Pathways and Triggers Brought to Life 53“Was that pretty typical?” the therapist asked the
parents.
“No, at home he’d have become a lot more frustrated,”
replied his mother. “He doesn’t usually hit us—although
he has hit kids at school—but he falls apart completely...
turns red, screams or cries, yells ‘I hate you!’ ”
“You know, in some ways his running out of the room
is adaptive,” the therapist commented.
“How’s that?” asked the father, a little surprised.
“Well, based on what you’ve told me, it seems pretty
clear that he has a lot of trouble thinking and talking
about his own behavior and tolerating the frustration he
feels when we ask him to do those things,” the therapist
said. “While we wish he would ‘use his words’ to discuss
things with us, his running out of the room probably
keeps him from doing other things—swearing, throwing
things, becoming physically threatening—that would be
a lot worse.”
“We can live with a lot of Casey’s behaviors,” said his
mother. “But his explosions ...and theway they disrupt
our entire family ...and our concern about what’s go-
ing to happen to him if we don’t help him...really
worry us.”
What were Casey’s pathways? So far, it seems reason-
able to hypothesize that difficulty shifting cognitive set
(executive), irritability (emotion regulation), discomfort
with new tasks or situations (cognitive flexibility), and
possibly social difficulties were setting the stage for his