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An 8 ½-year-old boy comes to the clinic for follow up of his ADHD. In the chart review, you note that the patient is taking short acting methylphenidate two times a day. His mother noted significant improvement in his morning classes but a significant problem with hyperactivity and in attentiveness as the day progresses. As you review comments on your patient’s recent report card, you can see that his academic performance is stronger in his morning classes as compared to his afternoon classes. His mother is afraid that the treatment is not working well enough. In talking to the patient, it becomes clear that he is unhappy with the medication. He says, “I have to go to the nurse and take my medication when all of the other kids are playing. The other kid knows that I’m different.” Question What is the next appropriate step in the management of this child? Question 7 options: Increase the dose of his current medication Stop the methylphenidate and begin dextroamphetamine Reassure the parents and see the patient for follow up in four weeks Initiate treatment with a long-acting form of methylphenidate Add a selective serotonin reuptake inhibitor as an adjunctive treatment

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