Percorsi clinici
Traiettorie evolutive: una lezione dall’ADHD
Developmental trajectories: a lesson from ADHD to look back to the past in order to face the future
Chiara Narducci
Scuola di Specializzazione in Neuropsichiatria Infantile, Università degli Studi di Cagliari, Clinica di Neuropsichiatria dell’Infanzia e dell’Adolescenza, Ospedale Pediatrico “A. Cao”, ARNAS “G. Brotzu”, Cagliari
Maggio 2021 - pagg. 321 -324 | DOI: 10.53126/MEB40321
Abstract
A 12-year-old girl was urgently sent by her paediatrician to the Child and Adolescent Neuropsychi-atry ward for behavioural disorders and suicide threat. At the time of the visit the suicide risk was low. Nevertheless, considering a possible underlying psychopathology, a short Day Hospital admis-sion for appropriate diagnostic investigations was warranted. Developmental trajectory showed several symptoms of inattention, hyperactivity, impulsivity, poor tolerance to frustrations, emotional lability, irritability, emotional dysregulation, rule breaking be-haviours and impaired socialization with her coevals from early childhood. The diagnostic delay may have led to demoralization and then to depressive feelings. This led to the diagnoses of Attention - Deficit Hyperactivity Disorder and Oppositional-Defiant Disorder. Pharmacological therapy with Methylphenidate was prescribed as well as cognitive-behavioural therapy and parent training intervention.
Riassunto
Un’adolescente di 12 anni viene inviata dal pediatra in visita urgente in Clinica di Neuropsichiatria dell’Infanzia e Adolescenza per disturbi del comportamento e minaccia di suicidio. Il rischio suicidario, al momento della visita, risulta basso, tuttavia, nel sospetto di una patologia sottostante, viene programmato un Day Hospita per gli opportuni approfondimenti diagnostici. La ricostruzione della traiettoria evolutiva ha consentito di rintracciare, sin dalla prima infanzia, sintomi di inattenzione, iperattività, impulsività, bassa soglia di tolleranza alle frustrazioni, labilità emotiva, facile irritabilità, disregolazione emotiva, difficoltà nel rispetto delle regole e compromissione della socializzazione con i coetanei. Ciò ha reso possibile formulare le diagnosi di Disturbo da Deficit di Attenzione ed Iperattività e di Disturbo Oppositivo-Provocatorio. Il ritardo diagnostico può aver determinato la comparsa di frustrazione e conseguenti sentimenti depressivi. Insieme alla restituzione clinica, viene proposta terapia farmacologica con metilfenidato oltre che un intervento psicoterapico di tipo cognitivo-comportamentale e parent training.
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Corrispondenza: narducci.chiara@gmail.com