Michael, 6 years old, was referred to the Early Childhood Disorders Clinic due to his verbally and physically aggressive behaviour at home and school, as well as non-compliance, anxiety, and perfectionist tendencies. Michael was a bright boy who needed constant attention from authority figures; this mode of relating to adults negatively affected his relationship with his peers. When Michael did not get his way or became overwhelmed, he would become verbally or physically aggressive.
Michael had supportive, involved parents, but his mother was dealing with her own anxiety. She struggled to contain her concerns over Michael’s lack of control when anxious, and she projected her fears of his regressing. The mother needed support to separate her own anxieties from her son’s. With support from the Transitional Care Team, Michael was able to maintain the gains he and his parents had made in treatment. Nevertheless, he continued to display an anxious, perfectionist style that might require further treatment in the future. In view of these ongoing challenges, one important role of the Transitional Care Team was to support the mother in encouraging him to separate and develop prosocial skills rather than regressing into a very dependent position.
Tommy: A 5-year-old boy, diagnosed with ADHD and ODD, reverted to his aggressive and defiant behaviour soon after discharge. He became unmanageable at his daycare and at home due to his physical outbursts. After a home visit with parents, it became noticeable that the child’s father was having difficulty assuming his authority. He would often give a double message when alternating between demanding that his son go to his room, and not intervening at all when the child was hitting his mother.
By exploring the father’s history, the Transitional Care Team learned that he respected defiance, and was subtly communicating that he enjoyed his son’s acting out. A very strict plan of authority, clear communication, and consequences and rewards was needed for home and school to keep the child contained.
Next case: IEPs
Rose and David Bloomfield Family Transitional Care Program 