An 11-Year-Old Girl Is Brought to the Office by Her

An 11-year-old girl is brought to the office by her mother after getting suspended from her new school for pushing a peer while waiting in line at the cafeteria.  The patient has had a history of behavioral concerns since first grade and was suspended once before for talking back to her teacher.  Her mother reports that the patient has always had a lot of energy and "needs to be active to stay out of trouble."  The patient requires frequent prompting to complete homework assignments and forgets to do her chores.  The mother states, "My daughter doesn't think before she speaks or acts, but this is the first really bad thing she has done this year.  Her dog died last month, and she's been pretty upset.  I have bipolar disorder, and I know what it's like to be down."  Vital signs are within normal limits.  Height and weight are consistently tracking at the 70th percentile.  On examination, the patient is cooperative, mildly restless, and talkative.  She says her mood is "fine" and that she "hates school because it's so boring."  In further discussion of this patient's diagnosis and treatment options, which of the following responses by the physician is most appropriate?

A) "Let's see how she does over the next year; most children outgrow these behaviors by adolescence and do not require treatment."
B) "Starting at a new school and losing a pet can be difficult for many children; she is likely experiencing an adjustment period, which does not require medication."
C) "There are no medications that have been proven effective for your daughter's aggression, although a parent-child therapy program may improve her conduct."
D) "Your daughter's behavior may be a sign of early-onset bipolar disorder; fortunately, this is highly treatable with medication."
E) "Your daughter's condition makes it difficult for her to focus and control impulses; there are very effective medications that can help improve her symptoms."