Raising Austin

Austin's small face contorts into a scowl. "I can't wait to get to school, to call them something bad!" he sputters.

His sister starts to say something, but he cuts her off. "Shut up, Maddie, I'm gonna kill you."

Jeanne frowns but determinedly ignores this. "Did you take your medicine?" she asks. She reminds him quietly that the reason he fell to Level 4 was that his conduct was not great last week and that he had expected to earn bonus points by behaving well and doing extra math on Friday -- but bad weather caused him to miss math.

"I'm gonna call them a beast, and anything I want," Austin says.

"That's not going to get you anything," Jeanne says.

Austin responds: "It gets me nothing because I don't have a GameCube. I can't get back the GameCube by good behavior at school -- only by good behavior with the babysitter." This apparent non sequitur involves Austin's major obsession: his Nintendo GameCube video toy. Under a separate incentive system at home, Austin earns minutes of weekend playing time by reading and behaving himself at home. But this past weekend, he acted out so wildly with a babysitter that the GameCube was confiscated until he earns it back, under a new contract with his parents.

"Can I kill you?" Austin asks matter-of-factly. Jeanne again ignores him. Psychiatrists and behavior therapists who have worked with Austin have told the Harples they believe his cursing and verbal threats come from a lack of impulse control arising from a complex combination of problems. They include an underlying neurological disorder that disrupts his sensory abilities; attention deficit hyperactivity disorder (ADHD); obsessive-compulsive disorder (OCD), which creates constantly recurring anxieties; and oppositional defiant disorder (ODD), which makes him inflexible and explosive. Austin's therapists have described his verbal venting as "mental debris" resulting from the volatile swirl of his emotions.

Jeanne has opened two capsules and mixed 250 milligrams of Depakote, a mood stabilizer, into a small bowl of applesauce. Austin swallows it, along with three pills of Trileptal, a similar drug. He also takes methylphenidate, the generic name of Ritalin, to help focus his attention.

"Austin, what do you want for lunch beside SpaghettiOs?"

"I don't know . . . a jackass?" He smiles naughtily.

"If you go in there with an attitude, it may be worse," she warns him, but if he behaves at school, "they may not drop you a level."

"No, they already did." Austin scowls. He is now eating breath mints and chewing gum.