Case History

Jim (not his real name) was a 9-year-old boy referred for a psychiatric evaluation by his psychotherapist of 1-1/2 years. At the time of this evaluation, Jim had lived with his adoptive parents for a 2-year period. Prior to his adoption, he had been in a fosterladoptive situation with these same parents for 1-1/2 years. He had been in another foster home since relinquishment from his birth mother when he was 2 years of age.

Jim's symptoms were of both a severe and long-lasting nature, predating even the initial relinquishment when he was 2 years of age. These symptoms included "acting out." He was described as stealing, lying, easily agitated, disruptive, intrusive, and verbally and physically aggressive. He was bossy and pushy with his friends. He was further described as self-centered and selfish. Adoptive parents described "up and down cycles" of roughly 3month intervals from at least the last 3-year period. In his "up cycle," Jim was described as a relatively easy-to-please goaldirected child who atempted to do his best to fit into his new family. On his "down cycles," all of the abovementioned symptoms were prominent. Additionally, he had a consistently difficult time falling asleep.

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