reviewcases - CASE: No Brakes Jeremy, age 9, is brought in...

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CASE: No Brakes Jeremy, age 9, is brought in by his mother to a mental health clinic because he has become increasingly disobedient and difficult to manage at school. Several events during the past month convinced his mother that she had to do something about his behavior. Several weeks ago he swore at his teacher and was suspended from school for 3 days. Last week he was reprimanded by the police for riding his bicycle in the street, something his mother had repeatedly cautioned him about. The next day he failed to use his pedal brakes and rode his bike into a store window, shattering it. He has not been caught in any more serious offenses, though once before he broke a window when he was riding his bike with a friend. Jeremy has been difficult to manage since nursery school. The problems have slowly escalated. Whenever he is without close supervision, he gets into trouble. He has been reprimanded at school for teasing and kicking other children, tripping them, and calling them names. He is described as bad- tempered and irritable, even though at times he seems to enjoy school. Often he appears to be deliberately trying to annoy other children, though he always claims that others have started the arguments. He does not become involved in serious fights, but does occasionally exchange a few blows with another child. Jeremy sometimes refuses to do what his two teachers tell him to do, and this year has been particularly difficult with the one who takes him in the afternoon for arithmetic, art, and science lessons. He gives many reasons why he should not have to do his work, and argues when told to do it. Many of the same problems were experienced last year when he had only one teacher. Despite this, his grades are good, and have been getting better over the course of the year, particularly in arithmetic and art, which are subjects taught by the teacher with whom he has the most difficulty. At home Jeremy’s behavior is quite variable. On some days he is defiant and rude to his mother, needing to be told to do everything several times before he will do it, though eventually he usually complies; on other days he is charming and volunteers to help; but his unhelpful days predominate. “The least little thing upsets him, and then he shouts and screams.” Jeremy is described as spiteful and mean with his younger brother Rickie; even when he is in a good mood he is unkind to him. Jeremy’s concentration is generally good, and he does not leave his work unfinished. His mother describes him as “on the go all the time,” but not restless. His teachers are concerned about his attitude, not about his restlessness. His mother also comments that he tells many minor lies, though when pressed, is truthful about important things. Differential Diagnosis:
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This note was uploaded on 05/20/2008 for the course PSYCH. 1 taught by Professor Chart during the Spring '08 term at Western University of Health Sciences.

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reviewcases - CASE: No Brakes Jeremy, age 9, is brought in...

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