A new patient, Antonio, aged 26 years, has been booked in to see you. When you enter the waiting room to greet him, Antonio appears as an overweight young man with long hair and a scrappy beard, wearing a death metal T-shirt, who is listening to and watching his iPad with earphones on. His mother, Anna, is with him, and she nudges Antonio to alert him that you have called him in. They enter the room together.

Simon, aged 11 years, is brought to your clinic by his mother. She is worried about him, as he has been having severe jerking movement of the neck and head. These movements started two weeks ago, but over the past few days they have become severe and frequent and are causing Simon considerable pain. He had similar head and neck jerks approximately a year ago, but they ceased after some months and were not this severe. While Simon’s mother gives you this history, you notice him shrugging his shoulder and clearing his throat repeatedly.

Nathan, aged 10 years, presents with his mother, Lisa, because of a reluctance to attend school. During the past fortnight, Nathan has missed four days of school because of nausea and ‘tummy aches’. These symptoms appear to self-resolve by mid-morning when Nathan remains home. At school, Nathan’s teachers note that he is quiet, rarely participates in class and has difficulties following instructions. Lisa describes Nathan as a ‘worrier’ who often gets lost in his own thoughts. Nathan tells you he ‘hates school’ because it makes him feel ‘dumber than the other kids’.

Fleur, aged six years, is the eldest of three children. She is brought to see you by her mother, who tells you Fleur started having tantrums at the age of two years. The tantrums have worsened, and Fleur now has 1–2 tantrums most days and up to 10 on a ‘bad’ day. She is bossy towards her younger brothers.

Wony brings her son Hajoon (aged 2 years, 10 months) to your surgery because she thinks he has a sore ear. She reports Hajoon is generally a well child but started pulling at his right ear last week. He is having difficulty sleeping and is more irritable than usual, regularly throwing temper tantrums. Wony is also worried about Hajoon’s hearing because he does not respond when she calls his name, and he does not say any words yet. Wony speaks English fluently but her first language is Korean, and the family only speak Korean at home. Hajoon has attended childcare three days per week for a year.