BUSL 1101 Online Business Law and the Regulatory EnvironmentSpri.docx

BUSL 1101 Online Business Law and the Regulatory
Environment
Spring 2020
Instructor: Prof. Martin A. Goldberg
Instructor’s Office: Maxcy 118B-8, Office Hours: TR 1-3 p.m.,
and by appointment
Class Times and Location: Online
Textbook: Goldberg and Kruth, Business Law 8e, available
online.
Course Description: An overview of the legal system as it
relates to the operation of a business. Topics will include those
relating to the establishment and continuity of business
relationships, including contracts, product liability, warranty,
agency, business entities, property, business crimes and torts,
intellectual property, credit and bankruptcy, and those
regulating business activities, including employment,
environment, securities, and antitrust laws. 3 credits
Course objectives: The objective of this course is to introduce
students to the legal concepts most relevant to the operation of
a business enterprise, and to understand their application to
business decisions. After this course, the student will be able
to:
· Understand the sources of business law
· Evaluate laws applicable to business, and recognize trends
· Incorporate business law knowledge into strategic and routine
decisions
· Identify potential legal problems in the operation of a business
· Understand different ways of protecting legal rights of a
business and its owners
· Recognize where government regulation is applicable to a
business in order to ensure compliance and avoid civil and

criminal liability
Calendar:
Week
Chapter(s)
By Tuesday 11:59 p.m.
By Thursday 11:59 p.m.
1/28 - 1/30
1
First online posts for module
Written assignment #1
2/4 - 2/6
1
Second online posts for module
Module/Chapter 1 Exam
2/11 - 2/13
2
2/18 - 2/20
2
2/25 - 2/27
3
3/3 - 3/5
3
3/10 - 3/12
4
First online posts
3/24 - 3/26

4
3/31 - 4/2
5
4/7 - 4/9
5
4/14 - 4/16
6
4/21 - 4/23
6
4/28 - 4/30
1-6
Final Paper Due
5/5
1-6
Optional: Paper revisions
Grading: (1) Online discussion on Tuesdays for each two-week
module will count for 40 points, for a total of 280 points for all
online discussion. (2) Each written assignment will count for
25 points, for a total of 150 points for all written assignments.
(3) Each exam will count for 60 points, for a total of 360 points
for all exams. (4) The final paper will count for 210 points.
So, the total points available will be = 1,000. A student’s grade

will be determined as follows: 900-1,000 points is in the A
range, 800-899 points is in the B range, 700-799 points is in the
C range, 600-699 points is in the D range, and less than 600 is
an F. In all cases, grading will be subject to applicable
policies, particularly but not limited to those related to
attendance and academic integrity.
Attendance: Attendance in this course is required, and in this
online course timely online participation counts as attendance.
Any student who is absent for more than two weeks of meetings
may be dismissed from the course or, if not dismissed, receive a
lower or failing grade.
As this is an online course and access to the Internet is nearly
everywhere, it will be rare for an absence to be excused.
However, if there is a special problem, such as a hospitalization
or a death in your family, please let me know as soon as you do
what the situation is.
Academic Integrity: The University of New Haven expects its
students to maintain the highest standards of academic conduct.
Academic dishonesty is not tolerated at the University. To know
what is expected of them, students are responsible for reading
and understanding the statement regarding academic integrity in
the Student Handbook. Please note that academic integrity
violations are not limited to plagiarism and cheating as those
terms are commonly understood, but also to any
misrepresentation, express or implied, related to this course,
such as making or silently acquiescing to the making of any
misrepresentation related to attendance.
Use of Email: Because of the large numbers of emails I get
from students, I recommend certain procedures that will help me
get back to you with as prompt and complete response as
possible.

· The subject line of an email should always begin with the
course number and your last name as it appears in university
records. Make sure that the section number is included with the
course number.
· Where there is an ongoing discussion on a particular subject,
please include the prior emails.
· Do not rely on my ability to get back to you within 24 hours
before an exam.
· You must check your UNH email routinely, and not rely on
mail being sent to a different email address.
· If you send me an attachment, your last name should be in the
name of the document file, as well as at the top of the document
itself, and attachments should be in MS Word, not pdf or any
other format.
· Everything you email me should be saved by you, in case for
any reason it needs to be sent again.
Disability Services: The University of New Haven seeks to
maintain a supportive academic environment for all students
inclusive of those with any disabilities, chronic medical
conditions or military related disorders. If you feel that you
may need reasonable accommodations in this course, please
provide me with your Verification of Disability/Request for
Reasonable Accommodations letter or contact the Campus
Access Services office to begin the process to ensure that
accommodations can be made available to you. Campus Access
Services is located in Sheffield Hall on the ground floor in the
rear of the building, and can be reached by email at
[email protected] or by phone at (203) 932-7332.
The Assessment and Treatment of Long-Standing Disruptive
Behavior Problems in a 10-Year-Old Boy
Julian A. Rote, Debra A. Dunstan
First Published May 24, 2011 Research Article
https://doi.org/10.1177/1534650111410228
Article information

