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Richard is just over 2 1/2 years old, and his mother asks for your help because she finds his “temper tantrums” increasingly difficult to handle. His behaviour is now so troublesome, that the entire family is affected. For example, they can no longer go out together for a meal.
Richard was born at term by normal delivery and his neonatal course was unremarkable. His mother says he was always a “difficult” baby: his sleep pattern was erratic, his predominant moods tended to be “grumpy” and he often winged and whined. He always did and still does display intense and extreme emotional reactions, both to novel situations or when he is thwarted. He has never been “cuddly”.
When going over his development, you notice a degree of speech delay: Richard only has a vocabulary of at most half a dozen words, and these are difficult to understand. He is not putting any words together. Richard’s mother reports that his non-verbal communication is good: he points at things when he wants them and becomes very upset when his wishes are not gratified.
Richard has brought with him a set of Thomas the Tank-engine and lies on the floor pushing the engines backwards and forwards for 20 minutes without interruption.