title: Behavioral changes associated with a disruptive new student in the classroom.
abstract: Marcus is a 10-year-old boy who was followed by his pediatrician for several years. She knows him as a socially engaged, active athlete, playing soccer and baseball, out-going, and a good student. He has been in good health without a significant medical history.At the beginning of this academic year, a new student was placed in Marcus's fourth grade class. This student is disruptive, impulsive, and abusive. He has frequent violent outbursts, yelling, kicking, and throwing objects, including recently throwing a desk across the room. The school has made efforts to manage this student. The teacher sets up behavior contracts, and the school has temporarily suspended the child; however, the school is unable to remove the child from the classroom. Many students, including Marcus, have been significantly affected by this disruption.Marcus describes the classroom environment as "tense." He reports he is never sure what is going to make the student "so mad." Over the last 3-4 months, Marcus developed nightmares, enuresis, and trichotillomania. The hair pulling is the most distressing feature for both Marcus and his parents. Marcus acknowledges that he is usually unaware of the behavior at first but then finds the sensation is relaxing. Afterward, he is typically embarrassed by the behavior. There is a family history of anxiety in both parents.He has been seeing a psychologist with some mild improvement in his enuresis. However, the hair pulling has not improved and has worsened. They were seeking additional advice regarding the next steps.
authors.affiliation: *Department of Pediatrics, University of California, San Francisco, CA; †Division of General Pediatrics, Child Development and Community Pediatrics, Department of Pediatrics, University of California, San Diego, San Diego, CA; ‡Preuss/UCSD Charter School, San Diego, CA.
authors.forename: Julie Stein
authors.initials: JS
authors.lastname: OʼBrien
authors.forename: Howard
authors.initials: H
authors.lastname: Taras
authors.forename: Scott
authors.initials: S
authors.lastname: Barton
authors.forename: Pete
authors.initials: P
authors.lastname: Sellick
authors.forename: Martin T
authors.initials: MT
authors.lastname: Stein
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000523:psychology*; D002648:Child; D002667:Child Reactive Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003299:Cooperative Behavior; D004325:Dreams / Q000523:psychology; D004775:Enuresis / Q000523:psychology / Q000628:therapy; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010372:Pediatrics; D010379:Peer Group; D012574:Schools; D012919:Social Behavior; D012931:Social Environment; D013239:Stereotyped Behavior; D013334:Students / Q000523:psychology*; D014256:Trichotillomania / Q000523:psychology / Q000628:therapy