . . 215

Peter S. Jensen, M.D.
Cathryn A. Galanter, M.D.

13 Stealing the Car: Disruptive Behavior in an Adolescent . . . 219

Peter S. Jensen, M.D.
Psychotherapeutic Perspective . . . . . . . .223
Scott W. Henggeler, Ph.D.
Psychopharmacologic Perspective. . . . . .225
Richard P. Malone, M.D.
Integrative Perspective . . . . . . . . . . . . . . 228
Peter S. Jensen, M.D.

14 Zero Tolerance: Threats to Harm a Teacher in

Elementary School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Karen C. Wells, Ph.D.
Psychotherapeutic Perspective . . . . . . . .238
Caroline Lewczyk Boxmeyer, Ph.D.
Nicole Powell, Ph.D., M.P.H.
John E. Lochman, Ph.D., A.B.P.P.
Psychopharmacologic Perspective. . . . . .241
Robert L. Findling, M.D.
Integrative Perspective . . . . . . . . . . . . . . 244
Karen C. Wells, Ph.D.

15 Anxious Adolescent in the Emergency Room:
Possible Abuse of Prescription Medications . . . . . . . . . . . . . . . 251
Jeffrey J. Wilson, M.D.
Psychotherapeutic Perspective . . . . . . . 256
Christianne Esposito-Smythers, Ph.D.
Robert Miranda, Jr., Ph.D.
Integrative Perspective . . . . . . . . . . . . . . 259
Jeffrey J. Wilson, M.D.

16 The Worried Child: A Child With Multiple Anxiety

Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Wendy K. Silverman, Ph.D., A.B.P.P.
Carla E. Marin, M.S.
Psychotherapeutic Perspective . . . . . . . 268
Bruce F. Chorpita, Ph.D.
Psychopharmacologic Perspective . . . . . 270
Daniel Pine, M.D.
Integrative Perspective . . . . . . . . . . . . . . 273
Wendy K. Silverman, Ph.D., A.B.P.P.
Carla E. Marin, M.S.

17 Affective Storms: A Careful Assessment of Rage Attacks . . . 281

Gabrielle A. Carlson, M.D.
Psychotherapeutic Perspective . . . . . . . 286
Penelope Knapp, M.D.
Psychopharmacologic Perspective . . . . . 292
Jon McClellan, M.D.
Integrative Perspective . . . . . . . . . . . . . . 295
Gabrielle A. Carlson, M.D.

18 Failing Out of School: Language and Reading

Weaknesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Lynn M. Wegner, M.D., F.A.A.P.
Psychotherapeutic Perspective . . . . . . . 307
Joshua M. Langberg, Ph.D.
Jeffery N. Epstein, Ph.D.
 Psychopharmacologic Perspective. . . . . .310
Lacramioara Spetie, M.D.
L. Eugene Arnold, M.D., M.Ed.
Speech and Language Pathology
Perspective . . . . . . . . . . . . . . . . . . . . . . . . 313
Helen Nelson Willard, M.Ed., CCC-SLP
Integrative Perspective . . . . . . . . . . . . . . 317
Lynn M. Wegner, M.D., F.A.A.P.

19 Functional Abdominal Pain in a Child With

Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . 325
Eva M. Szigethy, M.D., Ph.D.
Psychotherapeutic Perspective . . . . . . . .327
David R. DeMaso, M.D.
Psychopharmacologic Perspective. . . . . .331
John V. Campo, M.D.
Integrative Perspective . . . . . . . . . . . . . . 336
Eva M. Szigethy , M.D., Ph.D.

Part III: Toughest Cases:

Diagnostic and Treatment Dilemmas
Introduction to Toughest Cases . . . . . . . . . . . . . . . . . . . . . 345
Peter S. Jensen, M.D.
Cathryn A. Galanter, M.D.

20 Frequent Tantrums: Oppositional Behavior in a

Young Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Ross W. Greene, Ph.D.
J. Stuart Ablon, Ph.D.
Psychotherapeutic Perspective . . . . . . . .352
Alison Zisser, M.S.
Sheila M. Eyberg, Ph.D., A.B.P.P.
Psychopharmacologic Perspective. . . . . .355
Mani Pavuluri, M.D., Ph.D.
Integrative Perspective . . . . . . . . . . . . . . 359
Ross W. Greene, Ph.D.
J. Stuart Ablon, Ph.D.

