Atypical Child Case Study

Joshua is eight years old and has been recognized to have mild mental retardation. He is learning at a slower rate than his peers and is routinely two grade levels behind in all subjects. On a daily basis, Joshua meets with a speech therapist and a mobility therapist. Twice daily, he receives behavioral medication administered by the school nurse.

Joshua did not speak until he was three years old, which put him behind developmentally as he entered preschool and kindergarten. Even through, the profile on Joshua did not explicitly state whether he was held back or not, it is not unreasonable to infer he spent two years in kindergarten to make up for his slow developmental growth. If this is the case, Joshua is probably in first grade.

He has not been given much of a fair shake in life. His parents are drug addicts and homeless. They both have been in state rehabilitation facilities. It is common for Joshua not to see or hear from his parents for months on end.

Ms. Ella, Josh’s 75-year-old grandmother, is his sole provider and guardian. She has limited financial resources being retired and living off state welfare.

At school, Joshua meets with speech and mobility therapists and takes behavioral medication twice daily. When not on his medicine, Joshua becomes easily irritable and will verbally and physically lash out at classmates. He often plays alone and has few friends.

On a positive note, Joshua is musically inclined. I can visualize him enjoying music centers and probably can listen to books on tape. He is very creative and produces quality grade appropriate art and drawings. Joshua excels using computers.

When I read the case profile of Joshua, I was immediately reminded of a couple of students I worked with while directing an after school program and substitute teaching in the Fayetteville School District. Mason was a slow learner from the minute he walked into Ms. Smith’s kindergarten classroom. He spoke in broken, half-annunciated sentences. “Ms. Bedah, I wan pay.” (Ms. Rebekah, I want to play.) His fine motor skills were uncoordinated, as he would show while writing letters or cutting with scissors. Mason liked books, but couldn’t read them. He enjoyed looking at the pictures. He could identify what the represented, though. When asked to recall a story the teacher had just read aloud, Mason had difficulty providing accurate details and usually replied with one-word answers.

Basic math, counting, symbols, addition were trying for Mason. Reading a non-digital clock was not possible for him. He knew when his speech therapy session was scheduled, but had little concept of when it was in relation to the rest of the school day. He would often ask, “Is it 12:30, yet?” even after having gone to the therapy session.

A primary difference between Mason and the fictional profile of Joshua is their behavior. Mason was fun-loving, never violent. He always ran around with a goofy smile on his face and loved to hug. He had little concept of his disability, though the next year when he repeated kindergarten, I noticed he became a little more frustrated with himself (yet, rarely with other students).

Mason lived in a two-parent, working class home with caring parents.

A better comparison to Joshua is a student I had daily contact with for about two years. I had Cody in my after-school program. He came from a broken home – his mother and father were divorced – and often stayed with his paternal grandparents, by all accounts a well-to-do couple. There were days when neither of his parents would pick him up by 6 p.m., so, the first call was to the grandmother who was prompt in signing Cody out of the program for the day.

He was small for his age, skinny and did not speak.

I observed him during the school day while substituting as a reading interventionist and he struggled with sounds and spelling. Cody’s writing was illegible. His math skills were limited and he read at a kindergarten level. He repeated the first grade.

Cody’s behavior deteriorated as the months went by. He became an angry, reclusive and possessive child. If he wanted a ball or a game, he often took it from another child and ran off. He sat in the corner of the gym while others played games. He refused to participate in most group activities and on more than one occasion he tried to run away from the playground.

Cody spoke of how he missed his father one spring, how he had gone “on vacation.” I later learned Cody’s father had abandoned his responsibilities as a parent and ran off to New Mexico where he was incarcerated. One day, Cody was excessively troubled. He was playing with Lego blocks by himself when another child, a girl, came to play as well. Cody became very angry, grabbed at her blocks and threw them at her, yelling. When I approached Cody, he ran into a corner and sat. I followed him to the corner, slowly, but he ran away into another corner. Needless to say, I wasn’t not going to play Cat-and-Mouse with a nine year old. I let him be as long as he didn’t hurt anyone else. About 20 minutes later, all 30 of our after-school children went outside to play on the playground. But Cody stayed in the corner. I again tried to approach him, but he ran off into an opposite corner. So, I laid on my stomach in the middle of the court begging him to go outside with everyone. After a 15-minute standoff, Cody ran outside.

Then, things got worse. After just a short time on the playground, Cody hit and yelled at another child. He screamed ferociously. Unprovoked, he ran after another child and hit her. I, again, attempted to talk to Cody, but he ran off, back into the school. I searched the gym, the downstairs hallways. I later found him in an upstairs hallway by the office. He let me talk to him, I forget about what, I offered to buy him a canned soda from the teacher’s lounge and we went back outside.

Cody again lashed out at a child, screaming and yelling. I apprehended Cody, holding him around the waist and placed him on my knee. He kicked at my shins, pounded his fists into my forearms and tried to bite me.

“I hate you! You are a piece of shit!” he yelled. “Fuck you.” The nine-year-old was laughing now, fiendishly.

“I’m sorry you feel that way, Cody. I don’t hate you. I like you. I want to be your friend,” I said calmly.

“Shut up! You’re stupid.” He laughed again.

I wasn’t holding him tight. I simply balanced him on my knee while not letting him get away. I feared he would run off, again. Or, hurt another child. I held him for an hour.

My staff called his grandmother, who later came and retrieved Cody. When she arrived, I let him go and he ran off back into the gym. He never returned to the after-school program.

About five months later, while directing a summer camp, I was monitoring my group of about 60 school-aged children when I felt a tap on my shoulder.

“Mr. Dustin,” said the voice.

I turned around and it was Cody, waving and smiling. The Devil had disappeared from his features. He was sitting with his summer camp group, talking with a couple of friends, calmly eating. He looked peaceful. His grandmother was there, too. We chatted. She said Cody was living with her and her husband exclusively and he had begun taking some behavioral medication. Cody had changed schools and was improving his reading. He had begun to talk more, curse less.

I saw Cody several more times that summer in the lunch hall and on various field trips where his summer camp and mine crossed paths. The new Cody was more consistently tempered, more playful, non-violent.

When I read the profile of Joshua, I couldn’t help but think of Cody. And, then, I realized that was four years ago. Cody is probably 13 now.

Wow.

I wonder how he has grown. I wonder if he is happy. I wonder…

 While there is much controversy surrounding the use of behavioral medication for ADHD and other issues, there is little doubt in my mind they work for the extremely troubled. Cody is such a case. For Joshua, when he is not on his medication, his temper flairs. He becomes angry, frustrated and violent. There is a lot going wrong in both Cody and Joshua’s lives. Their parents are lifeless shills. They are playing against a stacked deck of cards. So, any aid that will give them a chance at happiness, a normal, consistent day is welcome. But, it doesn’t begin or end with medication. An honest, providing role model, an understanding teacher, and, at Cody’s present age, a positive virtuous friend all can play influential roles. But, ultimately Cody and Joshua grow up. They are not so disabled they won’t be able to live on their own and provide for their basic needs. They will be independent adults one day. The medication only goes so far. Both boys must learn to make their own decisions and learn from the mistakes of those they trusted the most. This scares me when I think of Cody.

When will the Devil come back?

While medication won’t solve Cody or Joshua’s long-term problems, it gives them the stability to work on those problems in the present. They can focus more on their interventions and general classroom studies. They can calmly coexist with friends and adults. They can begin to form habits in a stable environment.

I wish them the best.