Case Study: When Behaviour Is Not the Problem
- drbobcarey
- Jan 13
- 9 min read
A Positive Systems Analysis of Jeremiah
Introduction: A Child Caught in Failing Systems
Jeremiah is a 10-year-old Neurodivergent boy with prior diagnoses of Autism Spectrum Disorder (ASD Without Accompanying Intellectual Impairment) and Attention-Deficit/Hyperactivity Disorder (ADHD) who has been experiencing escalating behavioural challenges across home and school environments. His presentation includes multiple daily outbursts characterized by screaming, physical aggression toward others, attempts to flee or elope from supervised settings, and episodes of self-injurious behaviour. These behaviours have become sufficiently frequent and intense that they now threaten his continued placement in a mainstream educational setting and have placed significant emotional, physical, and psychological strain on his family.
Importantly, Jeremiah’s behavioural profile exists alongside a pattern of significant cognitive strengths. Formal assessment places his overall intellectual functioning in the Superior range, with particular strengths in short and long-term memory, expressive and receptive language, numerical reasoning, and abstract conceptual thinking. He demonstrates an exceptional depth of knowledge in areas of personal interest—most notably astronomy and theoretical physics—and is capable of sustained, sophisticated discussion on topics well beyond age expectations, including quantum mechanics and cosmology.
At the same time, Jeremiah exhibits relative weaknesses in social comprehension, particularly in understanding implicit social rules, peer intentions, and emotionally nuanced interactions. This uneven cognitive profile— very high intellectual ability paired with social-cognitive vulnerability—has repeatedly led to environments overestimating his capacity to cope with complex demands, especially within unstructured or socially dense settings such as a mainstream Grade 5 classroom.
Escalation Across Systems
While Jeremiah’s behaviours occur at home, they are significantly more frequent and severe at school, where expectations for independence, social navigation, emotional regulation, and behavioural inhibition exceed his current skill set. In response to these behaviours, the school has expressed concerns regarding safety and resource limitations and has indicated that further incidents of aggression may result in suspension.
This response has intensified family distress and reinforced a growing sense that Jeremiah is being viewed primarily as a problem to manage rather than a child to support. At home, the impact has been equally profound. Jeremiah lives with both parents and a younger brother, age 7. Episodes of aggression toward family members—particularly his sibling and mother—have eroded the family’s sense of safety and stability.
The parents describe chronic exhaustion, emotional burnout, and increasing isolation. Attempts to secure respite services have been unsuccessful, as alternate caregivers have declined involvement due to the perceived severity of Jeremiah’s behaviour.
History of Behavioural Intervention
Prior to the current consultation, Jeremiah and his family engaged in traditional behaviour therapy under the direction of a local behaviour therapist and psychologist. These interventions were largely rooted in consequence-based behaviour management, with an emphasis on reducing observable behaviours rather than understanding or addressing their underlying causes.
Strategies included:
Exclusionary time-out in response to aggression and screaming
Reactive consequence systems designed to suppress behaviour
Environmental restriction strategies, including locks and alarms placed on bedroom and exterior doors to prevent elopement
Although some short-term improvements were occasionally observed, these gains were brief, inconsistent, and highly situation-specific. Behavioural changes did not generalize to other settings—particularly school—and often deteriorated once expectations increased or supports were reduced.
From a Positive Systems perspective, these outcomes reflect a mismatch between the intervention model and Jeremiah’s actual needs. Strategies focused on control and containment rather than skill development, emotional regulation, or environmental adaptation.
Psychiatric Intervention and Medication History
In parallel with behavioural interventions, Jeremiah was evaluated by psychiatry and trialed on psychotropic medications, including Abilify (aripiprazole), in an effort to manage his aggression and emotional dysregulation. Despite careful monitoring, these medications produced no meaningful improvement and were associated with significant side effects, further complicating Jeremiah’s functioning.
Comprehensive medical investigations ruled out underlying medical causes for his behaviour, leaving the family with the painful realization that neither medication nor traditional behaviour management was addressing the root of the problem.
A Family at the Breaking Point
By the time of referral, Jeremiah’s parents described themselves as being “at the end of their rope.” They reported feeling blamed by systems, judged by professionals, and increasingly fearful about the future.
The convergence of school exclusion threats, ineffective interventions, medication failures, and lack of respite had created a crisis not just for Jeremiah, but for the entire family system.
This is precisely the kind of situation that exposes the limitations of traditional approaches and highlights the need for a Positive Systems Approach—one that recognizes that when behaviour persists, it is often the system that must change.
Closing Reflection: A Parent’s Perspective
When we look back over the past few years, it feels as though we have spent most of our time reacting—putting out fires, attending emergency meetings, rushing to appointments, and bracing ourselves for the next call from the school. Every new strategy was introduced with hope, and every failure felt heavier than the last.
