Interview With a Child Bill is a 12-year-old child, Caucasian, ethnicity unknown. He is the only son of Sandra and Dave, who are divorced. They separated when Bill was 9. He currently lives with Sandra in their home. Dave moved to a different city and is rarely seen by Bill.

Sandra is very protective of Bill. She homeschooled him for two years after she and Dave separated, but now she feels that Bill may need some sort of outside stimulation. He is often withdrawn and uncommunicative and she fears he may be depressed or suffering from autism.

Bill has always been sensitive to sounds and to touch. He did not begin speaking until he was almost 3 years old and then he had to take speech lessons. When he was 10, he told his psychiatrist that he hated his parents because they fought all the time and that they hated each other too.

Bill is very talented when it comes to processing data. He is exceptional at chess (which is why Sandra has enrolled him in a local chess club at one of the local schools, though she also wants him to interact with other boys his own age who share his interests). But Bill is not very socially inclined. He is not sure that he likes the chess club. He also enjoys acting and when he was younger he took great pleasure in mimicking actors on television or his parents and he could go from serious acting to comedy in a matter of seconds without missing a beat.

Bill did well in school until his parents began to fight constantly in the two years leading up to their separation. Bill's grades declined sharply and he seemed apathetic about his schoolwork. No matter how hard his parents pressed, they could not get him try harder. This is part of the reason Sandra decided to home school. The other part is that she is afraid for Bill's safety and does not trust that schools can protect her son.

One of Bill's psychological strengths is his sense of humor. He is keen on good jokes and his father Dave always sensed this. One of Bill's weaknesses is that he does not know how to socialize. He has broken down on occasion at the thought of having to leave his comfort zone and go outside of his room or his home. Sometimes Sandra can get him to attend the chess club, but other times she cannot. He has no friendships with boys his own age. His mother has shielded him from others. He prefers his computer and does not seem to mind that he has no friends, although he does seem lonely and dejected at times. Bill is intelligent but has shown signs of mood disorder and his doctor has suggested he be treated for a possible Asperger's syndrome. Bill refused to comply with his parents' wish that he receive treatment and his parents relented. Bill spends his time reading on the Internet and has a fascination with macabre stories (such as stories about serial killers). He has a home, but only an over-protective mother to look after him. Bill displays his humor at random intervals: it is sharp, witty and intelligent. But it can disappear as quickly as it appears. Bill returns to his typical, sulky display of disaffection and cynicism towards life.

Bill will throw violent tantrums from time to time in which he cries hysterically and thrashes about for fear of leaving the house and being in public. He often refuses to leave the house for days at a time and his mother can only coax him out nowadays by coming up with some new incentive.

Bill has been diagnosed as having Aspberger's (diagnosis was given at age 11 but Bill did not accept the diagnosis). Bill could have a co-morbidity or a differential diagnosis of being clinically depressed. This evaluation is based on the observance of extended periods and consistency of signs of anger, social withdrawal, sadness, difficulty concentrating on schoolwork, low energy, feelings of self-loathing, and obsession with thoughts of death. The stimulus for this depression it is believed is the disruption in his family life, which served as an adverse childhood event that has caused a trigger in Bill's mood (Upthegrove et al., 2015). It is also based on comments made by school administrators and of the observations of others (such as the coach of the chess club) and Bill's parents: Bill is described as having anti-social actions, and in his school writing when he writes short stories, Bill would use violent imagery to depict murders and bloodletting. His teachers in the past have expressed concern about Bill's interest in graphic imagery and in violence in his writings and these observations, coupled with Bill's extreme withdrawnness suggests that Bill is harboring something unhealthy in his psyche that needs to be resolved as soon as possible before it boils over into more negative and harmful activity.

His mother is too protective but is finding herself at her wit's end and does not know what to do with Bill. Recently she has been struggling to engage him in extra-curricular activities. She thought it would be a good idea to take him to the shooting range since he has an interest in guns. This is probably not the best choice for Bill at this time as it could fuel his interest in violence and lead to dangerous conflict especially if Bill has access to weapons in the house.
Recommendations for Bill are to enroll him in a special needs school so that he can be more adequately assessed, monitored and instructed; especially as his mother is finding it more and more difficult to maintain any sort of control over Bill. I would recommend a CSE process.

Recommendations for Bill could include cognitive behavior therapy (McKay et al., 2015) or family therapy in which both parents engage with Bill and a counselor in resolving deeper, underlying issues that are added stress to Bill's psyche. It appears that Bill has been deeply affected by his parent's troubled relationship and family therapy could be a good way to resolve these issues. It would be a good thing for Bill to have more of a fatherly influence in his life even if this does seem forced or arbitrary at the start. Bill is in a critical stage of development that could quickly deteriorate or veer off into more unhealthy behavior if it is not handled appropriately soon.

CBT would also be a good form of therapy as it could address issues for Bill directly and allow him to establish and pursue goals for himself that would be geared towards healthier and more productive behavior. Bill obviously has special needs and activities that he is good at should be encouraged: he could be supported in taking acting classes or anything where he is permitted to interact with others by way of getting around the wall of privacy he has built up for himself. Acting could be a good way to introduce this concept, as it allows him to "be" someone else and it could be viewed as a method of easing Bill into more and more social situations. However, it could be too late for this method to work at the beginning, especially if Bill is not responsive to the idea. The goal of CBT would be to simply align positive goals with action (Beck, 2011) and thus to stave off any harmful developments in Bill's life.

Advice for Bill and his teachers in the future is to take special note of Bill's childhood disturbance and to empathize with his impulses and to view him not as irregular but as one whose feelings are legitimate and justified (Rogers, 2012). Once he feels that he is understood and accepted, great strides could be made in helping Bill to develop more fully as a person.

References

Beck, J. (2011). Cognitive Behavior Therapy: Basics and Beyond. NY: Guilford Press.

McKay, D. et al. (2015). Efficacy of cognitive-behavioral therapy for obsessive-

compulsive disorder. Psychiatry Research, 225(3): 236-246.

Rogers, C. (2012). On Becoming a Person: A Therapist's View of Psychotherapy. NY: Houghton Mifflin.

Upthegrove, R., Chard, C., Jones, L., Gordon-Smith, K. et al. (2015). Adverse childhood events and psychosis in bipolar affective disorder. British Journal of Psychiatry, 206(3): 191-197.

Diagnostic Information:

• Age/grade for 1st evaluation

• Any additional evaluations

• Diagnosis/co morbidity

• Nature of the disability/etiology • Family history

• Recommendations for home/school • CSE process

• Explanation of the findings

• Sharing results with the child and family

Remediation/Intervention:

• Support in school

• Support outside of school

• Reactions of teachers

• School placement/setting • Communication with school

• Experiences with accommodations, tests, homework, assignments, class behavior

• IEP Process

• Areas for inclusion

• Assistive technology

Advice/Reflections:

• Advice for teachers, parents, school personnel

• Specific information that has been helpful/hurtful

• How might you help other families

• Wishes and predictions for the future

*The paper should not be in a question/answer format but rather a narrative, story telling…