CASE HISTORY

David is a 13 year old boy who has recently been admitted to a juvenile detention facility in San Luis Obispo, California. Police reports indicate that he and another boy were arrested for breaking and entering into a private residence. He has also been charged with assaulting police officers at the time of the arrest.

David grew up in an upper middle class section of San Luis Obispo. David's father, Oliver, is a professor at a small college, and his mother, Sharon, is a dentist who works for a large health care group. David has an older sister, Sarah, who is 15 years old. Their family has had no prior contact with law enforcement agencies.

Even as a small child, David seemed unable to restrain himself. He would bound around the house, crashing into walls and objects, frequently breaking items or destroying house plants. These activities became more pronounced just after meals and when he was angry or disappointed. David seemed to require very little sleep, and he would quickly become bored with most activities. However, he would spend long hours playing computer games, and also enjoyed playing with the family dog, Jessie. David entered a period of low mood at the age of 11 when Jessie died.

David's parents say that David has always been an insecure child. David was slow to complete toilet training, and his parents admit that they gently teased him about his frequent "accidents" which continued until he was 8 or 9 years old. David seems unable to compete with his precocious older sister, who has been very successful both socially and academically. Although Sarah takes David's side in front of her parents, David reports that she teases him when they are alone.

Sharon took a leave of absence for the first three years of David's life. She then returned to work on a part-time basis and enrolled David in a high quality day care center. David seemed to thrive in this environment and would look forward to his twice weekly visits. Just before his fourth birthday, however, David grew ill and had to be withdrawn from the school for more than a month. Afterward, David seemed highly anxious about returning to the center. Indeed, each time he did go to the center, he was highly agitated; at the school's request, his parents withdrew him from the program. For the next year until he began school, Sharon and Oliver arranged their schedule so that one or the other of them was available to take care of him.

At the age of 6 years, David's parents enrolled him in a private Montessori school, and with the help of the school psychologist, David made a fairly smooth transition. David developed few friends at school; most children seemed put off by his high level of energy and incessant talking. In spite of his social isolation, however, David seemed to enjoy learning very much, and did well in school through the fourth grade. Testing indicated an IQ score of 126. He scores particularly high on verbal abilities, though much lower on mathematics.

Unfortunately, David did not get along with his fifth grade teacher, who was fairly inflexible in his approach. David's grades dropped dramatically, and since then, he has steadfastly refused to put forth an effort at school. About this time, David began stealing small amounts of money from his mother's purse. When his mother confronted him about it, he denied it. But afterward, he continued stealing the money and made little effort to conceal his actions.

David entered puberty at the age of 11, and at that time, his mischievous behaviors became more destructive. He frequently got in fights with classmates, and would verbally assault teachers. He was suspended from school for defacing the school walls with obscenities. David explained himself by telling his parents that he was unable to control his actions. In turn, his parents disciplined him by preventing him from playing with his computer games for a month. Separately, each parent admits to allowing David to occasionally play with the games during this punishment period.

In middle school, David began associating with the older boys in school. His parents suspect that he may have tried smoking cigarettes and may have experimented with sniffing glue. He was suspended from school for fighting in the lunch room and repeatedly threatening smaller children. He is frequently truant from school, and his parents have caught him sneaking out of the house late at night.

After his arrest for breaking and entering, David began to cry and told his parents that he felt badly for what he had done. He added that he was unable to control himself.

David is reluctantly undergoing psychiatric evaluation at the juvenile detention facility.

INTERVIEW WITH THE SUBJECT

Q: David, do you use any kinds of drugs?

A: No man, not at all. Drugs are not cool so I don't do 'em.

Sometimes I'll sniff glue, though. That stuff is the bomb. Do you like the smell of it? It makes me feel really good.

Q: Do you like school?

A: I don't like to read very much. It's just boring for me, and I get a headache.

I really like it when I have a project. Like last year, I had to organize a presentation on professional baseball. There were a whole bunch of us guys, and I had to organize the whole thing. It got kinda disorganized, but it was cool. I didn't let anybody in our group screw around either. Everybody had their thing to do and they all did it.

