DM is an 8-year-old boy who presents today with his mother for a psychiatric evaluation. The Patient was referred by PCP as current meds do not manage his ADHD symptoms. Per the mother, the patient continues to have difficulty sitting still, struggles with homework, gets easily frustrated, yells and screams at home, and can be very dysregulated. Patient was started on Guanfacine and Vyvanse by primary care. According to the mother, the patient is very sensitive to meds. His vyvanse was decreased to 10 mg from 20 mg due to an increase in anxiety and crying episodes. The patient reported hearing voices from random people telling him “bad stuff and other stuff,” telling him to do his homework, and “one guy is Dave.” he reported being touched by someone while his mom and dad were sleeping. He said that the whole world has voices. He fears the voices, but sometimes, he is okay with it. Patient also reported that “there was a girl in the office” during this visit who walked out the door and also reported he saw “ghosts”. Mom also reported that the patient is talking to himself but never reported hearing voices and seeing things to them.