Tess is a 10-year-old girl. She is an only child who lives with her parents. Tess has suffered from asthma since she was six. Her asthma has often restricted her from outdoor activities and she has never been allowed to take part in games at school. In the past, because of this, other children have teased her but this has not happened recently. She has always been timid but has two friends she plays with at school although she has no social life out of school hours.

Tess has started to miss school regularly due to apparent stomach pains and nausea. The GP has indicated that there is no apparent organic basis to these complaints.

Her mother is anxious and inclined to be protective of her. She has never let her travel to school alone despite the fact that they live three houses down from the school. Her mother allows her to stay at home if Tess complains of feeling ill. When Tess attends school she seems pre-occupied and is unable to concentrate but can usually complete the requests of teachers. Her schoolwork has deteriorated recently and she has slipped from being one of the most able children to slightly below average. Poor school attendance has threatened her fragile social relationships.

She is anxious and worried and appears to be preoccupied with this at times. This seems to be related to going out of the house unaccompanied by her mother, and in particular at the thought of meeting other children. Tess doesn’t like playing out and prefers to stay at home with her mother. Recently she has started picking and scratching her skin occasionally drawing blood.

Tess’s mother was ill about six months ago with newly diagnosed diabetes and needed hospitalisation. Tess has since been very worried about her mother’s health. Her parents have been having loud verbal arguments every few days. Her father has responded to this by working very long hours and coming home long after Tess’s bedtime. Tess has felt low in mood since her father has been spending less time at home.
Tess’s mother is aware that the marital conflict is impacting on Tess and has found out what services are available to support them.

(Source: Adapted from NSW Mental Health Outcomes and Assessment training for Children and Adolescents (MH-OATCA) Facilitator's Manual, NSW Health Dept 2002)

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