Detailed contribution information
| Contribution title | Undiagnosed ADHD and Emotional Dysregulation in a 17-Year-Old Female: How Environmental and Systemic Failures Escalated a Complex Neurodevelopmental Disorder into Severe Psychiatric Comorbidities |
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| Contribution code | D3.063 |
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| Form of presentation | Poster |
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| Abstract |
Aims: To explore how delayed recognition of neurodevelopmental disorders (NDDs), such as ADHD, in females can lead to severe psychiatric outcomes, emphasizing the impact of familial and systemic failures in managing complex cases. Methods: A 17-year-old female presented with hyperverbal speech, mystical delusions, visual hallucinations, disrupted sleep, and increased energy, scoring 37 on the Young Mania Rating Scale (YMRS). Brain MRI was unremarkable. At age 15 she attempted suicide leading to a diagnosis of anxious-depressive syndrome. Retrospective evaluation using WAIS-IV (IQ 98), Conners' Rating Scale, MASC 2, ADOS-2, K-SADS, PQ16, DERS and socio-familial analysis revealed ADHD traits, severe anxiety, and possible ASD. Observations indicated significant social discomfort and atypical interaction patterns, despite subthreshold ADOS-2 scores. The patient was diagnosed with Bipolar Disorder with psychotic symptoms within a complex NDD and treated with olanzapine, risperidone, and lithium. Results: The patient exhibited significant academic challenges (difficulty maintaining attention, irregular school attendance), which were not explicitly reported by the school. Frequent mood swings, emotional dysregulation, the perception of being unusual compared to her peers, combined with attempts to mask these traits and the lack of recognition from her surrounding environment, contributed to maladaptive coping strategies, including substance abuse. Pharmacological treatment, initiated during hospitalization, led to remission of manic and psychotic symptoms, though residual content of thought, such as esoteric interests, remained bizarre. Following discharge from our unit, familial stigma and resistance to mental health interventions exacerbated the patient’s trajectory, leading to the abandonment of a proposed community-based rehabilitation program. Conclusions: Timely recognition of NDDs, particularly in females, is essential to prevent the development of severe psychiatric comorbidities. Gender-sensitive diagnostic approaches and systemic interventions, such as teacher training and accessible parent programs, are critical for early detection and support. Strengthened transitional psychiatric care systems can ensure continuity of care during adolescence, reducing relapse risks and fostering better developmental outcomes. This case underscores the necessity for systemic and gender-sensitive strategies to mitigate long-term psychiatric risks in at-risk-adolescents. |