Adam is a four-year old boy who was recently diagnosed with oppositional defiant disorder (ODD). He lives with his mother, Claire, who became a single mum, shortly after splitting up with Adam’s father, who moved abroad to pursue another life. Claire and Adam live in a two-bedroom flat. Claire became concerned when Adam’s behaviour led to him being asked to leave his second pre-school. Claire described Adam as being a delight in his first year of life. Shortly after he turned two years of age, he became very hostile, presenting with frequent temper tantrums and seemed to be deliberately annoying his mother, by pushing and bumping into her. Teachers at the pre-school reported that they had to give Adam a lot of time and attention compared to the other children, because he was distracted and disruptive to the other children.

Claire was advised to refer Adam to a pre-school with teachers experienced in including children with more special needs, which had a parent training programme.

At first Claire felt as if the previous pre-school was fobbing her off and because she had to work during the day, she could not see how her being part of a parent programme could work. However, Claire was very concerned about Adam and with the help of her doctor and teachers Adam was referred to the St. Andrews Pre-school who employed a number of special needs teachers and educational psychologists to support children and their parents with behavioural problems.

Adam was assigned to a four-year-olds class with a teacher called Allison who was trained in the education of children with behavioural problems. The initial goal of treatment was to assist Adam with the transition to pre-school. It was also important to establish a ‘breakaway’ time for Adam when he needed it. Another goal of treatment began with the Listening Programme, which is devised to help Adam focus his attention during lessons, maintain good communications with others and develop his social skills.

Throughout the treatment, Adam’s teacher would also provide positive feedback to him, through praising positive behaviours. Allison also set up age appropriate activities she wanted Adam to achieve each day, with limits and consequences. Adam started to respond to this approach. Claire was advised to enrol on the parenting classes provided at St. Andrews, to build her relationship with her son. Claire was able to attend these classes directly after work, with Adam. Claire reported seeing a difference in her son at home – Adam was less hostile, able to sit and do an activity for a period of time, without getting distracted and a happier child. Claire and Adam continued with the programme.

• What support may have been available to Claire at about the time Adam first started to have behaviour issues?
• What may have complicated the process of assessing Adam at this early stage?
• The initial goal of treatment was to assist Adam with the transition to pre-school. What do you understand by the term ‘School readiness’?