Abstract
A 10-year-old boy was referred for ongoing behavioral
problems. These problems were reported as having occurred at
home since preschool years and had become increasingly
problematic outside of the home in latter years, resulting in
frequent suspensions from school. A range of diagnoses had
been made in the years prior to referral, including attention-
deficit/hyperactivity disorder (ADHD), oppositional defiant
disorder (ODD), conduct disorder, and pervasive developmental
disorder–not otherwise specified (PDD-NOS). The central
intervention since age 6 had been pharmacotherapy, with
intermittent support at school in the form of school counseling
and teachers’ aids. However, the situation appeared to only be
worsening, and the need for a more integrated, multimodal
approach was recognized. In addition to individual therapy for
the client and his mother, the intervention also included
engagement of the father, collaboration with other educational
and professional service providers, and the development of an
integrated plan with shared objectives and strategies. The case
explores limitations inherent in taking a medical model
diagnostic approach to child behavioral problems and highlights
the need to utilize an idiographic approach taking a range of
individual psychosocial circumstances into account, rather than
taking a more nomothetic treatment approach based mainly on
diagnostic assessment.
Keywords disruptive behavior disorders, collaborative
multimodal approach, nomothetic, idiographic
1 Theoretical and Research Basis for Treatment
Disruptive behavior disorders (DBD) is an umbrella term
covering a range of conditions involving negativistic, rule-
breaking, and noncomplaint behavior. The category subsumes
conduct disorder (CD)—characterized by behavior violating
social norms and rules, and infringing on the rights of others—
and oppositional defiant disorder (ODD), featuring negativistic,

hostile, and defiant behavior. Attention-deficit/hyperactivity
disorder (ADHD) is also included in this general category
(American Psychiatric Association, 2000).
Although the etiology of these disorders is not fully understood,
twin and adoption studies suggest that biological (including
genetic) and a range of environmental factors are involved
(Hendren & Mullen, 2006). Those potentially relevant in this
case included comorbid ADHD, fearlessness and stimulation-
seeking behavior (Raine, Reynolds, Venables, Mednick, &
Farrington, 1998), early maternal rejection and inadequate
caregiving (Marks, Miller, Schultz, Newcom, & Halperin,
2007; Raine, Brennan, & Mednick, 1997), and neglect, abuse, or
violence (Loeber & Stouthamer-Loeber, 1986). Specifically
taken into account were findings of a recent study indicating
that moderators of childhood conduct problems include marital
adjustment, maternal depression, paternal substance use, and
child comorbid anxiety or depression, whereas critical, harsh,
and ineffective parenting were found to both predict and
mediate outcomes (Beauchaine, Webster-Stratton, & Reid,
2005).
A range of mechanisms has been suggested as being of
influence in child behavioral disorders. A social-cognitive
approach to mechanisms sees behaviors such as reactive
aggression as influenced by a hostile attribution bias—in which
interpretation of the action of others is biased in the direction of
assumed hostility, resulting in retaliatory anger and aggression
(Dodge, 1993). Behaviorally disordered children may also be
deficient in the cognitive problem-solving skills of generating
alternative solutions to presenting problems (Richard & Dodge,
1982). Emotional dysregulation and high levels of
temperamental activity from a young age are also seen as
factors involved in the development of ODD (Stringaris,
Maughan, & Goodman, 2010).
As the above risk factors and mechanisms would indicate, each
individual case of disruptive behavior is best conceptualized in
terms of factors operating within the child, factors operating

outside of the child, and the interaction between the two
(Kazdin, 2002). Thus, targets of intervention should include not
only the behavior-disordered individual but also family
members, peers, teachers, and other community members
(Cowling et al., 2005).
Individual-focused interventions generally involve components
of cognitive–behavioral therapy (CBT), including social skills
training, problem solving, cognitive restructuring, coping, and
anger control (Domitrovich, Cortes, & Greenberg,
2007; Henggeler & Sheidow, 2003; Kazdin, 2002; Kazdin,
Siegel, & Bass, 1992). The importance of adding parental
training to individual-focused approaches, especially for
preadolescent children, has been demonstrated (e.g., Kazdin et
al., 1992; Kazdin & Whitley, 2003) and integrated into
empirically validated programs such as Incredible Years
(Webster-Stratton & Reid, 2003) and the Positive Parenting
Program (“Triple P”; Sanders, Markie-Dadds, & Turner, 2003).
Furthermore, multisystemic (home, school, clinic) interventions
have shown promise for producing more durable outcomes
(Cowling et al., 2005) and the prevention of relapse (Baker &
Scarth, 2002; Brestan & Eyberg, 1998). School-based
interventions usually involve a behavioral approach, although
more recently there has been a shift toward using humanistic
strategies, building on the child’s strengths and involving the
child in planning and decision making, to build value and self-
worth (Chaplain, 2003).
Although a range of treatment programs has been devised and
demonstrated to be efficacious, it is not always possible for a
full intervention program to be implemented or that any one
manualized program will accurately address needs of an
individual case (Chorpita, Daleiden, & Weisz, 2005). There is
increasing recognition of the need to “distill” common elements
of the range of efficacious treatment programs, and implement
these elements in a flexible and idiographically tailored manner
(Garland, Hawley, Brookman-Frazee, & Hurlburt, 2008). Such
core elements involve both youth skills training and parent-

