| Tears quickly welled up in her eyes and flowed in | | | | offer a definitive diagnosis of ADHD, it was most |
| streams down her face. Her voice was choked with | | | | important that I respond to Kristen's unshakable belief |
| pain as she attempted to answer my questions | | | | concerning her impaired attention. Her self-diagnosed |
| regarding her school performance. Although I was | | | | ADHD in combination with her learning weaknesses |
| asking routine questions typical for an ADHD | | | | had already caused serious damage to her |
| (Attention-Deficit/Hyperactivity Disorder) evaluation, | | | | self-perception as a learner. |
| Kristen's emotional response could not have been | | | | Kristin's parents were given the chance to use a trial |
| anticipated especially for a thirteen year old high school | | | | of stimulants for Kristin. Even though Kristen was |
| student. Kristen believed that her problems with broken | | | | convinced she was attention impaired, her parents |
| concentration started in the fourth grade. She felt | | | | were still concerned about using medications to help |
| unable to control her wandering thoughts even when | | | | her. I was careful to outline my personal reservations |
| involved with casual conversations with others. Despite | | | | about using medications for a child with only a |
| her difficulty listening to auditory instruction in the | | | | provisional diagnosis of ADHD. In a myth dispelling |
| classroom, Kristen usually was too shy to ask for | | | | statement, I clarified that most stimulant medications |
| further explanation or additional help with her assigned | | | | often will enhance a child's attention and task |
| work. As a result, her grades suffered as did her | | | | engagement even when not diagnosed with ADHD. |
| feelings of confidence as a student. | | | | While I would never recommend giving medication to a |
| Kristen's tears and painful description of her academic | | | | non-ADHD child, a provisional ADHD diagnosis would |
| frustrations tugged seriously at my heart strings. It was | | | | allow us to be responsive to Kirsten's convictions |
| pretty uncommon for me to hear a teenager speak | | | | regarding her own attention impairments. In Kristen's |
| so candidly and credibly about her attention problems. | | | | case, stimulant medications could easily offer some |
| Kristen was convinced that she had ADHD. Yet, I was | | | | improved attention and concentration that may |
| struck by the lack of supporting data in other areas of | | | | enhance her learning. Her improved attention would |
| her life. Descriptions of her behavior by her parents | | | | also allow for a more valid assessment of possible |
| and classroom teachers failed to identify Kristen with | | | | learning disabilities disrupting her performance. Although |
| any notable attention deficits or distractibility. Kristen | | | | the use of medications should always be taken |
| had almost completed elementary school before her | | | | seriously and with recognition of associated risk |
| teachers expressed initial concern about her | | | | factors, close monitoring of Kristen's medication |
| inconsistent work performance. According to her | | | | response would diminish our remaining concerns for |
| parents, Kristen began to show homework avoidance | | | | this intervention. |
| just prior to the start of middle school. Neither her | | | | In addition to the trial of stimulant medications, Kristen's |
| parents nor early classroom teachers had ever | | | | parents decided to ask the special education team at |
| recognized that Kristen struggled with inattention or | | | | her high school to complete a learning assessment. In |
| distractibility. Kristen's early developmental history and | | | | this way, achievement and cognitive testing could |
| family history were equally absent of any positive | | | | provide invaluable information on Kristen's intellectual |
| ADHD factors. | | | | abilities as well as her learning style. If she should |
| My interview with two of Kristen's middle school | | | | qualify for programming, Kristen would likely benefit |
| teachers failed to reveal additional information that | | | | from the additional academic support the school could |
| would support ADHD. Kristen was described as a | | | | provide her. The parents were also prepared to |
| student with weak academic skills. Her work effort in | | | | provide Kristen with private tutoring as necessary for |
| the classroom was inconsistent at best. Her interest | | | | the remainder of her high school years. Although |
| and motivation to invest her best effort seemed to | | | | Kristen's career path promised many future challenges, |
| always decline at mid-year. She often would invest a | | | | her parents were comforted by the intervention plan |
| more concerted effort at the end of the school year | | | | that was formulated. |
| to improve her final grade. Yet her teachers never | | | | Seven days later, Kristen and her parents met with the |
| recognized Kristen as struggling specifically with | | | | pediatrician to review a selection of a stimulant |
| inattention or distractibility in the classroom. However, | | | | medication. Although Kristen was slightly anxious |
| her teachers did describe Kristen with weak | | | | starting a medication trial, she was substantially |
| comprehension and low quality performance that | | | | comforted by the hope of improved concentration and |
| earned her low grades in English, Math, and Science. | | | | mental organization. The medication seemed to |
| Kristen was described as a typical teenager at home. | | | | provide her with emotional reassurance and renewed |
| She often needed reminders in order to complete her | | | | optimism regarding her future academic efforts. Her |
| assigned chores. She showed a great deal of | | | | parents also informed her of their intention to request a |
| forgetfulness around personal responsibilities unless | | | | comprehensive educational assessment from her |
| there was an immediate incentive available to her. It | | | | school's special education team. If a learning disability |
| was not difficult for me to recognize her selective | | | | were identified, Kristen would then qualify for |
| memory and convenient forgetting as typical teenage | | | | individualized academic support. Even if a significant |
| behavior. | | | | learning disability was not identified, it remained possible |
| After reviewing all of this past and current information, I | | | | to recognize her attention weaknesses as a disruptive |
| felt it was impossible to identify Kristen with ADHD. | | | | handicap qualifying her for additional academic support |
| Yet here she sat in front of me personally convinced | | | | from special education. |
| that she had problems with attention. Emotionally | | | | Kristen's story can teach an important lesson when |
| distraught by this realization, Kristen saw herself as | | | | considering the possibility of ADHD. In her case, there |
| handicapped by ADHD. In her opinion, her difficulties | | | | were many factors that failed to support this diagnosis. |
| with English and Math were less important concerns. I | | | | Yet her personal conviction regarding her impaired |
| then realized how critical it would be for me to prioritize | | | | attention demanded to be factored into the ADHD |
| her attention weaknesses over her learning problems. | | | | equation. In this evaluation, I learned to listen more |
| I offered two provisional diagnostic statements for | | | | carefully to the self assessment provided by this older |
| Kristen that addressed her learning disabilities as well | | | | patient. Kristen was certainly well capable of |
| as attention deficits. I recommended that she receive a | | | | accurately describing her personal experience, and her |
| comprehensive educational assessment while starting | | | | self report justified a provisional diagnosis of ADHD. |
| a trial of stimulant medications. Although I could not | | | | |