What has been most painful is not simply the exhaustion, but the sense that Jeremiah has slowly been reduced to a list of behaviours—aggressive, non-compliant, unsafe—rather than seen as a whole child with strengths, curiosity, and a remarkable mind.
As parents, we have lived in a constant state of vigilance. Our home, which should be a place of safety and connection, has too often felt like a containment zone. We worry about our younger son. We worry about our marriage. We worry about what happens if the school gives up on him entirely.
What we are asking for is not perfection. We are asking for understanding. For patience. For a system willing to adapt, rather than punish a child for struggling.
A Contrast in Perspectives: School System Voices
Throughout Jeremiah’s journey, school staff have expressed genuine concern alongside significant constraints. Their perspective reflects the pressures faced by educational systems that are often under-resourced and risk-focused.
These statements are not without validity. Schools operate within real limits—time, funding, staffing, and policy. However, when viewed through a Positive Systems lens, they also reveal a fundamental misalignment: the system is asking whether it can tolerate the child, rather than how it can support him.
From the family’s perspective, this feels less like an intervention and more like a withdrawal of support.
Bridging the Divide: A Systems Reflection
This contrast—between a family pleading for understanding and a system focused on containment—highlights the core issue at the heart of Jeremiah’s case. His behaviour has been treated as a problem to be managed rather than a signal pointing to unmet needs, skill gaps, and environmental mismatch.
The Positive Systems Approach does not deny the challenges faced by schools, nor does it minimize the seriousness of aggressive or unsafe behaviour. Instead, it reframes the question:
Not “How do we stop this behaviour?”
But “What is this system asking of this child that exceeds his current capacity—and how can we change that?”
True progress for Jeremiah will not come from stronger consequences, higher doses of medication, or increased exclusion. It will come from alignment—between home and school, between expectations and capacity, and between behaviour support and genuine understanding.
Case Conceptualization Through a Positive Systems Lens
Rather than viewing Jeremiah’s behaviour as willful, oppositional, or pathological, PSA reframes it as communication occurring within a system that is not meeting his needs.
Below, Jeremiah’s situation is examined through the seven Individual Factors and seven System Factors central to the Positive Systems Approach
What if it's not Just Behaviour???…
INDIVIDUAL FACTORS
1. Identification: Understanding the “Why” Behind the Behaviour
Jeremiah’s behaviours are not random. They are predictable, patterned, and context-dependent.
Key identified contributors include:
Social comprehension deficits despite high verbal intelligence
Executive functioning challenges related to ADHD
Intense cognitive rigidity around preferred interests
Difficulty with transitions and uncertainty
Emotional overload, particularly in complex social environments
At school, Jeremiah is expected to function like a neurotypical Grade 5 student socially and behaviourally—despite clear evidence that this exceeds his current skill set. His behaviour communicates distress, confusion, and an inability to cope with competing demands.
PSA Insight: Behaviour is a signal, not a symptom to suppress.
2. Reinforcement: How Behaviour Has Been Accidentally Strengthened
Previous interventions relied heavily on:
Exclusionary time-out
Physical containment strategies (locks, alarms)
Reactive consequences
While well-intentioned, these strategies inadvertently reinforced:
Escape from overwhelming environments
Avoidance of difficult social or academic demands
Power struggles rather than skill development
At school, aggressive episodes often resulted in removal from class—providing immediate relief from stressors, thereby strengthening the behaviour.
PSA Insight: If behaviour continues, it is working for the child.
3. Coping: Absence of Usable Regulation Skills
Jeremiah has not been effectively taught how to:
Recognize rising emotional distress
Ask for breaks or modifications
Regulate during moments of overload
Recover after escalation
Expecting regulation without explicitly teaching it is a common systems error.
PSA Principle: We do not punish missing skills—we teach them.
4. Communication: High Language ≠ High Social Understanding
Jeremiah’s advanced vocabulary and expressive language mask:
Difficulty interpreting social nuance
Challenges with perspective-taking
Literal interpretation of expectations
Misreading peer intent
This discrepancy often leads adults to overestimate his social capacity, resulting in repeated failure experiences and frustration.
PSA Insight: Intelligence does not equal emotional readiness.
5. Relationships & Rapport: Erosion Through Control-Based Responses
Repeated crisis responses, physical containment, and punitive strategies have weakened Jeremiah’s sense of safety with adults—particularly at school.
Without psychological safety:
Trust diminishes
Compliance decreases
Behaviour escalates
PSA Principle: Regulation follows relationship.
6. Re-Direction: Missed Opportunities for Preventative Support
Redirection was applied after escalation rather than before distress peaked. Jeremiah required:
Predictive supports
Advance warnings
Choice-based transitions
Interest-based engagement
Instead, interventions focused on stopping behaviour rather than preventing it.
7. Stimulation: Strengths Used as a Barrier Instead of a Bridge
Jeremiah’s passion for space was treated as an obstacle rather than a resource. Attempts to suppress or limit this interest increased rigidity and distress.
