Background
Jeremy, a ten-year-old boy in the fourth grade, had been diagnosed at age six as learning disabled and suffering from attention deficit hyperactivity disorder (ADHD), and he had already been retained once. As a labeled special education child, he had spent part of every day of his first four school years in the elementary school learning center. In addition, he had been given a mild dose of Ritalin (7.5 milligrams daily) for four years on the advice of a pediatric neurologist whom the parents and school personnel considered an "expert." Jeremy had also been provided with summer tutoring by the learning center teacher, individual in-school counseling by the school psychologist, and language therapy by the speech therapist who, in addition to language work, initiated a behavior modification program for his poor social behavior. The learning center teacher had had literally hundreds of consultations with the mother over the years, and the mother had seen two or three psychiatrists, who had all prescribed antidepressant medications for her. While the idea of marriage counseling had been discussed in the mother's therapy, few marital sessions had taken place, reportedly because her husband was resistive.
After all these attempts at helping young Jeremy over four years, in literally thousands of hours of formal and informal efforts by home and school, Jeremy was unimproved and perhaps worse. At the beginning of his fifth year at the elementary school the school decided to refer Jeremy and his family to the family-school collaboration program. What follows is a list of school complaints, or "presenting concerns," regarding Jeremy that appeared on the referral form used by the collaboration program:
Assessment and Intervention
Because of the many previous efforts with Jeremy, the case was referred immediately for collaborative team intervention. The first collaborative team meeting with Jeremy and his family was attended by ten people: Jeremy, his father and mother, his regular teacher, his learning center teacher, his language teacher, the school psychologist (who set up the meeting), the school nurse, the school principal, and the ecosystems consultant. Jeremy's tenth-grade sister was out of town and could not attend the session. The meeting began with everyone describing the problem, which was stated in much the same terms as were listed on the referral form. There were several differences, however, from previous intervention formats:
1. Jeremy was present to hear everyone discussing him together. This format conveys respect for the child's ability to handle information about himself that is sometimes withheld from so-called handicapped children.
2. Jeremy was asked his opinion and invited to interact with staff members and parents regarding diagnosis and solution. This conveyed an expectation of involvement and an attitude of respect to him.
3. The open forum allowed everyone to hear all opinions and permitted all present to interact. In this collaborative environment, new and different information about Jeremy had a greater chance of being noticed than it would in one-to-one or smaller group interactions. Also, information that might have been given only to some could become public knowledge, for everyone to hear. By virtue of the number and importance of the people present, and the sad story of adult ineffectiveness and student failure that emerged, a strong need developed to solve the problem fast. It was possible for individuals to deny the problem one at a time, to get discouraged, and procrastinate; but with everyone present, extra pressure was generated on participants to finally help the child. If nothing else, failure was embarrassing.
4. Through the introduction of a competent ecosystems consultant, group interactions were skillfully orchestrated, and new ideas and methods were introduced.
The following actions were taken during the collaborative team intervention with Jeremy:
1. The use of Ritalin was discontinued. 2. Jeremy was allowed to earn more time in the regular classroom. 3. Jeremy was defined as "unhandicapped" and "just as good as his smart sister." This redefinition was crucial not only for Jeremy but for everyone else present. 4. Jeremy was asked to help develop and approve the plan for his success. Jeremy was asked to stop his temper tantrums immediately, conveying a belief in his ability to control himself. 5. Unpleasant consequences were prescribed if the tantrums continued, mainly having to spend "boring" time flat on his bed. 6. A "circle" meeting was arranged to discuss Jeremy's social problems and to find solutions to them. This meeting was held in Jeremy's mainstream classroom and was attended by Jeremy, his family, school staff, and Jeremy's regular classmates. 7. School staff continued to view the problem as motivational and focused on cooperating with Jeremy's parents to motivate Jeremy to do his work.
Results
In the case of Jeremy, the results were good. Jeremy did discontinue the use of Ritalin and felt much better. On the ball field, he said he could "see the ball again," and hit a grand-slam home run soon after stopping use of the medication. Jeremy's father, especially, was happy, since he never liked the idea, or the slightly immobilizing effect, of the medication. Jeremy's "circle" meeting was extremely successful, leading to better relations with his peers, more control for Jeremy, and new willingness to come to the teacher in case of conflict. Jeremy continued to have some problems staying on task, but there were signs of improvement, and because of his behavioral improvement, the school staff was more hopeful that academic progress would continue.
Jeremy's mother and father began marital therapy with the school consultant. The mother discontinued individual therapy with the psychiatrist, as well as the use of her antidepressant medication. The father gradually began to moderate his view that his wife was the main, or the only, problem, and to put more effort into pleasing her. The mother began to moderate her demandingness and to give her husband "the benefit of the doubt." The parents were both very happy with Jeremy's behavior, and the father began to help him every night with his reading. The school staff was extremely pleased with the intervention because for the first time in four years they felt in control of the problem and confident they were making progress.
Discussion
Reframing "neurological" child problems as motivational often helps to solve problems that are not primarily neurologically based. Most child problems are primarily of a motivational, not a biological or neurological, nature and are maintained by adult ignorance or dysfunctional relationships. In the case of Jeremy, reframing the problem as motivational allowed all those involved, including the child, to see the problem from a different perspective, which made it solvable. The school is an ideal site for the initiation and implementation of this reframing process. Jeremy's mother returned to therapy periodically to work on her self-esteem, and for six months for family therapy involving a niece whom she took in as a boarder. Jeremy's father joined a men's group. In a report three years following the collaborative team intervention, Jeremy was very happy and successful, socially and academically.
Reprinted with permission from "School-Based Collaboration With Families" by Dr. J.B. O'Callaghan, Jossey-Bass Publishers,1993.
More case studies:
Greg | Melanie | Jared | Samantha | Jeremy | Marie | Linda | Michael | Jonathan
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