mediated interventions, and include factors such as application
of positive reinforcement, delivery of effective limit-setting,
parent/child relationship building, problem-solving skills, anger
management and affect education, psychoeducation and
didactics, modeling, role-playing and behavioral rehearsal,
reviewing goals and progress, and assigning and reviewing
homework (Garland et al., 2008).
A range of pharmacological treatments has been utilized in the
treatment of behavioral problems in children, including
psychostimulants, antipsychotics, antidepressants, mood
stabilizers, and antiepileptic and adrenergic drugs
(Tcheremissine & Lieving, 2006). However, research into the
efficacy of pharmacological treatment has been carried out
mainly on inpatient, rather than outpatient, populations
(Tcheremissine & Lieving, 2006). Pharmacological treatment
alone has shown, in general, only limited efficacy in the
treatment of childhood behavioral problems (Kazdin,
2002; McMahon, Wells, & Kotler, 2006) and no drugs have
been demonstrated to be consistently effective in treating CD
(U.S. Department of Health and Human Services, 1999). It has
been suggested that the utilization of pharmacotherapy is most
strongly indicated in cases involving extreme or explosive
aggression (Campbell, Gonzalez, & Silva, 1992) and also that
pharmacological treatments are only successful when a
comorbid condition, such as ADHD or depression, is present
(Waddel, Lipman, & Offord, 1999). This efficacy of
pharmacological treatments for behavioral problems tends to be
associated with, or perhaps rely on, their integration into
multifactorial treatment approaches (Tcheremissine & Lieving,
2006).
The issue of child behavioral problems, then, is one that is not
easily addressed by conceptualizing the problems within a
straightforward medical-model framework, where a diagnosis
may be seen as “explaining” or being the main driver of the
behaviors. Viewing behavioral problems in this way tends to
lead to nomothetic-type “interventions to match the

diagnosis”—such as an emphasis on pharmacological
treatment—which are unlikely to adequately address the broader
influences on the child’s behavior. Rather, interventions for
childhood behavioral problems have been found to be most
effective when a multimodal approach has been used and
coordinated across a variety of settings (Baker & Scarth, 2002).
Such an approach is fundamentally idiographic in nature, taking
into account the range of pertinent factors specific to an
individual child’s life circumstances. Indeed, diagnostic issues
are just one of a range of variables to be taken into account in
selecting intervention strategies for any one client (Chorpita et
al., 2005).
2 Case Introduction
The client, “Sam,” was a relatively small, slightly built 10-year-
old boy whose presentation was somewhat unkempt, with
tousled hair and worn and/or ill-fitting clothing. He had a
naturally shy demeanor, but a ready and charming smile when in
good spirits.
The first appointment was attended by all members of the
family; Sam, his mother and father (who were separated), and
his (18-month-older) sister. Sam’s mother did most of the
talking and indicated that she felt unable to cope with Sam’s
ongoing behavioral problems. She displayed a rather harsh,
angry, and bitter demeanor—although she also displayed a sense
of humor on occasion. Sam’s father reported less difficulty with
Sam’s behavior than did his mother, and was reserved and
appeared to be somewhat dominated by his ex-wife. At this
session, Sam was sullen at times, but at other times he was open
and talkative.
Sam’s documented history indicated that while there had been
many assessments and consultations, there had been an absence
of substantial individual therapy for Sam, minimal therapy or
support for his mother, inadequate attempts to involve Sam’s
father in a more constructive role, and inadequate
communication and coordination between relevant medical,
educational, and other support services. A range of assessments

had been carried out and recommendations made; however,
intervention had been largely limited to help from teachers’
aides and school counselors, and advice to Sam’s mother. The
reported worsening of Sam’s behavior in recent years indicated
that these previous interventions had not met with any notable
success. The file review also indicated that diagnostic issues
remained somewhat unclear (see below).
3 Presenting Complaints
An outline of Sam’s difficulties was obtained from his parents,
school representatives, and Sam himself. The difficulties were
clustered in the areas of behavioral, emotional, social, and
academic problems. Sam’s mother described verbally and
physically aggressive behavior by Sam toward her and Sam’s
sister on most days, breakage of household items, persistent
defiance and disobedience, frequent school refusal, and poor
sleeping and eating habits. She indicated that Sam’s behaviors
had resulted in extreme negative feelings on her behalf toward
Sam and that she felt depressed and “at my wit’s end.” Sam’s
behavior had reportedly resulted in other families not wanting
their children to play with Sam. Conversely, Sam’s father
identified no major problems in the times that he was with Sam
and described Sam as “just like any other kid.”
Representatives from Sam’s school identified persistent
disobedience, swearing, occasional physical aggression,
repeated transgressions of school boundaries, failure to
complete schoolwork, and disruption of classes. A range of
disciplinary actions had been undertaken, including regular
suspensions and repeated transfers to a School Suspension
Center. Sam was reported as lagging approximately 1 year
behind in academic achievement.
Sam spoke of being taunted and teased by other children, and a
perception that teachers were mean to him and did not listen to
his side of the story. He described feelings of ostracism and
loneliness (especially at school), embarrassment about being
behind academically, and sadness at his lack of friends.
4 History

