Chapter 1. Test1

Introduction

Written by Elaine Cassel, J. D., M. A.

Lord Fairfax Community College

(c) 2013 Worth Publishers (Photo Credit: John Knill / Getty Images)

1.1 Presenting Complaint

Elizabeth talked to her friend and co-worker Courtney, about the problems she had been having with her six-year-old son, Eric, who was an only child.

"I am worried about Eric. He seems to be getting more and more disobedient. His first-grade teacher called me in for a conference last week and said that she had to send him to the principal's office twice the week before for refusing to do what she told him to do. He is argumentative and stubborn."

"How does he act at home?" Courtney asked.

"Well, it has been hard to get him to do his chores lately, and he complains and whines when I try to get him to read. His teacher wants him to read more at home because he seems to be slow to catch on to reading."

"Any other problems at home?" Courtney asked.

"Now that you mentioned it, we have a battle every night about taking a bath and going to bed. In fact, it seems like it’s getting to be more and more of a struggle. I have given in to bribing him with an extra dessert before he goes to bed. That seems to work."

"Have you seen him act out with any other adults?"

"Not that I can think of," Elizabeth replied. "But wait. Now that you mentioned it, I did see him talking back to his soccer coach at Saturday's game, and I had never seen him do that before. The coach put him on the sidelines for three minutes."

"Sounds to me like he is just spoiled, which is not surprising since he is your only child. I am sure he will grow out of it," said Courtney, trying to allay Elizabeth's concerns.

"Maybe so. I guess Dan and I need to read some of those parenting books."

Six weeks later, Eric's teacher, Donna, asked Elizabeth and Dan, Eric's dad, to come in for another meeting. She expressed her concern about Eric's continuing behavior problems and a new twist they had taken. Eric was struggling more and more to pay attention in class. He was daydreaming, fidgeting, and annoying other students instead of doing his assignments. When his teacher tried to get him back on task, he talked back to her, blaming other children for disturbing him. Donna had recently caught him crumpling up another student's drawing. When Donna asked him why he did it, he said the girl "deserved it" for not letting him borrow her glitter pen. Donna asked if Elizabeth and Dan had seen an escalation of symptoms at home.

Dan immediately spoke up. "Yes, we have. And most of it has to do with Elizabeth spoiling the kid. His soccer coach dropped him from the team because he spent practices fooling around instead of doing drills. The final straw was when he was playing goalie and refused to stay in the box and pay attention to the game. Get this—he drew pictures in the dirt or jumped up and down. It was a disgrace. I got so angry I had to leave the game. And don’t even get me started about Eric's behavior in the house. Six years old and he already has a chip on his shoulder. Of course he knows better than to argue with me, because I will let him have it—a good hard smack on the behind shuts him up. But you ought to hear him and Elizabeth go at it! You would think Elizabeth was his older sister by the way they constantly argue. I’m sorry, but I think this is her fault for treating him like her brother instead of her son."

"Blame me, if it makes you happy, Dan. Everything is always my fault. If you spent more time with Eric and treated him with respect instead of like a drill sergeant he would not be rebelling. His soccer coach is just like you. Eric is just a kid, for heaven's sake. He is not made to sit still in a classroom or stand in one place for a stupid soccer game."

Donna saw she needed to get Dan and Elizabeth focused back on Eric's problems and not their interpersonal issues. "I think this problem is beyond spoiling," she said. "I think that Eric is exhibiting signs of ADHD. His behaviors fit several of the warning signs. We can refer him to the school psychologist for testing and see if he thinks there is a problem with attention."

"Oh, great," Dan said. "Now you want to drug this spoiled kid instead of making him behave himself?" Dan was referring, of course, to prescribing Ritalin for children with attention deficit-hyperactivity disorder.

"There is a lot more to treating ADHD, if that is what Eric has, than taking medication, Dan. But we are getting ahead of ourselves. Eric needs a full assessment first. Will you both agree to that?"

"I'll agree to anything if it will help Eric get back to being the sweet boy he was before he started school," Elizabeth said sadly.

"I'll agree to only an assessment, but not to having any shrink telling me how to raise my kid," Dan said defiantly.

"I'll get the consent forms for the psychological evaluation and be right back," said Donna. As she left, she heard Eric's parents begin to bicker again.

"Poor Eric," Donna said to herself. "I wonder how much his parents' battles have to do with his own problems. Let's hope the psychological evaluation gives us some clues."

1.2 Social/Family History

Eric was diagnosed with both ADHD and ODD. He is now 10 years old and in the fifth grade. He began taking Ritalin while still in Donna's class. He has continued taking the medication, off and on, for the past four years. His schoolwork did not improve, though he was quieter. He was just as defiant at home.

Now he has a new reputation—the class bully. He is known as a mean kid who will go out of his way to hurt other boys in the class. His fights have led to suspensions from school, which means that Elizabeth has to take off from work to stay home with him. Elizabeth has given up—she has lost control over Eric's behavior. Dan has only gotten angrier and stricter. Eric spends a lot of time grounded in his room.

Last week Eric took Dan's cigarette lighter and set fire to papers in the trashcan in his room. Fortunately, the smoke detector went off and Elizabeth and Dan were in the kitchen. Dan was so angry that he ended up back-handing Eric in the face. Elizabeth took Eric and went to her mother's for the rest of the day.

Things reached a new low today. Elizabeth got a call from the principal to come to school. She had called the police because Eric pulled out a knife during recess and cut another student on the arm. The child had to be taken to the emergency room because the cut was so deep it required stitches. The principal advised Elizabeth that she better call Dan, too. She is sure that the police will file a charge against Eric.

1.3 Multiple-Choice Questions