A 6-year-old boy is brought to the clinic because of poor school performance. The parents stress that the child is very hard-working and go on to add that the child may actually work"too hard." He will only turn work into the teacher if the margins of his writing are perfectly aligned. Additionally, the patient makes it a point to wash his hands after every paragraph that he writes. Standardized testing shows that he is above average intelligence and has no specific weaknesses in any academic discipline. He has many friends and is always well behaved and friendly in all social and academic settings. On mental status examination, he is a well-related and friendly child appearing his state dage. He appears happy and denies any suicidalor homicid alintent, ideation,orplan. When asked why he must perform his school work in this manner, the patient replies,"I don't know why. I know the other kids don't, but I just have to." There is no evidence of auditory hallucinations or disturbances in his thought process. Which of the following is the most appropriate next step in management?
A. Place him in a special education setting
B. Prescribe a trial of a low dose of haloperidol
C. Prescribe a trial of methylphenidate
D. Recommend cognitive-behavioral therapy
E. Recommend increased strictness in the patient's household
A. Place him in a special education setting
B. Prescribe a trial of a low dose of haloperidol
C. Prescribe a trial of methylphenidate
D. Recommend cognitive-behavioral therapy
E. Recommend increased strictness in the patient's household