50 The Explosive ChildCASEYCasey was a six-year-old boy who lived with his parents
and younger sister. His parents reported that, at home,
Casey was very hyperactive, had difficulty playing by
himself (but wasn’t great at playing with other kids, ei-
ther), and had a lot of difficulty with transitions (getting
him to come indoors after playing outside was often a
major ordeal). His parents also reported that Casey
seemed to be quite bright, in that he had excellent mem-
ory for factual information, but that he became anxious
when presented with new tasks or situations and was fre-
quently in an irritable, agitated mood. The parents had
read a lot about ADHD; while they thought that this di-
agnosis fit Casey, they felt that many of his difficulties
fell outside the realm of this disorder. They thought the
term “control freak” fit their son better than any tradi-
tional diagnosis. Casey was quite restricted and rigid in
the clothes he was willing to wear and the food he was
willing to eat (he often complained that certain fabrics
were annoying to him and that many common foods
“smelled funny”). Most of these characteristics had been
present since Casey was a toddler.
His parents had previously consulted a psychologist,
who helped them establish a reward and punishment
program. The parents vigilantly implemented the pro-
gram but found that Casey’s hyperactivity, inflexibility,
and irritability were more potent than his clear desire to