A 16-Year-Old Boy Is Brought to the Office by His

question 554

Multiple Choice

A 16-year-old boy is brought to the office by his mother due to behavioral concerns.  The patient has been coming home after curfew most nights and arguing with his parents more than usual.  The mother notes that he has been spending most of his time at home alone in his room with the door closed and seems less interested in attending family get-togethers.  The mother also shares that she found a marijuana joint under the patient's bed last week; when asked about the joint, he stated it belongs to a friend and he does not use drugs.  The patient maintains a B average in school and plays in the high school band.  When interviewed alone, the patient states he has tried marijuana a few times and lied to his mother because he was afraid that she would tell his father.  The patient says he would rather avoid talking to his father for as long as possible and shares that his father refers to him as a disappointment.  He has no chronic medical conditions and takes no medications.  Vital signs are normal; growth curves are tracking consistently.  Physical examination shows no abnormalities.  Which of the following is the most appropriate next step in management of this patient?

• A)Encourage the patient to communicate more with his father
• B)Provide reassurance that the patient's behaviors are age-appropriate
• C)Recommend family therapy
• D)Recommend trial of fluoxetine
• E)Refer for drug counseling

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