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Case: Bella is 9 years old and in the 4th grade. Bella's mother sought treatment due to increasing disruptive behaviors over the past year, including non-compliance, physical aggression toward peers, and frequent behavioral meltdowns which resembled the temper tantrums of a much younger child. Tantrums included screaming, yelling, slamming doors, and crying. Bella and her mother both noted that it was difficult for Bella to "move on" when something angered her. She also noted that Bella had an underlying irritable mood, manifesting as Bella appearing "cranky" most of the time and the family feeling they needed to "walk on eggshells" to avoid upset. At school, at least one phone call home per week was being placed due to Bella's refusal to comply or sometimes to even speak to her teacher for days at a time. Bella and her mother noted that Bella was generally well-liked by peers and teachers, given that she was hardworking and funny. Yet, her current disruptive behaviors were causing significant interference in making new friends and meeting academic goals.
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