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Guest khuram

Boy with a knife

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Could some body help with this one from spring 2005.

A 14 years old boy at boarding school pulls out a knife on two other boys and threatens them.He is known at school for being conscientious and keeping himself to himself.

His parents are worried that he will be expelled.A few weeks ago another boy at school threatens somebody else with a knife.

How do you manage this situation?

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this is a yukky one

ok i'll give it a go

for starters this is a serious one because there are issues of risk

risk to the boy himself, his fellow classmates and his teachers

probably other members of the public and possibly his immediate family.

hes carrying a weapon, hes usually quiet and concientious at school but there seems to be a change,.

hes been referred

start by getting some collateral info

GP/past med hx, anything past hx of note? new recent meds? past/present illnesses  etc

when did Gp last see him, what does the GP know about his social situation his family situation/dynamics? might be some clues there.

?

Perhaps a member of the Team might make initial inquiries to the school for further collateral since that would have been the route of the referral initially.

With parent s consent.

whats his eduational record like? any decline recently?

behaviour at school?

preference for being a loner? integrates well or not?

up to this did school have any concerns? if so what were they?

Does he have any other siblings attending school? what are they like? does he get on with them etc/

Time to arrange to see him and his folks . Full hx and dev hx from folks.

get his version of events

what happened

why he feels he needs carry a knife.

threatened?

recent? pay particular attention to his MSE. Signs  of depression, anxiety disorder, psychosis? ADJUSTMENT disorder (doesnt like being away from home)

PDD, aspergers? TLe etc

substance misuse? poss ADHD? approp rating scales if so.

urine drug screen

any forensic hx?

harm to animals fire setting?

etc

would diverge according to direction of probes from here

?

if prodromal:   need tx. risk assessment etc Moving to boarding school could be a major life event for him risk factor for SChz (really grasping at straws now but he might have had environmental risk factors at birth who knows!)

if delinquent behaviour =  police caution?

depression etc/

HELP!

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assessment was good- dutchie.

Imp to find out if this was a modelling behaviour , given that few weeks back a similar incident had occured. Could have LD with/without PDD. Especially around the incident, I'd look into antecedents, the behv and the consequence- how was the situation handled, any punitive action taken?

M/g- MDT involving.....

In most of the C&A scenarios, I'd say that psychological tx including behv tx would be my mainstay. Support and train school staff to deal with diff behv. Modify unwanted behv & reinforce good behv. Psychotropic meds as last resort.

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yep point taken

just wondered if boarding schools were the place for LD's though?

maybe hes just a thug and his parents live in the costa del crime.

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not so sure about includin LD- it saya he s conscietious...but definetle include aspergers. OCD too.

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There are definitely boarding school for LD esp autistic ones and also aspergers. ESPA is one of them. Some of these cases are fascinated with knives. Also, there seem a knife culture and this guy could be 'protecting' himself

Over and out, I have a meeting now!

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need to mention bullying, family problems and sexual abuse

dont mention LD (conscientious student)

discuss safety with teachers and parents( case conference) may need to switch schools

extra support etc

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he's conscientous and keeps to himself. Amongst other DDs I'd certainly consider an autistic spectrum disorder, poss Apergers/ High functioning autism

As mentioned before, risk assmt. v. impt

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as a last one, it would be better to leave a line of concern on the school for having 2 kids with a knife culture and have they take steps to stop any more?

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I would also look at parenting style (he's in a boarding school, 'concientious', keeps himself to himself...). How long has he been boarding? What attachments has he formed? Has he got friends?...

Was there any relationship between this boy and the one who pulled out the knife two weeks before?

What kind of knife did he have, and where did he get it from? (access to weapons)

What was the outcome of the threat? (just a threat, or did he actually harm anybody?)

...

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need to mention bullying, family problems and sexual abuse

dont mention [highlight]LD (conscientious student)[/highlight]

discuss safety with teachers and parents( case conference) may need to switch schools

extra support etc

Why cant a person with LD be conscientious?

I would be very cautious in what I commit myself to unless this can be substantiated with evidence. With the limited information from the PMP I will be broad and include LD too. Let the examiner narrow you down to the area they want to to focus on.

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Agreed, especially if the LD is a 'mild' or 'borderline' (I don't know if suitable to use this term, it's referred to somebody having around IQ of 75-80).

All LD ppl did things 'conscientious', in terms of their level of intelligence.

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i think CONDUCT DISORDER is one of the imp dd's here we should go through the ICD criteria in the assessment part

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I think that most of the PMP have a key issue and you need to discuss that

In this case the key issue is regards to bullying. You need to mention other things but if you are too inclusive then you just look amateurish

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