Carlos: a 12-year-old boy discovers his mother is HIV positive

Carlos is a 12-year old Latino male who lives with his parents and his 5-year old sister. Carlos' mother is HIV positive. He was one year of age when his brother died of AIDS at the age of 3 years. Carlos' mother, who was severely depressed after his brother's death and continues to have episodes of depression, never informed Carlos about her HIV status. Carlos is HIV negative as determined by negative tests at birth and 18 months of age. Carlos developed numerous behavior problems in the past year. He was referred to the Children's Art Therapy Group sponsored by the University of California San Diego (UCSD) Mother, Child and Adolescent Program. The group is attended by HIV infected and affected children. Carlos did not understand why he was attending the group and asked his mother who was HIV positive. The mother eventually disclosed to Carlos that she was HIV positive. Subsequently, he was quiet, withdrawn and expressed anger in the art therapy group. His teacher, who was concerned about ADHD behaviors and academic underachievement in the past, reported that inattentiveness, poor concentration and forgetfulness were increasing in the classroom and his grades were falling. Carlos was referred to his pediatrician for an evaluation for ADHD. During the initial primary care appointment, a pediatric resident made a significant and positive impression on Carlos. The resident detected an underlying anger, and Carlos started to talk about himself and his family. The pediatric resident diagnosed ADHD, initiated medication, recommended classroom accommodations, and made a referral for individual therapy. Carlos continued to see the resident during monthly visits for monitoring ADHD treatment while encouraging Carlos to talk about home life, school and friendships.