On Healing 7/27/2009: Find a competent professional to diagnose ADD

Dear Dan,
My son has been anxious and easily distracted since he was 5 years old. He has had difficulty paying attention to his schoolwork.

He also was quite shy and didn’t make friends easily, but we thought this would improve with time. We never thought he had any kind of learning disability because he was not hyperactive. Rather, he was always a very sweet kid and did what he was told.

Except with homework. That was always a struggle. He would go to his room and emerge later having accomplished nothing.

Eventually, he would argue with us and say he was stupid and couldn’t get it right anyway. Thinking the problem was primarily anxiety, we sent him to a therapist for two years primarily for talk therapy. He liked going, so I think it helped. But the next year, when he got into middle school, things got worse. He became more withdrawn and started to behave as if he just didn’t care.

That’s when the arguing started. I guess out of fear and frustration, I began to push him harder, thinking that maybe he was being lazy.

Deep down, I knew this was the worst thing to do, but I felt out of control. When his seventh grade teacher said he might be depressed, we grew very concerned and took him to the pediatric neurologist she recommended. After a 45-minute interview, the doctor said that he had ADD (attention-deficit disorder) and should take medication. We were shocked at how quickly he made the diagnosis. By now, the symptoms have so disrupted our family life that there is constant tension.

My son is against medicine, yet I need to help him focus and be a successful student.
– Worried Mom

Dear Worried,
My heart goes out to you and your son. I can understand your fear and frustration. It must have seemed as if your precious child were slipping away.

And I can understand your son’s feelings. Like him, I was inattentive and got failing grades in school. And because I received no help, I continued to do poorly straight through college.

But worse than that was the great shame I felt as a child. Like your son, my parents called me lazy. Yet I knew I was trying as hard as I could, so I figured that if I’m not lazy, I must be stupid. I suffered with those feelings of shame and inferiority for many years.

Fortunately, you realize there is a problem and have been trying to do something about it for a long time.

But like many parents, you have been unable to understand what’s happening and what to do about it.

First, nobody can diagnose ADD or any other learning disability in 45 minutes. And before ADD is diagnosed, other things must be ruled out, such as anxiety, depression, and family conflict.

In addition, not every mental health professional is trained in the diagnosis and treatment of ADD, so before you make an appointment, find out the caregiver’s background. Once you find a competent professional, this evaluation should include family history, interviews with parents and school officials, and time spent with the child. Labeling any child after 45 minutes is ridiculous.

Medication is another issue. For children with severe ADD and ADHD, it can be life-altering. But as we know, our children are overdiagnosed and overmedicated. If you do opt to give him medication, one side effect could be increased anxiety.

On the other hand, medication could help his inattentiveness. The stimulant medication might also calm him down, and he could feel more comfortable with himself. But that doesn’t mean he has ADD. Nor does it indicate he should take medication. All it means is that the medication could help with some of his symptoms. We still have to figure out what the problem is.

When I spoke with you, you said you finally took him to psychologist Richard Selznick, director of the Cooper Learning Center in Cherry Hill, who did a thorough assessment.

You learned that this child, like many, had multiple learning disabilities, and that the label wasn’t as important as fully understanding what his learning style was and what supports he needs to make the process more enjoyable.

This is probably what happened with me. I know I had some problems with inattentiveness. If I went back to school today, without help, I would probably get poor grades again.

So now that you understand one another better, you can all begin to plan constructive strategies, including communications with school, help at home, and other interventions. There is a real chance that once he gets the help he needs, his anxiety and insecurity will diminish. If not, psychotherapy could also be included in the treatment plan.

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