When I first met this patient, she was about 14 years old, and always came to the clinic with her mother. I saw them from time to time for more than 1 year, and the girl noticeably grew during this time. Her mother is an attractive woman, and looked too young to have such a big girl. Their clothing was always stylish, especially the mother. She always had nice colored fingernails, neatly trimmed eyebrows and beautifully highlighted short hair. I thought she was prettier than her daughter. 

The girl was slim, good looking and had large eyes. Although she was not fully developed, I can see she would grow up to be beautiful. The only problem was she had some acne in her forehead. 

The girl spoke good English,and her mother also spoke English, but still had communication problems, which was very common among immigration families. She came to see the psychiatrist in this clinic, a young black male, about every 2 or 4 weeks over a year. At the same time, she had counseling at her school for one hour every week. But all of these treatments and psycho-therapy did not help her much.  

She was diagnosed with ADHD (Attention-deficit/hyperactivity disorder) and mood swing, and had been taking medication for these mental problems under the care of the psychiatrist. During the time, the psychiatrist kept adjusting the medicine and dosage for her because of the major side effects of these medicines. Sometimes, she still felt depressed even with the medication; sometimes, she felt great, but her mother claimed that she did not sleep or lost appetite. Therefore, the doctor kept making adjustments, but it looked like he never got the optimal treatment plan for the girl. Some drugs had some positive effects on her mood, but none of them showed any effect on her focus levels. 

The girl had a rough relationship with her mother, although she is the only family of her in the USA. According to her mother, she divorced with her first husband soon after the birth of this girl, who had a mild congenital heart disease which was cured later. Then the mother came to the USA, and the girl was left in China and raised by her parents. The mother remarried to a Chinese spoken man in the USA, and brought her daughter to the USA when she was about 10. The girl was fine for half a year to one year when she first came to America, and even got along with her stepfather, though her mother thought her husband did not care about the girl too much. However, the mother never told the girl that the guy was not her biological father, and she did not know that fact even when she told the psychiatrist about it. Later, she divorced with her second husband, so she and the girl were the only members of their current family.   

I was not sure what kind of job the mother had, but her shift began late in the morning, so when she went back home from work, it was usually around 9 pm. Therefore, the girl spent most of her after school time alone at home. Besides, she only has one day off on the weekend, so the mother and daughter can only spend one full day together every week. It looked like the girl spent most of her free time in her room surfing the internet or playing on her cell phone.

The mother complained a lot about the girl’s behavioral problems. First, she was very emotional. If her mother tried to control the amount of time she spent on cell phone, she would cry for several hours asking for it. Once, the mother was annoyed by the girl so much, she took off and left the girl alone at home. When she came back to the house a couple hours later, she found there was a police officer at her doorstep. Because the girl kept crying for several hours no stop, her neighbor thought something bad happened and called the police. 

Second, the girl did not have any self-control. The girl loves chocolate, and her mother brought her a lot of chocolate, and kept them in a jar. But the girl finished the whole jar in one set, and so much chocolate she ate, she vomited at the end. 

The girl also lied. Once her mother found she had worn her jacket, and asked about it, and she refused to admit that she did that, even when her mother told her it would be OK for her to wear her clothes as long as she told her mother about it. She would also lie about taking her medicine. The girl needed to take the medicine twice a day, and her mother usually called her in the middle of the day to remind her about her medication. Sometimes, she said that she already took them, but in fact she did not.

The girl also performed poorly in her school. She only likes drawing, and paid attention in art class. But in other classes such as math or science class, she would not listen to the teachers, and kept drawing or talking. Sometimes, she was asked to stay out of the classroom during some classes because of her bad behavior. As a result, she was falling behind in her school. If the situation continued, it was unlikely for her to graduate high school. She also did not have any friends and had been bullied in school. 

Her mother had been taking her to see therapists for a long time, but never got a good result. For example, she had seen this psychiatrist for over a year, and sometimes reported that she was in a good mood, but her mother, teachers and school social worker all said that they saw few changes in the girl’s behavior after her taking the medication prescribed by the psychiatrist.     

At the end, the psychiatrist also said since there was no noticeable progress in the girl, maybe it was time for them to find a new psychiatrist who can better help the girl. I even suggested that a Chinese psychiatrist may be a better fit for the girl. But her mother said that it was difficult to find a psychiatrist who can fit their schedule, and there is no Chinese psychiatrist available. Finally, the psychiatrist suggested the girl have another evaluation, and then adjust her treatment plan in regard with her evaluation result.  

It is obvious that the mother loves her daughter very much and the mood and behavioral problems of her daughter put a lot of stress on her life. They need help, and the help from school and psychiatrist were not enough. I sometimes thought that life would be easier for them if they went back to China.