Information about Sam’s history was gathered from an extensive
file review, a clinical interview with all family members, and
the gathering of information from past and present school staff
and the local pediatrician.
Social history
Up to age 6, Sam lived with his mother, father, and sister in a
major metropolitan city. His parents then separated, and Sam,
his mother, and sister relocated to a rural town. Sam’s father
also moved to the same town 2 years later and lived alone,
having regular contact with his children but little involvement
in school or day-to-day issues. Ongoing parental discord was
described, and financial hardship was reported; Sam’s mother
had part-time employment and his father was unemployed.
Long-term conflict between Sam and his mother, and also
increasing conflict with his sister, were described. At school,
lack of manners and aggressive tendencies had reportedly
resulted in ongoing relational difficulties with teachers and
peers. Sam was reported to have lost most of his friends over
the years due to his problematic behaviors.
Sam’s hobbies included skateboarding, riding bikes, art,
swimming, rugby league, soccer, X-box, and caring for his pet
cats. Despite his ongoing behavioral problems, Sam was also
described as having “a good heart,” a good sense of humor, able
to be loving toward other family members, “tender” with
animals and younger children, “enthusiastic,” and “responsible”
(generally came home on time following after-school
skateboarding, locking the house at night, looking after pets).
Developmental history
Sam’s mother reported frequent illness during with her
pregnancy with Sam and delivery via emergency caesarean
section. However, his birth weight was in the average range. He
was bottle-fed but did not tolerate formula well. Major
developmental milestones were achieved as expected. At age 7,
an occupational therapy report stated that Sam demonstrated no
psychomotor problems. Sam’s cognitive ability was shown to be
in average range in testing carried out at age 3 with the

Wechsler Preschool and Primary Scale of Intelligence–Revised
(WPPSI-R; Wechsler, 1989) and at age 7 with the Wechsler
Intelligence Scale for Children–Third Edition (WISC-
III; Wechsler, 1991)—with no attentional problems evident.
However, Sam gradually began to lag behind in his
schoolwork—by approximately 1 year by age 9—due mainly to
behavioral problems. There were no reports of exposure to any
major traumatic life events (beyond the psychosocial stressors
already outlined).
Medical history
No history of major illness or physical trauma was reported. At
age 5, Sam’s head circumference was noted as “just on the 2nd
percentile,” but with no other significant findings. No
impairment of sight, hearing, speech, or motor functioning was
evident.
Family history
Sam’s mother reported a personal history of a deprived
childhood and chronic depression. She described her father as
violent and dominating, and stated that she had two brothers one
of whom was psychotic and the other alcoholic. Sam’s mother
expressed the opinion that “all the males in the family had
mental health problems” and that Sam was following in this
path. Sam’s father reported a happy and stable childhood, and
no family mental health problems, but a personal history of drug
and alcohol abuse.
Previous treatment
Although contact had been made over the years with a range of
service providers, the main focus appeared to have been on
assessment and diagnostic issues. Some direct psychological
and educational support for Sam had been provided by school
counselors and teachers’ aids but limited success was apparent.
Attempts at family intervention, comprised mainly of
psychoeducation for Sam’s mother regarding behavioral
management, also had met with little success, with no
substantial treatment planning evident. The central and ongoing
treatment had been the prescription of psychotropic medications

for Sam.
History of medications
Sam had been prescribed Dexamphetamine from age 5 to 6;
Ritalin at age 7, and then also Risperdal and Catapres; Risperdal
increased at age 8 but ceased after deleterious effects and
Strattera commenced; “on and off” Strattera at age 9, and
Ritalin recommenced; Strattera increased to maximum dose at
age 10 and Ritalin ceased—but then Strattera ceased after
sudden worsening of behavior and Risperdal was represcribed.
At the time of assessment, Sam reported that Risperdal made
him “tired and happy” whereas some other medications (e.g.,
Strattera) had made him “angry.”
5 Assessment
Assessment involved an extensive file review, a clinical
interview with all family members, and the gathering of
information from past and present school staff. At age 3 years
10 months Sam was assessed, both by an early intervention team
and a psychiatrist, for “behavioral problems” at home; however,
no diagnosis resulted. At age 6, Sam was seen by a pediatrician
who had his mother and grandmother fill out brief ADHD
checklists—which indicated possible hyperactivity but not
inattention. The pediatrician then described Sam as “a boy who
has ADHD with some severe socialization difficulties . . . there
may be an element of ODD/parenting.” The pediatrician also
raised the possibility of pervasive developmental disorder
(PDD), seemingly based on the responses by Sam’s mother on
the Gilliam Asperger’s Disorder Scale (GADS).
At age 7, Sam was administered the WISC-III, administered by
a school counselor, who wrote that he “was a delight to work
with and was easily refocused after short breaks when
necessary.” An occupational therapy report the same year also
indicated no problems with attention or stamina. However,
problematic behaviors at home continued, and two incidents of
verbal aggression toward a teacher were reported. Sam was seen
by a child psychiatrist who wrote that his “developmental
history and previous standardized testing is not suggestive of a

