Sunday, November 11, 2012

CAN YOU IDENTIFY ANY OF THESE CHILDREN FROM THEIR "REFERRAL" CASE NOTES?


I found them on an American website and tweaked a bit.
Makes you wonder to what extent Attachment disorders and other conditions were known and understood by story-tellers way before psychologists came along.

Answers at the bottom.


Case 1

Diagnosis: Adolescent narcissism: 
P’s grandiose ways and lack of care and empathy make him a danger to himself and to others.
Physical presentation: P appears healthy, although he is small. It is difficult to judge his age from his appearance.
Diet: There is evidence of an eating disorder. P can eat if it is part of a game, but not just to “feel full”. We believe this eating disorder, like many, can stem from a desire to avoid growing up.
Family background: P was born in London. Little is known of his parents. He ran away from home having overheard his parents discussing his future. This distressed P greatly since he felt threatened by change.
Social Worker notes:  P is unwilling to grow up and take on age-appropriate responsibilities. However he wants total control. He refused to tell a female friend W his age when asked, suggesting that he feels uncomfortable confronting the whole issue of maturation. 


He also finds it difficult to admit that he might have any weakness. When W met him for the first time, sobbing, he denied that he had been crying, soon persuading himself that he had never cried. P uses “splitting” – dealing with emotional conflict by seeing things either as all good or all bad and not recognising the grey areas in between – as a defence mechanism. 

On meeting W, for example, he declared that mothers are “very overrated” and that he had “not the slightest desire to have one”, although his vulnerability was all too apparent. While denying his need for a mother, he appears on a deeper level to realise he and his male friends need some kind of nurturing relationship, one that traditionally a mother would provide. He manipulates W into playing this role by suggesting that girls “are much too clever to fall out of their prams” and that “one girl is more use than 20 boys”. It is interesting to note that in making such comments he was appealing to her vanity – a trait that is strong in him – to persuade her to be compliant. P requires a lot of attention and is easily bored, causing those around him to become exhausted by his demands. Evidence suggests that when P is not present, everyday life functions much more normally. P dislikes routine and can be quite contrary; something he would find amusing one day becomes tedious the next. This is common in individuals with destructive narcissistic traits. It leaves those around him feeling confused, as what will please him one day may enrage him the next. 

P did once attempt to return to his family home, but found the window locked and barred and a boy in his place. While he doesn’t admit it, it’s likely he found this very hurtful. Often, when there are strong narcissistic traits in a person, there has been a disturbance in their early care.

Case 2

Diagnosis: Attention deficit hyperactive disorder: 
T’s continual hyperactivity and irresponsible attitude cause problems for him and those with whom he lives, as well as those he interacts with in the wider community.
Physical presentation: Rarely sits still. He’s always running, climbing, or fidgeting.
Diet: T has settled on extract of malt as his food of choice. While this particular substance is unlikely to exacerbate his condition, a more balanced diet would almost certainly benefit him and perhaps contribute to an improvement in his behaviour.
Family background: No information is available on T’s life before his arrival at acquaintance P’s house. Nothing is known of his previous address or his family of origin, although it has been said that he is an only.
Social Worker notes: T’s arrival at P’s house in the middle of the night is evidence of his inability to control his impulses. A less disordered individual would have known that it is more appropriate to visit people during the day. Impulsive behaviour, interrupting and intruding are at the heart of T’s problems. Soon after their first meeting, for example, T suddenly interrupted P, climbed on to the table, wrapped himself in his host’s tablecloth and brought everything crashing to the floor. When questioned by P about his behaviour, rather than accepting responsibility for his actions, T accused the tablecloth of trying to bite him. T makes bold statements, such as declaring that he is only bouncy before breakfast. He proclaims impulsively that whatever food he is offered is what T likes best, then gulps down large mouthfuls of the food in question, only to find he dislikes it very much. More evidence of T’s recklessness and poor impulse control is displayed by his belief that he can do anything. He has no sense of fear or responsibility. This was apparent when he climbed up a high tree with R on his back before he had ascertained whether he was able to climb a tree in the first place. Inevitably, they then got stuck when he realised he had no idea of how to get down. On one occasion, T grabbed R’s medication  from K, which he proceeded to swallow, almost devouring the spoon as well. Obviously the medicine might have proved dangerous to him. T never learns from his mishaps, bouncing back almost immediately after a frightening and potentially hazardous incident. As a result, T’s behaviour causes concern to those around him. Living with someone suffering from ADHD can be trying. Perhaps this is why R suggested the rather extreme measure of taking T into the forest and losing him in the mist. R and his friends believed the shock of being lost might cause T to calm down a little on his return, a strategy that backfired, however.

Case 3

Diagnosis: Attachment issue generated antisocial personality traits: 
G behaves in a reckless and destructive way that violates the rights of others.
Physical presentation: G appears physically healthy. Her most notable feature is her long, blonde hair, worn in ringlets and neatly tied with ribbons.
Diet: Other than an obsessive concern about the temperature of her food, nothing else is known of her dietary needs.
Family background: There is little information on G’s background, although evidence points to a family unit within a widespread rural community in which the younger members have considerable freedom to roam.
Social Worker notes. G behaves in a selfish and reckless manner. She shows a disregard for the law and refuses to face the consequences of her actions. For example, she broke into the secluded woodland home of a family, ate their food, although there is no evidence that she’s denied sustenance at home, broke their furniture and tried out their beds. In doing so she was guilty of trespassing, theft and vandalism. Such disregard for other people’s property indicates that G lacks empathy. She treated the  house as if it were her own and when she broke a chair – even one clearly designed for a child and therefore likely to cause greater distress if it were damaged – she made no attempt to repair it but simply moved on to wreak further havoc in the upper floor of the house. This insensitivity towards others is also evidenced by the way she then tried out all the beds, a particularly gross invasion of the owner's privacy. G will not acknowledge quite how violating her actions were. Moreover, not only was the act of “violation” committed once in each case but repeated, seemingly out of a sense of perfectionism that something should be neither too hot nor too cold, neither too hard nor too soft, but “just right”. On finding that the youngest child's bed met her criteria, G fell asleep in it, demonstrating a remarkable ability to relax in circumstances that most people would have found intensely stressful, as the owners could have returned at any minute. It also provides further evidence of her lack of concern for the family’s feelings. When the owners finally appeared, she didn’t stay to explain her actions or apologise for her behaviour. Instead, rather than facing their possible anger and any punishment that might follow, she ran away.


Answers below and upside down








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