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Case: Carl is a 9‐year‐old male who presented to an outpatient clinic because he was demonstrating increasing social isolation and preoccupation with cockroaches. His teachers are also concerned about his unusually graphic drawings depicting violent themes. He is often described as “flat” and not easily engaged. He is reported to have an “odd” pattern of speaking. He has no close friends and is struggling academically. His mother and maternal uncle have a diagnosis of schizophrenia. His father has a history of being incarcerated for assault. He lives with maternal grandparents.