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- Mar 11, 2006
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Wondering if any child psychologists or those in training can help me with this case: 6 years and two months old caucasian girl. Intact family, mom 38, dad 44, brother 3.5 yrs. Very wealthy family. Identified as jewish, child is enrolled in a pvt jewish school. Childs developmental and psych hx unremarkable thus far but medically she suffers from anal fissures and constipation. Child has had multiple caregivers since birth (baby nurse, day nanny, night nanny, weekend nanny) currently there are only two of three nannies who have been with the family for any significant length of time (longest is day nanny about 5 yrs, night nanny was brothers baby nurse so 3.5 yrs). Unclear whether child was breastfed. Child currently exhibits interpersonal difficulties. Very parentified and bossy toward brother and bossy with peers. Extreme difficulty accepting any limits -- often can not tolerate "no". Manipulative and negotiates to get what she wants. Makes statements to adults such as "I hate you, I will have you fired, you are a mean bad person" etc etc. Child hits and punches family members and peers seemingly at random and during "play" but also occassionally when she doesn't get her way (though she usually "pouts, whines, cries, negotiates" until the exhausted adult party acquiesces to whatever is being demanded). Presence of nocturnal enuresis almost every night but usually at least three nights/week -- sleeps with a pull up which she and parents call her "diaper" -- unclear whether nocturnal control was ever acheived. Nightmares several times per month about "mean adults that leave her alone or punish her". Often viewed as "rude and defiant". Parents seem superficially involved but have limited face to face contact -- mother seems particularly indulgent (presents are given out constantly as "rewards" for being sick, or doing something the child doesn't want to do). Child is also slightly overweight. Child usually seems excited to talk about/see mother but is quick to get angry with her. Enjoys playing board games but has difficulty accepting a loss and tries to cheat. Strengths are: intelligent, strong vocabulary, interest in drawing and art, interested in playing "pretend" From an attachment perspective would she be classified as anxious-ambivalent? How much of what is being exhibited is the "normal" 6 year old tension? What behavioral interventions would be recommended? Rules seem to be created but then arbitrarily enforced. Any thoughts, suggestions and insight would be appreciated!
should have made that clear earlier...
