Bethany, a 12-year-old black girl, arrives for her first visit at your office with her aunt, Cassandra. Cassandra is Bethany's legal guardian and is concerned that Bethany is failing school. Cassandra, who has raised Bethany from birth, tells you that Bethany was born 2 months early to a mother who abused drugs and alcohol during pregnancy. Although Bethany was a colicky infant who was difficult to feed, she had no major problems after birth and has been healthy except for a few early ear infections. She has since developed into a very social child with endless energy and is currently active with cheerleading. Bethany's talkativeness appeared in first grade and has been noted by every teacher since then. At age 6, she was unable to read simple words but subsequently made adequate progress on reading through elementary school. Although Bethany has never received evaluations or services through school, Cassandra has been helping significantly by structuring Bethany's approach to her schoolwork and by paying for private tutoring. Lately, Bethany has been very low about her academic performance, is having trouble falling asleep, and is difficult to arouse in the morning. Her appetite has been poor, although she insists that she is just not hungry. She denies any suicidal thoughts. Her grades had been average until last year when she began middle school and started failing. On physical examination, Bethany is at the 75th percentile for height, weight, and head circumference. Her vital signs, vision screening, and hearing screening are normal. She has no dysmorphic features, and her physical examination is normal. Bethany is articulate and answers your questions willingly.