This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division) efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷) in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.