Case Study Background Information

Adam was a slightly built eight-year-old boy with brown hair and dark eyes. Adam was interesting to converse with and stayed on-task for long periods during these one-on-one situations. When Adam was tired of an activity, he said so. Adam was referred to the ABLE program because of significant behavioral problems at school. During one week he was reported to have run away from the classroom; he pushed and shoved other children; he turned over desks, and called his teacher and the school principal profane names. Adam’s behavior problems had escalated to biting others, hitting a psychologist, and assaulting a teacher’s aid in the school. Adams was reported to fight often. At the time of intake into ABLE, Adam had been suspended from school for several weeks.

At home, Adam had temper tantrums centered on his older nephew, during which he threw things and became very negative and loud; also, Adam would “shut down.” Adam lived with his natural mother, his stepfather, an older aunt and his paternal grandmother.

At school, Adam had a change in teachers and was suspended on a safety issue involving threats to others. But Adam’s mother reported this new teacher seemed to get along with Adam better than earlier teachers did and that the teacher and Adam liked each other. Adam had fewer problems in the afternoons than in the mornings at school.

Generally, Adam had a history of impulsiveness, compulsiveness and of over-focusing. Adam appeared to always be self-stimulating, liked to put things together, was a good sleeper and had a good memory. He was a “sweet boy,” initiating the process of giving others whatever they wanted, as if to maintain a sense of control.

Adam’s history included his mother’s high-risk pregnancy and Adam’s premature, low-weight birth. He was in the hospital for almost a month due to serious respiratory complications and then was readmitted at one month of age for a viral infection from which he had residual wheezing problems. Adam’s mother reported using an herbal solution for him and found the process helped calm the boy. Adam’s mother and natural father separated during this time, which is within the important attachment-building time of Adam’s life. The parents unsuccessfully attempted to restore their relationship. Adam saw his natural father erratically and his father didn’t seem to be readily available to him when Adam was staying with his father and his stepmother.

Adam was bothered by seasonal allergies, but had no known food allergies. He was a fussy eater and had unique compulsions with eating. For example, if his spoon touched his plate, Adam needed a new spoon. Adam also had a germ phobia and a hand-washing ritual. His room was dirty and disorganized, though he had rituals about lining up his trucks and his closet had to be arranged in a certain way. Adam had considerable difficulty making choices.

In school, Adam had difficulty with handwriting but, with the exception of low math and writing skills, his academic profile was normal. Adam had been in a Title I reading program. He did well enough in math, and although behind, he was receiving no resource help. Adam did have an IEP for his behavior problems and got along with younger children better than older children. Adam was especially competitive with older boys. According to the school, Adam was quite close to his mother and Adam reported that people didn’t like him much, that’s why he was the way he was.

When examined, Adam was oriented to a sense of time and to the room he was in. And, when told he could have a book of his choice if he cooperated with the examiner, Adam appeared to like the idea. He was asked to draw pictures of his family and a house, for which he used multiple, colored markers and took a lot of time. Adam seemed to become bored easily. He said he was generally happy, and was happy with his parents. Adam seemed upset with his stepfather, a man who, he said, would yell at him, and he was kinder about his mom. He said his nephew, who was with them every other weekend, was favored by his father and was given special privileges.

Family history included dyslexia and attention-deficit problems, the mother was challenged in public schools herself. There was a family history of moodiness on the mother’s side and on the part of the stepfather. Caregivers were concerned about whether Adam might be depressed, and whether he was having mixed-attention problems with over-focused and under-focused styles. Adams behaviors suggested the autistic spectrum, anxious, and/or obsessive/compulsive traits.

Adam did know right and left. Showing inconsistent laterality, he was left-handed for some activities and right-handed for others.

Adam was quite likable. He had difficulty writing and his written words did not make sense. He was disorganized and had problems with copying-type tasks. But he drew a picture well.

Adam displayed no abnormal genetic features, his heart sounds were normal, as were his ears. His wheezing was not pronounced. His build was somewhat thin and high-toned. He was able to stand on one foot and had a normal gait. Adam’s teeth showed several cavities.

Adam had trouble catching a ball and threw a ball with difficulty, but seemed to kick the ball well.