longitudinal history consistent with ADHD”; however, the
diagnostic description was given as “DBD with ADHD and
Conduct Problems.” The psychiatrist also wrote of “social
difficulties and some mild symptoms possibly suggestive of
PDD-NOS.” Letters by the pediatrician subsequently referred to
Sam having “known PDD.”
At age 8, a (teacher report) Achenbach checklist showed
aggressive behavior in the clinical range, whereas other
subcategories including anxious/depressed, social problems,
thought problems, and attentional problems were shown to be in
the normal range.
At age 9, Behavioral Assessment System for Children (BASC)
reports from Sam, his mother, and his teacher again indicated
that attentional and hyperactivity problems were not in the
clinical range. However, the results led to the conclusion that
“Sam presently meets criteria for ODD,” and “his difficulties
persist despite medication.” The diagnosis of CD was also used
in some communications by the pediatrician at this time. Sam’s
case manager at Child and Adolescent Mental Health Services
(CAMHS) communicated Sam’s diagnosis to the school at this
time as “(a) DBD with ADHD and conduct problems and (b)
social difficulties and possible symptoms of PDD-NOS.”
However, it is notable that after communication with the school,
this diagnostic picture was changed several days later to “(a)
PDD-NOS, (b) ADHD, (c) ODD”—apparently to enable school
funding for support services, an increasingly recognized
problem (Hansen, 2010).
Following referral to our Clinic, an Achenbach System of
Empirically Based Measurement (ASEBA) Teacher’s Report
(Achenbach, 1981) indicated that social problems, attentional
problems, rule-breaking behavior, and aggressive behavior were
all in the clinical range, whereas internalizing problems and
thought problems were in the borderline clinical range. The
Adaptive Functioning Profile indicated that “academic
performance,” “working hard,” “behaving appropriately,”
“learning,” and “happiness” were all in the clinical range. An

ASEBA Parent Report sent to the father was not returned. Sam
and his mother were not asked to complete forms, as part of the
overall aim of shifting their focus from assessment to treatment.
Given the diagnostic history, it appeared that the broad
diagnostic category of “DBD” was justified, and perhaps ODD.
The diagnostic picture was complicated and confused, however,
by the PDD-NOS and ADHD diagnoses, which appeared to be
initially based on brief questionnaires answered by Sam’s
mother when Sam was seven. Minimal evidence of PDD or
ADHD was suggested by formal testing or social/developmental
history up until that time (little evidence of any impairment in
verbal or nonverbal communication skills; no stereotyped
behavior, interests, or activities; no significant developmental
delays; little evidence of attentional or hyperactivity problems).
It is also notable that according to the Diagnostic and Statistical
Manual of Mental Disorders–Fourth Edition (DSM-IV), ADHD
should not be diagnosed in the presence of a PDD (American
Psychiatric Association, 2000).
Although possibility of attentional problems playing a current
role was raised by the clinical range result on the latest teacher
report ASEBA, the lack of any evidence of attentional problems
during ongoing therapy sessions—combined with the lack of
evidence of attentional problems evident in Sam’s documented
history—indicated that ADHD was unlikely to be accurate as a
diagnosis. Overall, the category DBD was considered the most
appropriate term for describing Sam’s ongoing behavioral
problems and possibly the most useful for informing multifocal,
idiographic treatment.
It was obvious that social isolation, falling behind in
schoolwork, and difficulty in getting along with others caused
Sam emotional distress. However, he was not apparently
suffering from a depressive disorder, as he did not exhibit
significant guilt, hopelessness, worthlessness, anhedonia, low
energy, or suicidal ideation. Sam also showed no significant
indication of suffering from an anxiety or other disorder.
6 Case Conceptualization

Although a range of diagnostic possibilities had been suggested
for Sam, it seemed that perhaps lack of clarity regarding
diagnosis may have contributed to the lack of consistent
therapeutic support beyond pharmacotherapy. As Dr. Jon
Juredeini, of the Adelaide Women’s and Children’s Hospital,
has succinctly stated,
The approach to kids who present with behavior problems seems
to be, “What’s wrong with this kid? What is their medical
diagnosis?” I think it’s the wrong question to be asking. The
question we should be asking is “What is bugging this kid?
What is not right in this kid’s life?” (Juredeini, 4th time quoted,
in Cleary, 2005).
In Sam’s case, it was evident that some of the things “not right”
in his life included social, environmental, emotional, and
learning issues. The past inability of Sam’s family, support
services, and school to successfully deal with his behavior had
led to what appeared to be an ongoing cycle of punishment,
suspension, and ostracism, followed by increased feelings of
social isolation, inadequacy, and negativity. These negative
emotions appeared to have underpinned much of Sam’s
propensity toward angry outbursts, lack of academic motivation
and achievement, and continuing interpersonal and behavioral
problems. We proposed that any successful intervention would
thus need to address emotional issues and improve social
capacities. Findings that emotional outbursts and temperamental
actions tend to be associated with ODD (and hyperactive-type
ADHD; Stringaris et al., 2010) underscored the need to address
emotional triggers and regulation.
CBT was the main approach utilized in individual therapy for
Sam. A behavioral approach, aimed at understanding the
function of particular behaviors in relation to the antecedents
and consequences, was utilized in the school and at home.
Elements of a humanistic approach were applied to all settings
to address Sam’s negative self-view and feelings of low self-
worth. For Sam to become engaged in therapy, we considered it
vital that he feel accepted, valued, and capable of change

