Phillip, age 18, was suspended from a small town in the mid-west and referred for psychiatric treatment by his school social worker. The following note came with him:
This adolescent has been exhibiting severe behavioral disturbances since
enrolling in our school. He constantly initiates fights on the playground and has been observed attempting to torture squirrels and pigeons. He has been caught and reprimanded for pulling the wings and legs off Insects. He consistently defies authority and has been suspended for fighting on the bus. He consistently makes up stories and feels that we are picking on him. He presents a sullen and defiant attitude at all times. When questioned as to his behaviors, he claims “I’m not right up here.” Phillip requires a full psychiatric evaluation before he can return to school.
The psychiatrist learned from his grandmother that he was born when his mother was a senior in high school. Her parents refused to allow her place Phillip for adoption and his grandmother received custody after neglect and abuse charges were filed against his mother. Phillip was born prematurely and, according to his grandmother, he was a “blue baby.” Phillip has been a bed wetter for several years and his grandparents have tried various techniques to assist him with this condition.
Phillip and his grandmother were in a serious car accident when he was 7 years old. His grandmother was injured and a person in the other car was killed. After the accident, Phillip began experiencing nightmares and night terrors, a fear of the dark and a refusal at times to ride in a car, and a fear of separation from his grandparents. Phillip’s grandmother reports a worsening in his behavior after the car accident. Phillip’s school performance has been poor and he repeated the second grade and is in danger of repeating the twelfth grade. His teachers complain that he is disruptive, does not sit still, is impulsive, speaks in a rapid pressured manner and hyperactive.
What would Phillip’s current diagnosis be? What is your rational?
