r old child. Basic problem: Borderline intellectual range (and possible brain lesion or deficient embryonic development) hinders acquisition of concepts and relationships; limits acquisition of communicative forms; and impairs visual-motor integration.
Adaptive behaviors. The child's self-help skills appear to be age appropriate. However, her socialization skills are poor. She has difficulty relating to her peers and is frequently involved in arguments. The teacher reports that she "has difficulty functioning in the classroom and is defiant at times. She often will refuse to obey any adult authority." Basic problem: Aggressivity (anger/hostility) and poor adaptive skills to both peers and adults render socialization and self-esteem very difficult.
Personal/social development. Elizabeth presents as an oppositional youngster with a tendency to be uncompromising and inflexible. She appears to be lacking self-control, and has difficulty in accepting authority. She can be extremely disrespectful towards adults. The neuro-psychiatric evaluation indicates that "Elizabeth has underlying anger and hostility. She is emotionally labile and impulsive. She has had a great deal of acting out behavior. She does not listen in school or at home. She basically tends to be a very lonely girl. She acts out her anger and hostility fairly directly. She presents features of Oppositional Disorder." Basic problems: Poor personal acceptance hindering social development. Lability and impulsiveness are probably due to high level of frustration and to anger towards an abusive adult society, but borderline intellectual capacity and possible brain lesion should not be eliminated from total diagnosis. On the positive side, her acting out anger and hostility portends well for a successful therapeutic intervention.
Language skills. Elizabeth is bilingual English-Spanish. Her home environment is hispanic. Inasmuch as her attention span is restricted, she may alt...