Sally, an eight-year-old girl, was put on Zoloft, a selective serotonin uptake inhibitor (SSRI) because she was becoming more “compulsive” and fretful, according to her mother. She was washing her hands twenty times a day, refusing to let her mother leave her “alone” at school, and would only play with children at her house. She and her mother were seeing a child psychologist employing “behavioral strategies” involving rewarding “appropriate behavior,” but when the symptoms got worse, Sally was put on medication. The medication, however, made the symptoms even more severe. That's when mother came in for a second opinion and I had an opportunity to conduct a comprehensive evaluation.

I learned that Sally was very sensory and affectively over-reactive, ever since she was an infant. While she had precocious language skills, her ability to sequence actions and engage in “big picture thinking” (i.e. see the forest for the trees) was limited. Mother was very anxious and tended to intrude and overload Sally by yelling a great deal, always demanding Sally do this or that and offering almost no soothing interactions. Father was a workaholic and didn't get home until Sally was asleep and on weekends was either short-tempered or into his work.

Sally was attentive and verbal, but very reactive to sensations, including loud voices or even rapid gestures. She did some pretend play, but it focused mostly on fears, such as dolls running from witches or “perfect worlds” where “everyone is nice.”