Case Study "George" Eight-year-old George was brought by his parents for an appointment at his local community mental health centre with the psychologist, Dr. Milton. His parents reported that they were at the end of their rope" trying to manage his behavior and activity level. They were becoming concerned as George was more and more disruptive in their home and he did not seem to have friends at school. George lives at home with his father (Mike, a chef) and step-mother (Nadine, a police officer), as well as his 5-year-old half-sister, Molly. They reported that they agreed in terms of their concern about George, and in fact, agreed about most things related to their children and home. No stressors were reported in terms of socio- economic factors. After a very conflictual period in his biological parent's relationship, George's biological mother (Jenna; an accountant) had separated from Mike. Jenna would usually call George on his birthday and at Christmas, but otherwise George had limited contact with her. The family had previously lived in Cape Town, South Africa before moving to Canada when George was 5-years-old; both of George's biological parents and step-mother were also raised in South Africa. With regard to family history, Mike indicated that he himself had struggled with social anxiety and had previously been taking medication to manage his anxiety. He also noted that he did not do well in school as he thought it was boring and would rather be doing other things. He indicated an extended family history of anxiety disorders, ADHD, ASD, and bipolar disorder. He also noted that George's biological mother was never formally diagnosed with a learning disability, but that she always struggled in school. There were no concerns reported with Molly's development except that sometimes she copies George's behaviour. Mike described that George was born premature at 33 weeks at a very low birth weight, following a planned pregnancy. Mike indicated he thought Jenna's early labour was due to her smoking during pregnancy. George's parents were both in their mid-to-late thirties when George was born, waiting until they had established their careers before having children. Despite being born premature, George has not had any health problems and a recent physical examination found him to be in good health. His hearing and vision were also recently checked, and no concerns were noted. He met all of his motor milestones at the expected ages, but was slow to start speaking, although now there were no language concerns. Mike indicated that once George finally started speaking in full sentences, he "hasn't stopped since", and talks incessantly, even if no one appeared to be listening. George was described as being a busy child who was constantly on the move and getting into accidents because he was always climbing and jumping off things, seemingly indifferent to the pain caused by his injuries. Sleep was described as slightly problematic for George, with some bedtime resistance but that once he was asleep (which took about 20 minutes to fall asleep) he stayed asleep and woke up feeling rested. No snoring, nightmares, or any other sleep problem were endorsed. Mike and Nadine indicated that they were concerned about his development and learning, as his younger sister was starting to surpass him in some of his academic skills. Nadine described how she had purchased a variety of educational materials to try and work on his reading and math at home, but despite this additional support, as well as additional support at school, he still was struggling with learning. Mike and Nadine described that George's behavior at home was become increasingly problematic over the past year. They described George as being " constantly moving like he has a motor", never able to sit for more than a minute at a time, leaving his seat often, and running around when he should be seated. This was reported as extremely disruptive especially if they were trying to have a meal or play a game as a family. Mike and Nadine both expressed that they were extremely frustrated and would often send George to his grandparent's house when they could not handle his behavior anymore. George's current Grade 3 teacher, Ms. Johnson, reported that George was extremely difficult to manage in the classroom. She described that George was almost never in his seat during class, and when he was in his seat, he would be touching all the objects in/on his desk and fiddling with them. She described him as the "Energizer Bunny". Whenever there was a noise somewhere in the class, he had to go inspect the source of this noise. Despite the fact that he was wandering around, he appeared to be