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christian counseling today
Vol. 20 no. 2
O
Ste ve Warren
Dave and Kim lie awake again tonight with fear and confusion about what to do with their eight-
year-old son, Sam. His second suspension from school could not have come at a worse time.
Dave has an important meeting out of town he cannot miss. After the last “blow-up” over his
report card, Sam nearly destroyed his room.
Dave and Kim feel hopeless.
acting
out or a
ticking
time
bomb?
One of the most referred cases a counselor will
face when working with children and adolescents
is known as disruptive behavior disorders. These
types of disorders can be very difficult to assess
because of normal developmental challenges
that children have, such as temper tantrums and
difficulty with transitions and emotional regula-
tion. Is this just normal developmental struggles,
or is there a clinical disorder lurking in the
background?
Take, for example, the instance above with
eight-year-old Sam. Both mom and dad work,
but dad’s job keeps him out of town during most
weeks, which adds stress for mom. Sam has an
older sister who is being treated for Attention
Deficit Hyperactivity Disorder (ADHD), and
an older brother, the middle child, who does
not currently have any symptoms. Mom also
had a complicated pregnancy with Sam—from
day one, he has had difficulty with hyperactivity
and impulsivity. He struggles with regulation,
including sleeping and eating patterns. Sam typi-
cally has trouble with calming down and often
has tantrums and gets frustrated when there is a
change of plans or an interruption of the normal
schedule. Whenever things do not go his way, he
is likely to explode, which has occurred both at
home and school. Sam has also been on medica-
tion for ADHD to help him focus and decrease
hyperactivity. His case is complex, but it is
useful to show the many elements of disruptive
disorders.
