54 The Explosive Childexplosions. Whether Casey’s difficulty talking about his
problems reflected lagging language processing skills
wasn’t yet clear. In terms of triggers, sensory hypersensi-
tivities certainly seemed to be coming into play.
Thus, the initial goal was to achieve greater certainty
on Casey’s pathways (so as to identify skills that he
needed to learn) and to develop a comprehensive list of
triggers (in order to identify the specific problems that
needed to be solved). Whether medications for reducing
hyperactivity and impulsivity and reducing irritability
might be necessary wasn’t yet certain.
HELENHelen and her mother and father first sought help for her
explosions when she was seven years old. Helen was de-
scribed as a charming, sensitive, creative, energetic, socia-
ble girl. Her parents also described her as intense, easily
angered, argumentative, resistant, and downright nasty
when frustrated. They had observed that Helen seemed
to have a lot of trouble making the transition from one
activity to another and tended to fall apart when things
didn’t go exactly as she had anticipated. They reported
that weekends were especially difficult; although Helen
didn’t love going to school, she became bored during un-
structured weekend time and became very difficult to