Challenging Case-In the Teens it Takes a Team

Derrick is a 17-year-old young man who presents to the DBP clinic with a several year concern that he is "neurodivergent." He presents with his father, who states that he has been worried as well since Derrick was about 3 years old. He was a late talker, and he had no friends in middle school. He often was teased by his classmates. Derrick's father felt that his primary care clinician did not recognize his concerns, particularly as middle school was at the start of COVID and school shutdowns. Derrick was much happier with virtual learning. When he went back in person at the start of high school, he mostly kept to himself and academically did exceptionally well. He is now in 11th grade and starting the college admissions process, and he has been feeling immobilized about the future. He has started refusing to attend school and he told his pediatric clinician at the last primary care visit in an off-hand manner, that he is "better off dead." He typically goes to sleep around 2 am. He is very groggy for wakeup at 6 am , so his family has been letting him miss school. He is "too sleepy to pay attention." This academic year he has had 30 absences and the school is threatening action, even though he is getting A's to B's on tests. He states he does not enjoy going to school, feels he has no friends, and eats lunch alone. He has not joined any extracurricular activities. Nevertheless, his strongest interests lie in academics, and he scrolls on college websites in the middle of the night, reading course options and intrigued by the possibilities. His primary care clinician referred to a pediatric specialty program. How would you approach his care to support him and his family?