Case Study of a Child with Behavioral Problems: Causes and Treatment Approaches
Patient Information
- Age: 10
- Gender: Male
- Background: Bhairav (changed name), aged 10, is a resident of Kolkata, living in a nuclear family with his parents and younger sister. He is educated in a prestigious English-medium school and has an academic track record of achieving great grades during his initial years at school. His father is an IT professional, and his mother is a homemaker.
History or Cause:
Bhairav's parents went to Jagruti Rehabilitation Centre in Mumbai following repeated complaints from his school about violent outbursts, refusal to obey, bullying peers, and frequent disruption of the class. At home, he showed temper tantrums, resistance to rules, and disobedience. During the previous year, such behaviour escalated, most times refusing to do homework, being quick to irritate, screaming at members of the family, and an inability to control emotions.
After extensive discussions, the parents explained that Bhairav's behavioural problems started soon after the family went through a significant change. The father's line of work involved extensive travelling and spending lengthy periods away from home. Bhairav, who was emotionally close to his father, began to feel abandoned. During the same time, the arrival of his younger sister diverted the attention of the family, which Bhairav interpreted as abandonment. This void left by emotions gradually found expression in attention-seeking, aggression, and disobedience.
The school counsellor first suspected ADHD, but further clinical assessment at Jagruti Rehabilitation Centre brought more clarity.
Diagnosis :
Following a comprehensive psychological evaluation at Jagruti Rehabilitation Centre, Bhairav was diagnosed with Child Behavioral Problem Disorder, marked by persistent oppositional defiant traits, impulse control issues, and anger dysregulation. These behaviours were consistent across both home and school environments, significantly impacting his academic performance, peer relationships, and family interactions.
Diagnosis Findings
The following key observations and clinical insights were made during Bhairav’s assessment:
- Persistent aggression and irritability were observed, especially when facing rules, restrictions, or changes in routine.
- Frequent emotional outbursts and tantrums, often disproportionate to the situation, impacted both classroom behaviour and family dynamics.
- Defiance towards authority figures, including teachers and parents, indicated oppositional defiant traits.
- Difficulty in impulse control, with Bhairav acting out without considering consequences, was a recurring concern.
- A history of emotional neglect and exposure to a turbulent family environment, including frequent parental conflicts, contributed to his emotional insecurity.
- Lack of positive reinforcement and inconsistent discipline from caregivers led to confusion, mistrust, and poor emotional regulation.
- Limited coping skills and an inability to express emotions in healthy ways often result in physical aggression or withdrawal.
- Social difficulties, including trouble maintaining friendships and understanding social cues, were evident during peer interactions.
These findings formed the basis of the treatment plan, focusing on emotional regulation, behaviour modification, and strengthening family support.
Treatment :
Approach:
A 90-day structured outpatient behaviour modification program was started in Jagruti Rehabilitation Centre with the flexibility to change as per the weekly progress of Bhairav. The therapy was planned to address his latent anxiety, instruct emotional management, enhance communication, and promote family bonding.
Program:
Week 1–2 (Initial Assessment and Rapport Building):
- Centred on establishing trust between Bhairav and the therapists via play therapy, non-verbal expression, and child-directed activities. Parent counselling sessions were also begun.
Week 3–6 (Behavioural Therapy & Emotional Regulation):
- Cognitive Behavioral Therapy (CBT): Streamlined sessions were employed to assist Bhairav in recognising emotions, triggers, and positive responses.
- Anger Management Exercises: Role plays, stories and visual materials enabled him to comprehend frustration and consequences.
- Parental Training: Bhairav's parents were trained in positive reinforcement, setting boundaries, and non-punitive discipline.
Week 7–10 (Building Routine & Skill Development):
- Daily and weekly routines: with balanced academics, recreation, and rest.
- Social Skills Training: through group play, storytelling, and cooperative activities.
- Art Therapy: Bhairav participated in drawing, clay modelling, and emotion-mapping exercises to safely express his fears and concerns.
Week 11–12 (Review, Reinforcement, and Graduation Plan):
- Reducing therapy from weekly to bi-weekly, introducing self-assessment charts.
- Encouraging participation in peer mentoring, such as assisting younger children during structured games, to increase their self-esteem.
- Parent-child interactive sessions to reaffirm emotional bonding.
Medical Interventions:
- Even though the drug was not the first course of action, the child psychiatrist at Jagruti Rehabilitation Centre prescribed a weak, non-addictive anti-anxiety medication for the initial four weeks to help Bhairav with sleep problems and restlessness. The drug was tapered off gradually as his emotional control increased.
Therapy Types:
- Cognitive Behavioral Therapy (CBT): Bhairav was taught how his thoughts affected his behaviour and how to alter his thought process.
- Play Therapy: As a tool of communication to be understood and shaped by his emotional experiences.
- Art Therapy: Reducing stress and creatively expressing suppressed thoughts.
- Family Therapy: Joint weekly sessions treated parenting skills, communication, and emotional support in the family unit.
Improvements/Recovery Timeline :
| Week | Key Milestones |
|---|---|
| Weeks 1–2 | Initial resistance, but slow trust built up with therapists. Parents observed minute mood stability. |
| Weeks 3–4 | Intense reduction of aggressive behaviour. Sleep patterns stabilised. Teachers appreciated improved classroom engagement. |
| Weeks 5–6 | More expressions through therapy sessions. Bhairav started identifying his errors and apologising without prompting. |
| Weeks 7–8 | Developed healthy peer relationships in the therapy group. Started regular schoolwork completion. |
| Weeks 9–10 | Developed a daily routine independently. Reduced defiance at home. |
| Weeks 11–12 | Exhibited emotional maturity. Completed a school art competition and took third prize. Parents observed significant improvement in behaviour and confidence. |
Our Success:
Impact on Bhairav's Life:
Upon the successful completion of the 90-day programme, Bhairav's behavioural issues greatly diminished. He learned effective coping strategies, emotional intelligence, and improved communication. His school noted a drastic behaviour change, and he started enjoying his studies once again. He now attends extracurricular activities such as drawing and public speaking.
Bhairav's Mother’s Comments:
"The change we've experienced is nothing less than miraculous. I was afraid to even request Bhairav to complete his homework earlier. Today, he maps out his day independently. Jagruti not only healed my son, but gave empowerment to our entire family."
Family and Community Impact:
Bhairav's parents are more confident about their parenting style and have a more harmonious home life. His younger sister, who previously felt neglected by Bhairav's tantrums, now has a loving relationship with her brother. The school has commended the family for their dedication and recommended that other parents dealing with the same problem consult with Jagruti Rehabilitation Centre.
Future Steps:
Part of Bhairav's continuation in recovery involves regular follow-up visits to Jagruti Rehabilitation Centre every month over the next half-year to ascertain ongoing progress and stabilise his emotions. His regular day now encompasses writing in his journal to maintain self-reflection about his mind, family communications exercises to instil trust and togetherness, and working through art expressions to continue building his creativity and emotive release. Bhairav has also joined a peer support group for children. It is helping him develop leadership skills and social empathy. Additionally, if Bhairav faces any emotional or behavioural challenges in future, he and his family can seek Jagruti’s tele-therapy support for timely intervention and guidance.
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