BACKGROUND
Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carries behavior has been difficult to manage and they dont know what to do.
SUBJECTIVE
Carries parents report that they have concerns about her behavior, which they describe as sometimes not normal for a 13-year-old. They notice that she talks to people who arent real. Her behavior is calm and passive. Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that its normal for younger children to have imaginary friends, but they feel that at Carries age, she should have grown out of these behaviors. Carries parents report that she has friends that are half-cat and half-human, and spirits who speak with her in her head. She also reports that the people on television know when she is home and that they have certain shows just for her.
Carries parents report that they have taken her to her pediatrician who has given her a clean bill of health. Carries parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carries social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were ok in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carries teachers had wanted to hold her back a grade, but her parents acknowledge that they were insistent that this did not happen. Now they are describing some regrets over this as Carrie seems more lost than ever in her schoolwork. Carries mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.
Carries parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her into a zombie. Carries mother also confides that her husbands grandfather spent a few years in the nut house. When you probe further, she began crying and said, He was schizophrenic  what if Carrie is schizophrenic?
During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, I dont really have any. I dont like those people. You inquire if she is sad or upset that she doesnt like them, to which she states no, why should I be? I guess they would be friends with me if I asked, but Im not interested. I could make them be my friends if I wanted, but I dont  but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to. When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that Im into witchcraft or something.
When you ask Carrie about the homework assignment that you read, she explains that her teacher is just miserable. She doesnt understand how I think I think high, she just cant get it.