Case Study: Daniel Age 14

Daniel has been in foster care for most of his life. He is now fourteen and has been with the same foster family for the last six years. His foster parents, Jean and Bill, find him extremely demanding and difficult to handle. They believe Daniel has a psychiatric or neurological disorder and want to find the correct diagnosis. However, they feel let down by Social Services, who do not support them in this quest. Jean and Bill have seen a number of programs on TV about Ausberger’s syndrome, autism, Tourette’s syndrome, Oppositional Defiance Disorder, Conduct Disorder, Attention Deficit Disorder, and Attention Deficit Hyperactivity Disorder. However, no medical practitioner with whom they consulted believed Daniel had any of these diagnostic categories. Eventually, they found a pediatrician who was willing to diagnose Daniel with ADHD and prescribe Ritalin. When the Ritalin did not make any difference, they became angry with the medical profession for not being able to recognize Daniel’s pathology.

Eventually, although reluctantly, they succumbed to pressure from Social Services to go to counseling. Jean said that she was not going to stay; she only came to be certain the therapist understood the truth of the situation. She spoke of their conviction of Daniel’s pathology, their anger at Social Services’ lack of support, and the medical profession’s reluctance to agree with them. Daniel, in this situation, was shy and withdrawn.

The therapist asked Daniel if he would be willing to talk on the phone the next time he had a bout of anger. He agreed. Later that day Bill called. Daniel had not been allowed to watch his favorite TV program before finishing his homework. He got angry and abusive, threw around some ornaments, and then went outside and began hacking down the garden with a big stick. To everyone’s surprise, when Bill asked Daniel, he came to the phone. At first he was just huffing and puffing. The therapist talked to Daniel quietly, gently asking him questions. Eventually, Daniel began giving “yes” or “no” answers and indicated that talking on the phone was helping him to calm down. He also said this was what he wanted to do. Over the space of an hour he was able to gain self control and begin an attempt to make amends for his destruction and abusiveness. As a result of this call and with Bill’s support, Daniel began to develop a list of people he knew. He wrote a letter inviting some of them to be part of a telephone support group that he could call on when he was afraid an outburst was threatening. In this way Daniel gradually began to experience support in regaining control over these outbursts.

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