21 Toddler With Temper Tantrums: A Careful Assessment
of a Dysregulated Preschool Child . . . . . . . . . . . . . . . . . . . . . 365
Helen Egger, M.D.
Psychotherapeutic Perspective . . . . . . . 370
M. Jamila Reid, Ph.D.
Carolyn Webster-Stratton, Ph.D.
Psychopharmacologic Perspective . . . . . 375
Joan L. Luby, M.D.
Integrative Perspective . . . . . . . . . . . . . . 378
Helen Egger, M.D.

22 Won’t Leave His Room: Clinical High Risk for

Developing Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Cheryl M. Corcoran, M.D.
Psychotherapeutic Perspective . . . . . . . 389
Jean Addington, Ph.D.
Psychopharmacologic Perspective . . . . . 392
Christoph U. Correll, M.D.
Andrea Auther, Ph.D.
Barbara A. Cornblatt, Ph.D., M.B.A.
Integrative Perspective . . . . . . . . . . . . . . 395
Cheryl M. Corcoran, M.D.

23 I Just Want to Die: Double Depression . . . . . . . . . . . . . . . . 403

David A. Brent, M.D.
Psychotherapeutic Perspective . . . . . . . 405
Kevin D. Stark, Ph.D.
Psychopharmacologic Perspective . . . . . 412
Christopher J. Kratochvil, M.D.
Integrative Perspective . . . . . . . . . . . . . . 415
David A. Brent, M.D.

24 Cutting Helps Me Feel Better: Nonsuicidal Self-Injury . . . 419

Matthew K. Nock, Ph.D.
Tara L. Deliberto, B.S.
Psychotherapeutic Perspective . . . . . . . 422
Alec L. Miller, Psy.D.
Dena A. Klein, Ph.D.
 Psychopharmacologic Perspective. . . . . .426
Niranjan S. Karnik, M.D., Ph.D.
Hans Steiner, Dr. med. univ., F.A.P.A., F.A.A.C.A.P., F.A.P.M.
Integrative Perspective . . . . . . . . . . . . . . 429
Matthew K. Nock, Ph.D.
Tara L. Deliberto, B.S.

25 From Foster Care to the State Hospital:

Psychotic Symptoms in a Child Who Is
the Victim of Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Patricia K. Leebens, M.D.
Psychotherapeutic Perspective . . . . . . . .439
Nancy C. Winters, M.D.
Psychopharmacologic Perspective. . . . . .443
Harvey N. Kranzler, M.D.
Integrative Perspective . . . . . . . . . . . . . . 447
Patricia K. Leebens, M.D.

Part IV: Kids in Crisis

Psychopathology in the Context
of Social Stressors
Introduction to Kids in Crisis . . . . . . . . . . . . . . . . . . . . . . . 461
Peter S. Jensen, M.D.
Cathryn A. Galanter, M.D.

26 Suicidal Ideation After Supervised Visits With

Biological Mom: Depressed Mood in a Child in
Foster Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Paramjit T. Joshi, M.D.
Lisa M. Cullins, M.D.
Psychotherapeutic Perspective . . . . . . . .468
Anthony P. Mannarino, Ph.D.
Psychopharmacologic Perspective. . . . . .472
Sandra J. Kaplan, M.D.
Integrative Perspective . . . . . . . . . . . . . . 477
Paramjit T. Joshi, M.D.
Lisa M. Cullins, M.D.

27 The Legacy of War: Irritability and Anger
in an Adolescent Refugee . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Brian L. Isakson, Ph.D.
Christopher M. Layne, Ph.D.
Psychotherapeutic Perspective . . . . . . . 486
Judith A. Cohen, M.D.
Psychopharmacologic Perspective . . . . . 490
Frank W. Putnam, M.D.
Integrative Perspective . . . . . . . . . . . . . . 493
Brian L. Isakson, Ph.D.
Christopher M. Layne, Ph.D.

