ADHD

Tammy’s Story

Tammy, an 8-year-old third grader, was halfway through the second grading period when her parents asked for another conference with her teacher. Her grades were very low with failure to complete class assignments and inconsistent performance on homework.

This wasn't the first time the school had raised concerns. Tammy was struggling with reading at the end of first grade in spite of testing by the school guidance counselor which showed very good ability. At the time Tammy complained that all the noises in the classroom were distracting. Further evaluation at that time through her pediatrician had suggested a possible diagnosis of ADHD, primarily inattentive type. Since there were no problems with hyperactivity her parents, especially her father, were reluctant to consider any medications. They got some self-help books to learn skills to help Tammy with her school assignments and address her "smart mouth" responses to adults. There was progress but her father complained that Tammy's mother was not consistent with discipline. Her mother argued that it didn't seem right that Tammy was always grounded and prohibited from all of her favorite activities.

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To help identify Tammy’s difficulties and to address the disagreement between the parents regarding the correct approach, Tammy was referred to a child psychiatrist. That evaluation confirmed the diagnosis of ADHD. The parents’ efforts at providing Tammy with structure for her schoolwork were helpful, but they all agreed this was not enough. Her father's position had softened after he talked with his sister whose son also has ADHD and had a good response to treatment with medication. She also reminded him of the struggles he had in elementary school and all the times he was sent to the office.

In a session that included her parents Tammy talked about how tired she was of being in trouble all of the time and about how discouraged she was about her school efforts. She cried herself to sleep many nights.

A decision was made for treatment with stimulant medication. Tammy had an expected response. She was especially pleased when she was moved to a higher reading group and she was picked for her school basketball team. Her medication was tailored for school time since her evening and weekend behaviors were not a problem.

Josh’s Story

Josh, a 19-year-old college student, came to a school clinic for help with academic problems. Since starting college six months earlier, he had done poorly on tests and could not manage his study schedule. His worries about flunking out of college were causing him poor sleep, poor focus and lost hope. After a week of low grades, he returned home and told his family he should drop out of college. His mother brought him to the clinic where he and his older brother had been treated for ADHD when they were younger. She wondered if his ADHD might be causing his problems, or whether he had outgrown it.

Josh had been to the clinic when he was 9 years old and had been diagnosed with ADHD. Notes from that evaluation showed Josh had been in trouble at school for getting out of his seat, losing things, not following instructions, not completing homework and not listening.

A psychologist also confirmed reading problems during the evaluation. Because Josh’s problems did not meet the standard for a learning disability diagnosis, he could not receive special education services. Josh’s primary care doctor had proposed medication, but his mother refused. Instead, she hired a tutor to help her son “with concentration and reading.”

Since starting college, Josh said he often had trouble staying focused while reading and listening to lectures. Because of his stress at school, he had trouble falling asleep, had poor energy and didn’t “have fun” like his peers.

Josh’s older brother had ADHD. His father, who died when Josh was seven, had dyslexia (a reading disorder). His father had dropped out of community college after one semester.

Josh was referred to a psychologist for more testing, and the doctor diagnosed him with ADHD. The report stated that Josh had certain problems with reading fluency and comprehension (reading quickly and know the correct meaning), as well as spelling and writing. When he was first assessed at age 9, the standards for ADHD required six of nine symptoms. He had been diagnosed with the combined type of ADHD, because the specialty clinic had found at least six symptoms in inattention and hyperactivity/impulsivity. With DSM-5, only five symptoms are needed for people age 17 and older. At age 19, Josh met the standards for ADHD and for a specific learning disorder. With the correct diagnosis, he was able to receive services for academic support for his college studies.