NAME:   Josh Andrews AGE: 8 years 10 months CASE: Brought into A&E; fall from garage roof. No movement in left arm.

NOTES

Josh falls 4 metres onto concrete.

His shoulder and arm are X-rayed: he has a break in both. He will need support for his neck. While he is being treated he is abusive to doctors and nurses. This upsets his mother a great deal. She tries to excuse it; “Never does what he's told.” “Just acts crazy all the time - even at school.”

His erratic behaviour has often been commented on at school. Teachers say, “Blurts things out when he feels like it.”

Mother at her wits' end. Diet…only eats sausage and chips or burgers and chips. Throws plate across room if given anything else. Mother says that he behaves perfectly well with his grandparents. NB: grandparents give into his every wish.

RELEVANT FACTORS:

• Josh's arm and shoulder need attention; the bones need to heal and his muscles will need attention afterwards.
• Josh's behaviour – especially his speech, erratic behaviour, eating habits. Note that it would seem to be more than a naughty boy. His behaviour is irrational. Take these three issues together.
• Josh is diagnosed with Attention Deficit and Hyperactivity Disorder – ADHD. How can this be managed?
• The final issue here is his behaviour with his grandparents. Josh, his mother, his grandparents must be seen as a group; their relationships are important. Josh may need to practise good social interaction.