PSA reframes intense interests as:
Emotional regulators
Motivational anchors
Learning and connection tools
PSA Insight: Interests regulate the nervous system.
SYSTEM FACTORS
1. System Consistency: Fragmentation Across Settings
Home and school responses were inconsistent, leading to:
Confusion
Increased testing of boundaries
Lack of generalization of skills
PSA emphasizes cross-environment alignment.
2. System Flexibility: A One-Size-Fits-All Classroom
Jeremiah’s placement in a standard Grade 5 classroom without adequate supports placed excessive demands on him.
Rather than asking:
“How do we make Jeremiah fit the classroom?”
PSA asks:
“How does the classroom adapt to Jeremiah?”
3. Team Health: Burnout and Fear-Based Decision-Making
Parents are exhausted. School staff feel unsupported. Decisions are driven by risk management rather than therapeutic intent.
Burnout leads systems to default to exclusion rather than problem-solving.
4. Tolerance & Perseverance: Short-Term Fixes, Long-Term Failure
Previous interventions were abandoned when immediate results did not appear. PSA recognizes that:
Skill development is nonlinear
Behaviour worsens before it improves
Persistence is essential
5. Leadership & Advocacy: The Family Left to Navigate Alone
Threats of suspension reflect a system prioritizing liability over inclusion. Jeremiah’s family requires:
Advocacy
Collaborative planning
System-level accountability
6. Environment Design: Crisis-Driven Rather Than Predictive
Locks and alarms addressed fear but did not teach safety or autonomy. PSA emphasizes:
Predictable routines
Clear expectations
Dignity-preserving supports
7. Values & Philosophy: Control Over Understanding
The dominant framework applied to Jeremiah was behaviour suppression rather than human support.
PSA represents a philosophical shift:
From control → connection
From compliance → competence
From punishment → prevention
Why Previous Interventions Failed
They failed because they:
Targeted behaviour without understanding function
Ignored cognitive-emotional mismatch
Relied on exclusion and control
Did not modify the system
Overlooked strengths
Created fear rather than safety
A PSA-Aligned Path Forward
A Positive Systems Plan for Jeremiah included:
Interest-based regulation and learning
Explicit teaching of coping and transition skills
Environmental accommodations at school
Collaborative crisis planning
Parent support and respite development
Removal of exclusionary and punitive strategies
Rebuilding trust through connection
Jeremiah does not need more consequences. He does not need stronger medication. He does not need tighter controls. He needs a system that understands him.
When we stop asking, “How do we stop the behaviour?” and start asking, “What is the system asking this child to tolerate that exceeds their capacity?”—real change becomes possible.
Outcomes: What Changed When the System Changed
To better understand the impact of implementing the Positive Systems Approach, outcomes were tracked across several meaningful dimensions—not simply whether behaviour “stopped,” but how Jeremiah’s overall functioning and recovery improved over time.
Key Outcome Domains Tracked
Frequency of behavioural escalations
Intensity of escalations
Length of recovery following distress
Risk of exclusion or suspension from school
The chart above used a 10 point rating scale (with 10 representing extreme difficulty and 1 representing no difficulty), completed by Jeremiah’s parents and his teacher. The results illustrate a clear reduction across all domains following system-level change. Notably, the most significant improvements were seen in intensity and recovery time, even before frequency fully stabilized—an expected and healthy trajectory when regulation skills are being learned rather than forced.
PSA Insight:
A child who recovers faster and escalates less intensely is becoming more regulated—even if behaviour has not disappeared entirely.
These changes were achieved without increasing consequences, restrictions, or medication, and instead through coordinated adjustments to expectations, environments, relationships, and supports.
What the Data Doesn’t Show (But Families Feel)
While visual data captures measurable change, it does not fully reflect the lived experience of the family:
Mornings became calmer
School calls decreased dramatically
Parents reported sleeping better
Sibling interactions became safer and more predictable
Jeremiah began to seek help instead of fleeing
Bringing It All Together
Below - the charts, checklists, and guides reinforce a central lesson from Jeremiah’s case:
When systems change first, children don’t have to fight so hard to cope.
Free Downloads
Positive Systems Approach (PSA) – Implementation Checklist
To support families, schools, and professionals in applying these principles, a PSA Implementation Checklist has been created as a downloadable resource for your use.
👉 Download: PSA Checklist for Parents – Parent Guide (PDF)
How to Use the PSA Checklist: A Practical Guide
Parents often ask, “Where do we start?” This guide was created to answer that question clearly and compassionately.
👉 Download: How to Use the PSA Checklist – Parent Guide (PDF)
PSA School-Based Implementation Checklist
This second checklist was developed specifically for educational teams, recognizing the unique pressures and constraints schools face.
👉 Download the PSA School Implementation Checklist (PDF)
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