(Chaplain, 2003). Thus, a central theme in helping Sam to alter
his negative views of school and of other people was to help
him to value himself as a worthwhile person.
Although the possibility of a manualized treatment for ODD
was considered, it was felt that a more tailored idiographic
approach, utilizing the recognized key elements of the range of
treatment programs available, would be likely to optimize
engagement and outcomes (see Chorpita et al., 2005; Garland et
al., 2008).
Treatment Plan
The overarching goal of treatment was to return Sam to healthy
ways of interacting at school, home, and with peers. Factors
taken into account in developing the treatment plan included
Sam’s apparent problems with emotional regulation and lack of
problem-solving skills; Sam’s mother’s negative feelings toward
Sam in the context of her own emotional difficulties, resulting
in critical and harsh maternal parenting; paternal substance
abuse issues and the minimal involvement of Sam’s father in
day-to-day issues; and the punishing and ostracizing cycle that
had developed in the educational system’s handling of Sam. The
aims and objectives of the plan were as follows:
· Aim 1: To facilitate development of a healthier sense of
acceptance, inclusion, and emotional connection, at home,
school, and with peers. Objectives: (a) improve feelings of self-
efficacy and control, (b) facilitate improved social skills, and
(c) facilitate better emotional connection with others.
· Aim 2: To empower Sam to be able to control his own
behavior. Objectives: (a) reduce angry and violent reactions, (b)
build self-efficacy, and (c) increase Sam’s capacity for
communication.
· Aim 3: To facilitate successful reengagement with school
environment. Objectives: (a) reduce negative factors at school,
(b) improve Sam’s capacity to communicate his
needs/desires/frustrations at school, and (c) build on positive
aspects of school.
· Aim 4: To improve communication and family dynamics at

home. Objectives: (a) strengthen the ratio of positive to
negative interactions at home, (b) support the emotional well-
being of Sam’s mother, (c) engender greater positivity from
Sam’s mother, (d) facilitate greater involvement by Sam’s
father, and (e) engender greater stability and certainty at home.
· Aim 5: To remediate academic problems. Objectives: (a)
facilitate improved understanding by Sam of the relevance of
academic matters to him and (b) increase academic work being
done at home.
To bring about meaningful change in these areas, it was evident
that a goal-focused, collaborative, multimodal treatment plan
was required. As well as engaging Sam and his parents in
treatment, work was also undertaken to facilitate
communication and collaboration between all involved parties
(educational and other health professionals), and to enable a
common framework and goals within a shared treatment plan.
7 Course of Treatment and Assessment of Progress
Summary of Contact With Relevant Parties
Following the initial interview, the first author (J.R.) provided 3
therapeutic sessions with Sam’s mother alone, 2 joint sessions
with Sam and his mother, 10 sessions with Sam alone, 2
sessions with Sam’s father alone, and 2 joint sessions with the
father and Sam. As Sam’s mother was obviously struggling with
her own emotional issues and expressed exasperation at being
“told what she should be doing at home” over the years, she was
offered a supportive individual intervention—provided in the
form of 6 therapy sessions by the second author (D.D.). Four
meetings with staff from Sam’s school and three meetings with
staff from the School Suspension Center, were held. Two child-
protection-service-convened meetings of all relevant parties and
one psychiatric review were also attended. The period of
individual treatment was limited to 5 months because of the
vagaries of the timetable of the movement of interns through the
Clinic, and the number of individual sessions for Sam was
further limited because of his reluctance to attend during school
holidays and several missed appointments.

Psychological Therapy for Sam
The initial therapy session focused on rapport-building and
resulted in Sam engaging well. The relationship between moods
and behaviors was discussed in Session 2, and Sam identified
“respect” as an important theme in communication—in that he
felt he wanted to be treated with respect and recognized how
others might similarly dislike not being treated with respect.
Breathing and relaxation exercises were also introduced and
practiced.
In Sessions 3 to 5, the focus was on the relationship between
thoughts and feelings. The concept of the “anger (thermo)
meter” was introduced, illustrating anger as graduated, not
simply “on or off.” Sam demonstrated good capacity to
recognize and manage unhelpful thoughts, and thus become
more the boss (a term that appealed to him) of his own
reactions, and thus be more able to orchestrate desirable
(“green”) outcomes rather than negative, unwanted (“red”)
outcomes. These themes were explored using real-life examples
and also through the use of puppets.
In Session 6, the “Magic Macaroni Jar” (Irvine, 2000) was
introduced. In this activity, positive messages about the child
are written on small pieces of paper by various people in the
child’s social environment, then rolled up and placed inside
tubes of penne pasta, and collected over time in a large jar. This
activity engenders a focus on the positive and provides a
physical (and readable) reminder of positivity and competence.
Sam clearly enjoyed the initial activity of writing positive
messages about himself and saving them in the jar—and the
activity was subsequently continued over coming weeks by his
parents, sister, and school staff.
In Session 7, the distinctions between “Cool, Weak, and Aggro”
responses to various situations were introduced (“Stop Think
Do” behavioral program; Adderley, Petersen, & Gannoni, 1997).
These distinctions tied in with the “red” and “green” alternative
response choices from Session 5. Sam identified strongly with
wanting to remain “cool” in his responses, and a coping

