Decision making about children with psychotic symptoms: using the best evidence in choosing a treatment.

A school guidance counselor contacts your office worried about an ll-year-old boy, Peter, initially referred to her for declining school performance. Along with the counselor you meet with the child and his sole parent, Susan, who is a 34-year-old parttime nursery school teacher. Throughout the interview, Peter appears perplexed and frightened and is extremely evasive, giving monosyllabic answers to nearly all questions. His mother tells you he had rather late developmental milestones and little interest in his peers, but was managing at a mainstream school with support until a year ago, when he began to complain that the children were "really out to get me," and at times would appear terrified when left at the school gates. Twice during the past month, he has claimed that he heard a group of"bad boys" screaming insults at him, although the mother was certain there was no one else present. Despite these changes in Peter, his mother does not feel he has been unusually sad, and although he lacks drive, he stills retains some of his interest in computer games and has been sleeping and eating well. He is in good health and recently had a normal physical examination by a pediatrician. In addition, the mother gives a history