Q: Q:Do you like girls?

A: No. I mean, some of them are okay. Some of them are bitches, especially the pretty ones. I like girls who aren't prissy, they come out and can play in the soccer games. Those are the ones I like.

Q: Can you tell me a little about your fifth grade teacher?

A: Mr. Burke. Man, I got in bad fights with him. He was a cool guy but he kept pushing me and telling me that I needed to do better. We got in a big fight in the math lessons. He kept telling me that I wasn't trying hard enough, that I was so smart that the stuff should be easy for me. It wasn't, man. It wasn't at all. But he kept telling me that I should do better, and I got mad, and kinda sad too, when I kept getting things wrong.

I told everyone that I hated him, but that wasn't really it.

Q: What were you looking for when you broke into the house?

A: I don't know. Money I guess. Nothing really. I just wanted to mess stuff up. I like breaking stuff up. I did that a lot when I was a kid and it really pissed off my mom. I like seeing this really nice thing and then just tearing it apart.

Q: Do you know the difference between right and wrong?

A: [Long silence] I don't know. Wrong is the stuff you ain't supposed to do. That stuff that your parents get mad about. Right stuff is good stuff. Stuff that helps other people maybe . . . Right is all the boring stuff like reading or sitting quiet at church. Wrong stuff is the fun stuff. . . . That's a stupid question.

Q: What's the worst part about school?

A: Waitin' for stuff. I hate waitin' all the time. Like if I know the answer to a question, I hate waitin' for the teacher to call on me. Or in the cafeteria. Those old ladies who work there are really slow and I just get mad and jittery, you know? The school should have a better way to do things so that we don't have to spend so much time just sittin' around.

Q: Do you like your family?

A: They're all right. My sister is a pain in the ass. She is always lecturing me and telling me I'm weird. My Mom and Dad are okay. I know they're pretty mad at me, but they try to be nice to me mostly.

I really like Grandma Jones, though. She's a neat old lady. She said I'm just a growing boy and she lets me do anything I want. She's got this great jungle gym in her back yard, and I really have fun on it. One time I broke the legs on the slide, and Grandma cried about it. I don't break things at her house anymore.

Q: How do you feel about the other boys who are in the juvenile facility with you?

A: They're cool. Some of 'em are really tough. I mean they have been here a lot before and they know their way around. One of 'em says he killed an old lady. That's not cool. But another kid stole a car and then wrecked it. He says he does it all the time. That kid is cool. Some of the other kids here are are really scared and just want to go home.

Q: What can we do to help you, David?

A: Teach me how to do math!

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Related Links

http://mentalhelp.net/

Mental Health Net is a comprehensive site for information on psychopathology, providing more than 5000 links. After you have identified a potential diagnosis, use this powerful search engine to narrow your search to other relevant sites.

http://adhd.mentalhelp.net/

If you suspect that David may be suffering from ADHD, this site will be of interest to you. It provides a detailed description of the disorder and suggestions for treatment.

www.ldonline.org/

If you suspect that David may be suffering from a conduct disorder, this site will be of interest to you. It provides links to Web resources on behavior disorders.

www.hood.edu/seri/behavior.htm

If you suspect that David may be suffering from a conduct disorder, this site will be of interest to you. It provides a detailed description of the disorder and suggestions for treatment.

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ANALYSIS RESPONSE

In this phase of the activity, your task is to review all of your observations, and determine appropriate diagnoses.

In all real-world cases, the client expresses a wide range of symptoms, and as a result, it can be difficult to determine a diagnosis. Keep in mind that there is not necessarily a "correct" answer. The important thing is that you carefully review all of the clinical information and provide a compelling argument about why a particular diagnosis is appropriate.

After answering all of the questions, you can electronically mail your answers to your instructor.

Please provide one or more diagnoses for this case. Please include both the name and the DSM-IV category for your diagnosis(es).

Please describe the observations that support each diagnosis. Be sure to cite evidence (a) from the clinical file, (b) from your on-line research, and (c) from your textbook.

Please describe any clinical evidence that seems to be inconsistent with your diagnosis.