want you to watch what is happening in there and tell me if you come to any conclusions,’ Dr Benedict said, handing out copies of the child’s case notes. ‘Matthew is six years old, and his mother is becoming quite concerned about his behaviour. He takes little notice of what she tells him, and she is increasingly worried about his habit of pulling faces and making odd gestures. There are problems at school, too. According to his teachers, he isn’t making progress in quite the way that they might have expected, and they feel that he can sometimes be disruptive and inattentive, and answer questions with inappropriate or nonsensical remarks.’
He showed them where they could stand and watch the proceedings. Megan stood to one side of the view panel, ignoring the case notes for a moment while she watched the little boy work his way around the room.
At this moment he appeared more confident and was rushing around from one table to another, but then he stopped and sat down, seeming to be momentarily unsure of himself. The therapist spoke to him but he didn’t appear to be taking much notice of what she was saying. After a minute or two, though, he suddenly stood up and swerved away from her and swooped on a table where soft toys had been set out. He picked them up one by one and danced them round the table.
It wasn’t long before he lost interest in that exercise, too, and turned to see what else there was for him to do.
At the side of the room, a jigsaw caught his attention. He began to chuckle and gathered the pieces up in his hands, dropping them like a shower of confetti on to the table so that some of them fell to the floor. Then he sat down and simply stared at them until the therapist came to stand beside him.
She spoke to him but once again he ignored her and after a moment or two he began to pick at his clothes in an odd fashion, before continuing to study the pieces on the table.
Megan briefly turned her head towards Sam Benedict and asked quietly, ‘Has he been here before? Is the room familiar to him?’
He shook his head. ‘No, this is his first visit.’
They watched him for a few minutes more, and then Sam looked at David Jones and James Morgan and asked, ‘What do you think? Any suggestions as to what might be his problem?’
‘I think it’s probably a case of attention deficit disorder,’ Dr Jones said confidently. ‘He totally ignored what the therapist was saying to him at one point.’ He was a young man with a shock of fair hair that tumbled over his forehead and caused him to push it back from time to time.
‘And possibly hyperactivity as well,’ Dr Morgan added, rubbing a hand thoughtfully over his jaw. ‘He seems excitable at times, with all that rushing about, and then at others he appears to dismiss what the therapist is saying to him and does what he pleases instead.’
He was a year or two older than Dr Jones and Megan had found that she got along well with him. He had a wry sense of humour that she appreciated.
‘And what treatment would you recommend?’
‘Given that the school has noted his lack of attention and excitability, I would suggest that he attends a child guidance clinic. We should probably ask for social worker involvement, too,’ James responded. ‘There may be a problem at home that needs to be looked into. According to the case notes, there’s a younger brother, so there may be some sibling rivalry.’
David added, ‘It might be a good idea to bring in an educational psychologist to liaise with the school.’
‘Hmm… Is there anything else?’
‘Well, they do say that some cases respond to treatment with Ritalin, though I don’t know what the long-term situation would be if we went down that road,’ James murmured. ‘I imagine that we would assess him every six months or so to check on his progress.’
‘And what is your opinion, Dr Llewellyn?’ Sam Benedict turned to Megan, his grey eyes narrowing sharply on her. ‘You’re keeping very quiet. Are you in agreement with what has been said so far? What do you think should be done?’
Megan swallowed carefully. ‘I wouldn’t like to say, at this stage,’ she returned evenly. Dr Benedict lifted a dark brow, and she added cautiously, ‘I would prefer to talk to the child myself before I made any decision, especially one that would involve a barrage of specialists invading his life.’
His mouth made a wry shape. ‘If that’s what you want, by all means go in and spend some time with the child. While you’re occupied with him, the rest of us will sit here and talk for a while.’
He probably thought that she was wasting everybody’s time, but she went ahead anyway, leaving them to it. She had never believed in practising medicine at a distance. To her mind, you needed to talk to a patient to be able to really understand what was going wrong.
Matthew studied her suspiciously as soon as she entered the room, glaring at her from under dark lashes. He had dark hair, cut short and spiky, and to her he looked like a very young and vulnerable little boy who was unsure of the adults around him.
She gave him a smile. ‘Hello, Matthew,’ she said gently. ‘Don’t mind me. I’ve never been here before, and I thought I would come and have a look around. There are lots of things in here to play with, aren’t there? I don’t know which I would choose for myself. What sort of toys do you like best of all?’
‘Trains,’ he said. Then, clearly warming to the subject, he went on, ‘You put them on the track and they whizz round and round and up and down over the bridge, and then they crash off the lines and everything falls over.’ He paused for a moment, then added grumpily, ‘They haven’t got one here.’
Megan looked around. ‘No, you’re right. I can’t see one. That’s a shame, isn’t it? Do you have a train set at home?’
He didn’t answer, appearing to lose interest in the conversation. He stared straight ahead at the pieces of the jigsaw. Megan tried again. ‘What do you like playing with when you’re at home?’
There was still that blank stare, then after a moment or two he picked up a couple of pieces of the jigsaw and slotted them into place. He selected another piece and studied it carefully. ‘This one’s part of the slide—see? It’s red, and the children like playing on it,’ he said seriously.
The picture on the jigsaw box showed a children’s playground, and she guessed that he was imagining the scene.
‘They look happy, don’t they?’ She glanced at his face, and asked, ‘Do you like doing jigsaws?’
He shrugged his shoulders, and at that moment she became aware of Sam Benedict standing by her side. She had been absorbed in her conversation with Matthew, and didn’t know how long Sam had been standing there.
She looked up at him. ‘Sorry—have I been too long?’
‘Not at all. You should take as long as you think you need.’ He pulled up a seat and sat down next to Matthew. ‘Have you been all right, here, Matthew? Is everybody looking after you properly?’
‘They haven’t got a train set,’ the little boy complained. ‘I’m not coming here again.’
‘Haven’t they? I’ll have a word with Miss Maxwell about that,’ Sam said, his face taking on a serious expression. ‘What about everything else here? Is there anything else you would like to do—what do
