Upon arrival at the office, you receive a telephone call from Mrs S. Over the weekend her normally "well-behaved" 14-year-old son Paul, together with a group of school friends, were found by the police at a construction site in the process of spray-painting nicknames, slogans, and "obscene language" on a newly built concrete wall. Several bottles of beer, cigarette papers, loose tobacco, and a small quantity of marijuana were found nearby. Although he began to cry when his parents arrived at the police station to arrange his release, Paul has been "uncommunicative and sullen" ever since, refusing even to attend school today. Paul and his parents must appear before the Juvenile Court in two days, and Mrs S. would like you, as Paul's pediatrician for 14 years, to "see what's wrong" with Paul before then.

Among the various options that you might initially choose, how would you decide whether or not to:

—refer Paul to a teenage drug rehabilitation program,

—arrange an adolescent psychiatric consultation for Paul because of his sudden change in behavior,

—have Paul come to see you at the office, to be followed by a meeting with his parents,

—reassure Mrs S. over the telephone that Paul is a normal healthy teenager,

—inform the school guidance counselor of the reason for Paul's absence and request information concerning his school performance and activities.

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