Sebastian had been born prematurely and with significant neonatal complications.1 His growth was stunted, and he had an odd appearance: a head too large for his body, a barrel chest, and an awkward gait. His extensive vocabulary contributed to the mismatch between his appearance and his age and gave evidence of his extraordinary intelligence. When he was seen at age 7 years in an evaluation at the Community Therapeutic Day School, he was threatening to kill himself or someone else and had recently gone after his parents with a pair of scissors. It was near the end of the academic year and the school and parents were considering either a residential placement or a hospital day treatment when we suggested that we put a program in place in the Waterloo Elementary School. The school hired an aide whom we recommended, and she began the program at Sebastian’s home to stabilize him and to establish a relationship that would enable her to contain him when he was ready to return to his classroom. After several weeks at home, Sebastian and his aide reentered the classroom to finish out the year. He continued to have great difficulty when he could not follow his own agenda or otherwise felt intruded on. He had a diagnosis of pervasive developmental disorder and clearly had significant sensory processing issues. He refused to write and resisted doing any mathematics. He would suddenly spiral down into despair, and through waves of anxiety

and threats he would attempt to pull down with him anyone he could. His aide spent much of the time holding him both in and out of the classroom and managed to work well with the teacher, who accommodated Sebastian’s presence there. He finished out the year having made some gains and solidifying his relationship with the aide.