He had received weekly speech therapy since a speech and language evaluation in third grade had shown a mild language deficit. There were no additional interventions or accommodations in place at school. School personnel were concerned about classwork and homework completion, comprehension and writing. He had recurrent otitis media until 8 years of age, resulting in 2 sets of tympanostomy tubes, but normal subsequent hearing. He has mild seasonal allergies.
Review of systems is notable for a long history of eating a limited volume and variety of foods.
This history predated medication usage, but subsequently became much worse. He is rarely hungry for lunch or dinner and often complains of a stomachache at dinnertime. He is afraid of spiders, and is unusually nervous about the safety of family members when they are traveling. He is bossy with his siblings and younger children and does not socialize well with children his own age. He has difficulty accepting changes in plans or stopping an activity when he is called to do something else.