Johnathan is a nine year, eight month old, Caucasian boy with a history of severe physical assault of his mother and peers, homicidal threats, self-abusive behaviors, firesetting, and psychotic symptoms, admitted to Perkins for a forty-five day, diagnostic evaluation, and possible long-term placement.
             The first time I met john, he was in the time-out room. He appeared dissociated and possibly psychotic. He had glassy eyes, he alternated between staring in space, laughing loudly and jumping around, throwing himself against the walls or lying down, rolling, imitating being in restraint with his arms folded and his hands on his back. When questioned about what was going on, he did not respond.
             The second time we met, we played a board game. John was constantly moving, distracted by minor stimuli joking. He cheated all the time, but denied it, and was irritated when confronted about it. He avoided answering any questions about his past except that he acknowledged being scared of his father. His affect was anxious and mildly elated. He admitted that he had a bad temper and had hit people in the past and smiled while talking about it. He denied current auditory and visual hallucinations, but said that he had heard voices in the past telling him to hurt people. He also said that he was sad because he wanted to go home, and that he would run away. He denied suicidal and homicidal ideation. He did know why he had rage outbursts and could not talk about his odd behaviors in the time-out room. He often redirected the conversation toward the game and it was difficult to assess his thought process. However, there was no evidence of delusional belief. During the fi!
             rst three weeks in the program, john made several attempts to run, refused to do school work, and had a very low frustration tolerance that led to several physical restraints. Then, he appeared to settle and become motiv
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