A 3-year-old girl is brought to the office by her parents who express concern about their daughter's behavior. They report that she frequently refuses to comply with requests, throws 3-5 minute tantrums when frustrated, and resists bedtime routines despite requiring minimal parental assistance once she cooperates. Her preschool teacher describes her as active, talkative, and appropriately interactive with peers without being disruptive in the classroom setting. The parents note she sleeps through most nights but occasionally has episodes of enuresis. Developmental history is significant for first words at 11 months and independent ambulation at 14 months. Physical examination is unremarkable. Mental status examination reveals initial shyness that resolves within minutes; the child demonstrates age-appropriate play, 90% intelligible speech, and vocabulary consistent with her age. Vital signs are normal. Which of the following is the most appropriate next step in management?

  1. A)Reassurance to parents that these behaviors are developmentally normalGABARITO
  2. B)Referral to child psychiatry for evaluation of oppositional defiant disorder
  3. C)Initiation of methylphenidate for suspected attention-deficit/hyperactivity disorder
  4. D)Prescription of an enuresis alarm system for nocturnal bedwetting
  5. E)Referral for speech-language pathology evaluation

Explicação

At age 3 years, oppositional behavior (negativism, refusal to comply), temper tantrums, bedtime resistance, short attention span, and occasional nocturnal enuresis are all within normal developmental limits. The child demonstrates normal language development (... Ver explicação completa e trilha adaptativa →

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