The story of Stephanie, an eight-year-old patient in our practice, illustrates our approach to ADHD and how we help children overcome the challenge of learning to pay attention. Her name and other identifying information have been changed.
Stephanie came to us because she was having difficulty with reading and math in school and because her teacher had labeled her as having ADHD. At school, she was active all the time, chitchatting with her friends and darting about the classroom. At home, Stephanie was also always on the move, getting into frequent conflicts with her sister, even becoming aggressive, which is unusual for a girl her age. Her teacher kept putting pressure on Stephanie's parents to see her as having ADHD and get her "medicated" to improve her focus and attention. Stephanie was in the second grade and heading into the third grade very shortly, and her parents were told she wouldn't be able to keep up with the work, given her "ADHD."
When I initially observed Stephanie in my office, I saw a spirited girl who came in with two motivated, conscientious, thoughtful parents. (Dad was an attorney, and Mom, who previously worked in public relations, stayed at home with Stephanie and her two younger siblings.) Stephanie was indeed active, and her curls bounced as she explored every corner of the office, getting up and down, fidgeting, and moving her arms and legs all the time. Not only was her activity level very high, but her thoughts shifted rapidly as well. When I observed Stephanie with her parents and individually, she would jump from topic to topic, from who was mean to her at school to what's behind the door in my office and then back to her friends and then to how she hated math, and so on. Even when I talked to Stephanie alone, it was hard for her to develop a topic. For example, when I asked her why she thought a certain friend was mean, she would say, "She's mean to everyone" or "I don't think she likes me," but then quickly jump to examine one of the toys and games in my office. When I watched Stephanie's parents with her, they tended to structure things to try to bring her back on topic, but without much success.
I suggested that Stephanie and her parents talk about what they might talk about at home so I could see the flavor of their relationship. Morn said Stephanie occasionally liked to help with cooking, so Morn opened up with "What do you want to help me cook today?" Stephanie, who loves sweets, smiled at her mother and said, "I want to make my favorite lemon pie." Kid With ADD
As we reviewed Stephanie's history, we saw that she had always had difficulties in certain areas ever since she was little. When she was a toddler, she flew about and explored everything. Her parents thought this was a sign of intellectual curiosity and potential. Indeed, Stephanie was a very bright little girl, but had difficulty remaining with an interest for more than a moment. Despite her constant activity, Stephanie showed a warm attachment to her parents and a lively range of feelings and humor in describing her "pesky" siblings.
Now with math in the second grade, Stephanie's problem wasn't in comprehension but in slowing down long enough to understand the methods behind solving the problems. She was very impatient and wanted to speed through things. She tried to finish so quickly that she often made mistakes.
Stephanie was called the family "whirlwind." She liked music and sports, and was an enthusiastic soccer player. She was well coordinated, but frequently didn't follow the rules because she was so eager and couldn't slow down. She had difficulty following directions, whether they were verbal, like giving her three or four clues in a treasure-hunt game or following directions at school, or visual clues, like reading a map with clues to how to find something. Her challenges seemed to be across the board.
Stephanie also showed some sensitivities, being overreactive to noises, particularly to high-pitched sounds. If music was in the higher frequencies, as in much popular music, she would get more active, move around more, and sometimes hold her ears. She also avoided certain types of touch, like smooth, silky things and foods that were slippery or "slushy."
When we evaluated Stephanie further, we found that even though she was good at sports, fine motor skills were difficult for her. Her handwriting was sloppy and hard to read, and when she took piano lessons she struggled to manage the fingering. She preferred to play the drums because she could pound away and move around more. Kid With ADD
In our discussions with Stephanie, we found that she was more of an all-or-nothing thinker rather than one who would look at subtle variations in what she heard or comprehended. In her preferences and friendships, Stephanie tended to go from one extreme to the other - she loves me, she hates me, rather than she likes me a little bit or not too much. This carried over to math concepts - that's tiny, rather than "bigger than this." Stephanie didn't have an internal feel for graduated amounts, whether it was emotions, math, or annoyances from her siblings.
Observing all these facets of a child's profile takes several sessions with both child and parents. In contrast to many approaches to diagnosis, which often consist of a parental or teacher report and session of observation, followed by a prescription, our approach takes in a number of evaluations, often involving more than one professional.
Rather than simply labeling Stephanie as having ADHD, we saw her as a child who had uneven growth in making sense out of different elements of her world and in regulating how she responded to sound, sight, and touch. She also had problems with how she planned her actions and thought. To learn more, you can check out Kid With ADD.