statement of “Stay Cool” was formulated.
Sam’s father attended the next session with Sam. Material
covered so far was reviewed and a hand-drawn summary,
similar to Figure 1, was formulated. Sam took pride in
describing his learning and achievements to his father. Also
introduced in this session was a discussion about change and
growth, and how the past did not have to dictate, or reduce hope
in, possibilities for the future.
Figure 1. Overall “framework” in which the various strategies
and skills were conceptualized
In the ninth session, Sam was able to express much-improved
positivity regarding his own positive attributes and capabilities.
However, he expressed concern about his ability to cope when
returning to school (from the Suspension Center), which was
discussed in the light of the strengths he had identified and the
possibility of growth and change.
In the last session (after return to school), Sam indicated that he
was feeling much better about himself and expressed pride in
his achievements. Gains and changes were reviewed, and Sam
expressed sadness that the therapeutic relationship was ending.
We discussed the need for ongoing practice, learning, and
growth in the years ahead.
Intervention for Sam’s Mother
The three initial sessions with Sam’s mother addressed
parenting skills, whereas the six sessions of psychotherapy by
D.D. that followed focused on validation and acceptance, self-
awareness, personal goal-setting, and behavioral activation.
Sam’s mother later indicated improved mood, smoother
interactions at home and with her ex-husband, and increased
positivity about Sam.
Counseling for Sam’s Father
J.R. provided two individual sessions with Sam’s father,
supplemented by several telephone discussions. The value and
importance of his role in his children’s lives was reinforced,
and relevant information regarding fathering provided. This

translated to a reported increase in enthusiasm and willingness
to be more involved with his children. An offer of ongoing
support to address alcohol abuse problems was declined.
Collaboration With Department of Education and Other
Professionals
In addition to the seven meetings held with Education
Department staff, numerous telephone contacts were also made
with teachers and support staff. Communication was entered
into with the pediatrician and psychiatrist, and culminated in a
joint meeting, plus a follow-up meeting, of all concerned parties
to facilitate an ongoing coordinated approach. A coordinated
treatment plan for Sam’s further management was
collaboratively formulated and distributed to all relevant
parties, and other relevant documents and materials regarding
behavioral management provided.
Sam’s Perceptions of Outcomes
By the end of treatment, Sam demonstrated positive feelings
about himself and no longer showed the sullen moods that had
been evident in some early sessions. He was able to more
readily articulate positive self-attributes and expressed pride in
his achievements, including being more socially accepted. He
said that his friends at school were “communicating more” with
him, and he named a list of people who thought he was “more
cool now” (including friends, family, and school staff). Sam
also expressed significantly increased enthusiasm about school
and schoolwork, and reported positive interactions with
teachers. Conflict at home was reported as having reduced in
intensity and frequency, from almost-daily to approximately
once every week or two.
Changes at School
Some strategic changes were implemented regarding the
management of Sam’s behavioral problems at school (e.g., self-
initiated “time-out”). Sam was invited to contribute to
formulation of strategies to address his issues at school, which
he found empowering. School staff, Sam’s parents, and Sam
himself reported that he was demonstrating minimal disruptive

behavior, increased prosocial behavior, a more positive mood
and attitude, and improved enthusiasm for schoolwork. On his
return to school near the end of treatment, the deputy principal
emailed J.R. to say that Sam “seems relieved to be back at
school and was very positive about doing quality work (ran
across the playground to show me his morning’s efforts!)”
Changes at Home
Sam’s mother expressed pleasure in the positive changes that
had taken place. She reported minimal arguing and fighting at
home, appeared more relaxed, and was more positive about Sam
and his behaviors. Sam’s father had become more involved in
Sam’s school activities and homework, and was caring for him
for some hours each day.
Overall, all parties agreed that Sam’s behavior and emotional
state had improved but that, given the recency of changes in the
context of long-term problems, ongoing work and consolidation
was necessary.
8 Complicating Factors
A complicating factor was the lack of clarity regarding Sam’s
past diagnostic picture. It seemed that the unclear and often-
changing past diagnoses had contributed to a sense that Sam
was more “complicated” than was actually the case, and resulted
a degree of pessimism regarding his treatment. It also appeared
to maintain the “ongoing search for the correct diagnosis” at the
cost, it seemed, of directly addressing relevant issues.
The tendency of relevant parties to continue conceptualizing
Sam’s problems in medical model terms also reinforced the
perception by Sam’s mother that the problem was sourced
“inside Sam.” This supported her view that she was relatively
powerless to alter the situation and that behavioral management
strategies were doomed to fail.
The continuation of conceptualization within a biomedical
framework was evident in a decision by the pediatrician to
reinstate prescription of Risperdal for Sam toward the end of
treatment at our Clinic—even though he had been making
substantial gains while undertaking psychological therapy,

