A difficult adjustment to school: the importance of family constellation.

CASE The parents of a 6-year-old boy whom you have known most of his life request a long appointment to discuss some recent troublesome behaviors. Apparently, the first-grade teacher is concerned about his being withdrawn and quiet in class and hanging back from his classmates in free-play time. Occasionally he is aggressive with the other children. This behavior puzzles his parents because he was an exuberant and outgoing child in the playgroup and kindergarten that he attended for 2 years, and there had been no reports of disruptive behaviors. His parents are both professionals, one a nurse and the other a high school teacher. They live in a comfortable middle-class suburban community. Because they are lesbians, they took their son to a preschool playgroup and kindergarten in a neighboring town with several other gayand lesbian-headed families. Many of their social activities have been with this same group of families. They are expecting another child in 3 months. The boy has shown no worrisome behavior at home but has seemed increasingly unenthusiastic about going to school. In addition, recently he has been asking a lot of questions about his father, wanting to see pictures of him and demanding to know why he is not a part of the family. He has been reluctant to invite any of his classmates to play dates but prefers to visit with his friends from his former kindergarten class.