Brian Smith is a 4-year-old who resides with his mother, father, and younger brother Luke in a four-bedroom home in a comfortable suburban neighborhood. Brian’s father is a civil engineer and his mother is a dietitian. As a newborn, Brian was described as a “fussy” baby who did not enjoy being held by others, including his parents. As he grew, Brian’s parents coped by minimizing their interactions with him, often encouraging him to play by himself. Although he is able to talk, he prefers to express his needs by grunting and mumbling. His pediatrician has recommended speech therapy to encourage him to use a greater vocabulary on a regular basis, Brian’s parents are hesitant to “label him” as a “special needs child” at this young age and have declined any intervention at this time.
Brian has had four different childcare providers since he was six months old. For the past year, he and Luke have spent weekdays with their childcare provider, Tracy, who cares for three additional children under age seven, two of whom frequently wrestle, throw food and hit each other during the day. Last year, Brian’s parents decided to enroll him in a pre-school program five days per week. Brian attended exactly two weeks before his parents were contacted over concern that he was constantly hitting others and throwing toys. Rather than work with the pre-school, Brian’s mother decided to return him to Tracy’s house, explaining that the pre-school did not understand the energy level of boys. Tracy describes Brian as exasperating but has been reluctant to discuss her concerns with the Smiths, for fear that they will remove Brian and Luke from her care, and she needs the money.
In addition to his preschool classmates, Brian has been aggressive with his now 2-year-old brother Luke since Luke was an infant. For example, he has hit Luke, smashed toys over his head, and recently ran Luke over with his tricycle. Brian’s father has become increasingly frustrated as he struggles to communicate with his son. He responds to Brian by yelling and demanding that Brian speak clearly. Interactions with his father often result in Brian screeching, biting his own arm, or throwing objects. Brian’s mother attributes much of Brian’s behavior to being a “toddler boy.” She disciplines him by attempting to explain the reasons his behavior is “not nice.” Brian’s father has begun implementing time-outs as a means of discipline.
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