without medications, for some months. This decision reinforced
ongoing perceptions of Sam’s problems as having a biological
substrate, and blurred the picture regarding what factors had
been effective in achieving the positive changes noted.
The difficulties that can occur in attempting to engender a
collaborative and unified approach were also illustrated by
defensiveness and resistance by Suspension Center staff to
changing their conceptualization that Sam’s problems basically
emanated only from Sam himself. This resulted in a lack of
engagement by Suspension Center staff in the collaborative plan
and a subsequent decision by Sam’s school to withdraw Sam
from the Suspension Center service.
It appeared that the range of diagnoses proposed for Sam, prior
to referral to our Clinic, was influenced by the need for specific
diagnoses to obtain school funding (see Hansen, 2010).
Utilization of the diagnosis of PDD-NOS, while it may have
achieved access to services such as teachers aids, appeared to
do little in terms of leading to treatment options pertinent to
Sam’s behavioral problems.
A major complicating factor was the restricted time frame (5
months) available. To be effective, treatment for child behavior
disorders must be multimodal, address multiple foci, and
continue over extensive periods of time (Steiner & Dunne,
1997). Although we attempted to address multiple foci in a
multimodal fashion, and in this way appeared to facilitate
substantial gains over a relatively short period, we were unable
to offer treatment over an extensive period of time—and thus
had to rely on other services to continue the work after our
contact with Sam and his family had ended.
9 Follow-Up
Due to the ending of J.R.’s placement, and the closure of our
Clinic for some months, we were unable to provide longer term
follow-up. Sam was referred—with substantial information
regarding treatment that had been undertaken and the
collaborative plan—to a private psychologist (with funding
from a child support agency) for a further 12 sessions of

individual therapy. Sam’s parents were referred to a family
support service for counseling on shared parenting and
communication. Sam’s school and the child protection agency
stated their intention to continue working with the collaborative
treatment plan and had a case conference of all relevant parties
organized for a date some months following the end of
treatment by our clinic. Unfortunately, follow-up data were also
unable to be collected.
10 Treatment Implications of the Case
The case demonstrates the need, in the case of child behavioral
problems, to take a broad, idiographic approach incorporating
all relevant influences on behavior. The way in which we assess
and diagnose largely determines the type of interventions that
are chosen—and ultimately the outcomes that might be
achieved. The current dominance of the biomedical model-based
classificatory diagnostic approach, which encourages clinicians
to conceptualize problematic behavior through the lens of a
diagnosis, may at times sway our thinking toward “seeing the
problem in the person,” rather than as the end result of a range
of influences occurring within and outside of the person. The
World Psychiatric Association International Guidelines for
Diagnostic Assessment Workgroup (WPA; 2003) has called for
standardized diagnostic formulation to be supplemented by an
idiographic diagnostic formulation—involving the
contextualization of clinical problems and “the elucidation of
pertinent mechanisms and contributory factors, from biological,
psychological, social, and cultural perspectives” (WPA, 2003,
p. s55). Thus, there is recognition that the nomothetic
diagnostic approach needs to be balanced by a more idiographic
approach—in order that clients be offered treatment options
pertinent to their individual circumstances, and not necessarily
dictated by diagnosis. This interplay of idiographic and
nomethetic approaches is an area of ongoing debate
(e.g., Thornton, 2010).
In Sam’s case, it was necessary for diagnostic factors to be
understood in relation to relevant contextual factors and for

treatment to occur within a broadly focused, idiographically
tailored plan. It seemed that had this been possible from earlier
in Sam’s life, the deterioration of his behavior and academic
functioning may not have occurred to such a significant degree.
11 Recommendations to Clinicians and Students
This case demonstrates the need for children to be understood in
the social context in which they are embedded and, in complex
or chronic cases, that working with both the child and the adults
in the child’s social environment is imperative to achieving
positive outcomes. A large part of a necessary intervention
should involve broadening the view of people in the child’s
social world, away from a focus purely on “faults” or problems,
toward an understanding of the emotional underpinnings and
environmental influences on undesirable behaviors. It is also
important that clinicians are aware of theoretical frameworks
and approaches that influence case conceptualization and
intervention design. The pervasive influence of the currently
dominant classificatory diagnostic paradigm needs to be
recognized for both its utility and limitations. To again quote
Dr. Jon Juredeini (6th time quoted, in Cleary, 2005),
If you just assume that this is a condition that needs treatment
with medicine and you don’t try and understand what is going
on, you can miss very important things, very dangerous things
that might be happening in the child’s life.
Clinicians need to take the best that both nomothetic and
idiographic approaches have to offer and combine them in the
most effective way for any individual case to optimize outcomes
for each client.
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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