28 Moody Child: Depressed in Context of Parental Divorce . . . 501

Sharlene A. Wolchik, Ph.D.
Irwin N. Sandler, Ph.D.
Psychotherapeutic Perspective . . . . . . . 503
Clarice J. Kestenbaum, M.D.
Psychopharmacologic Perspective . . . . . 506
Bruce Waslick, M.D.
Integrative Perspective . . . . . . . . . . . . . . 510
Sharlene A. Wolchik, Ph.D.
Irwin N. Sandler, Ph.D.

29 It Should Have Been Me: Childhood Bereavement . . . . . . 517

Cynthia R. Pfeffer, M.D.
Psychotherapeutic Perspective . . . . . . . 520
Elizabeth B. Weller, M.D.
Ronald A. Weller, M.D.
Thomas A. Dixon, B.S.
Psychopharmacologic Perspective . . . . . 526
Karen Dineen Wagner, M.D., Ph.D.
Integrative Perspective . . . . . . . . . . . . . . 528
Cynthia R. Pfeffer, M.D.

30 Won’t Settle Down: Disinhibited Attachment in a Toddler. . 533
Stacy S. Drury, M.D., Ph.D.
Charles H. Zeanah, M.D.
Psychotherapeutic Perspective . . . . . . . .536
Alicia F. Lieberman, Ph.D.
Psychopharmacologic Perspective. . . . . .540
Mary Margaret Gleason, M.D.
L. Eugene Arnold, M.D., M.Ed.
Integrative Perspective . . . . . . . . . . . . . . 544
Stacy S. Drury, M.D., Ph.D.
Charles H. Zeanah, M.D.

Part V: Diagnostic and

Treatment Decision Making

31 Diagnostic Decision Making . . . . . . . . . . . . . . . . . . . . . . . . 553
Cathryn A. Galanter, M.D.
Peter S. Jensen, M.D.

32 Research and Clinical Perspectives on Diagnostic and

Treatment Decision Making: Whence the Future? . . . . . . . 573
Peter S. Jensen, M.D.
David A. Mrazek, M.D., F.R.C.Psych.
Cathryn A. Galanter, M.D.

Appendix
Screening Tools and Rating Scales Useful in the Screening,
Assessment, and Monitoring of Children and Adolescents . . . 591

About the Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . 613

Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 667

Index of Cases by Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . 697

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Contributors

J. Stuart Ablon, Ph.D.

Associate Clinical Professor of Psychiatry, Harvard Medical School; Associate
Director and Cofounder, Collaborative Problem Solving Institute, Depart-
ment of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts

Jean Addington, Ph.D.

Professor of Psychiatry, University of Toronto; Research Scientist, Director of
Psychosocial Treatments, First Episode Psychosis Program, and Director or
the PRIME Research Clinic, Centre for Addiction and Mental Health, Tor-
onto, Ontario, Canada

Anne Marie Albano, Ph.D, A.B.P.P.

Associate Professor of Clinical Psychology, Division of Child and Adolescent
Psychiatry, and Director, Columbia University Clinic for Anxiety and Related
Disorders, Columbia University, New York, New York

L. Eugene Arnold, M.D., M.Ed.

Professor Emeritus of Psychiatry; Former Director, Division of Child and Ad-
olescent Psychiatry; Former Vice Chair of Psychiatry; Interim Director,
Nisonger Center of Excellence in Developmental Disabilities, The Ohio
State University, Columbus, Ohio

Andrea Auther, Ph.D.

Assistant Director, Recognition and Prevention (RAP) Program, The Zucker
Hillside Hospital, Glen Oaks, New York

Susan Bacalman, M.S.W.

The M.I.N.D. Institute (Medical Investigation of Neurodevelopmental Disor-
ders Institute), University of California, Davis Medical Center, Sacramento,
California

Gail A. Bernstein, M.D.

Head, Program in Child and Adolescent Anxiety and Mood Disorders; En-
dowed Professor in Child and Adolescent Anxiety Disorders, Division of Child
and Adolescent Psychiatry, University of Minnesota Medical School, Minne-
apolis

xvii