Families with children on the Autism Spectrum face unique challenges during this stressful time. The ongoing COVID-19 pandemic has added more stress on families and many who have children with special needs are feeling the effects of a significant change in routines, structure and no longer having the same access to special education supports and services as they did pre-pandemic. One change that often follows treatment disruption is that patients return to their pediatric primary care provider to rebuild the care team and create an effective treatment plan. The following is a case example:

Jordan is one such child, an 8-year-old female who lives with her biologic parents and younger sibling. Since the pandemic began, she has struggled with increased aggressive outbursts and temper tantrums.

Given concern by her pediatrician and mother that these outbursts were due to worsening anxiety and depression, her pediatrician started her on low dose Sertraline. Within a few days, her mother called back to report worsening behavior changes: increased hyperactivity and making bizarre statements such as wanting to go live with wild animals, making verbal threats to her mother and family and having a change in sleep patterns.

The Sertraline was promptly discontinued and Jordan’s pediatrician called Project TEACH requesting help with diagnostic clarity and management.

Given concern by her pediatrician and mother that these outbursts were due to worsening anxiety and depression, her pediatrician started her on low dose Sertraline. Within a few days, her mother called back to report worsening behavior changes: increased hyperactivity and making bizarre statements such as wanting to go live with wild animals, making verbal threats to her mother and family and having a change in sleep patterns.

Given concern by her pediatrician and mother that these outbursts were due to worsening anxiety and depression, her pediatrician started her on low dose Sertraline. Within a few days, her mother called back to report worsening behavior changes: increased hyperactivity and making bizarre statements such as wanting to go live with wild animals, making verbal threats to her mother and family and having a change in sleep patterns.

The Sertraline was promptly discontinued and Jordan’s pedia- trician called Project TEACH requesting help with diagnostic clarity and management. Through immediate telephone consultation, the consulting Project TEACH Child and Adolescent Psychiatrist (CAP) suggested initiating low dose Risperidone to help with the aggressive outbursts as an urgent interim measure to prevent the situation escalating to require higher level of care such as hospitalization at this time. A virtual Face-to-Face consultation with the Jordan and her parents and the Project TEACH CAP was also promptly arranged.

During the Face-to-Face consultation, a thorough evaluation was done, and helped to reassure the pediatrician that, despite this unsettling and adverse reaction on Sertraline, the child did not meet criteria for Bipolar Disorder at this time. Jordan was doing significantly better since stopping Sertraline, and on her new treatment regimen. The Project TEACH CAP along with Jordan’s pediatrician and input from Jordan and her parents on the Face-to-Face consultation explored environmental factors that might be causing increased stress on Jordan and her family, and how this was impacting Jordan’s mood and self-esteem.

The Project TEACH CAP along with Jordan’s pediatrician recommended ongoing treatment for Jordan’s co-morbid psychiatric disorders such as ADHD, monitoring of mood and of psychiatric medications, and advocating for additional supports at this time to help provide more structure and respite, such as utilizing recommendations from her special education teachers in the home setting and obtaining in-home supports for the family, even though virtual at this time.

The case of Jordan illustrates the high complexity of patients and acute situations that pediatric primary care providers are encountering during COVID-19. During this time, when families are faced with difficult tasks of playing multiple roles for their children, ongoing challenges are made even more difficult with children who have special needs. As demonstrated in this example, Project TEACH can assist in both immediate and longer term assessment and management of such challenging situations.