Inattention, disorganization, and procrastination can be signs of Attention-Deficit/Hyperactivity Disorder (ADHD), but they also can indicate underlying learning or emotional problems. The following cases of three children suspected of having ADHD (with names changed) show how a comprehensive psychological evaluation can provide answers.
Derek’s parents and teachers were frustrated. Previously an easy-going child, the third-grader had become distractible and defiant. Although his reading skills had been developing nicely, he suddenly refused to read.
Travis, an athletic ninth-grader, attended a challenging school. As a first-grader, language-based learning challenges were identified and then addressed with tutoring and school support. Recently, however, his grades had fallen.
Suzanne earned good grades in advanced classes, but weeks after starting eleventh grade, she already had many missing assignments and late homework grades. Her parents were confused about why their high-achieving daughter could not seem to “pull it together.”
Getting to the root of a child’s issues requires a more complex approach than administering a simple test. A comprehensive psychological evaluation assesses a child’s cognitive, academic, and social-emotional profile to determine what combination of issues exists and what treatment will be helpful. The better the understanding of the issues, the more effective the treatment plan will be.
Evaluation revealed that Derek had mild ADHD, but reading was the bigger issue. Instead of learning how to decode unfamiliar words, he would memorize each word. When that strategy no longer worked, he became confused and self-doubting, and he coped by acting out.
Travis did not have ADHD. Rather, he had auditory processing problems, including difficulty processing information presented orally (as in lecture-type classes). The first year of high school in an academically challenging environment created a “perfect storm” for his weaknesses to emerge.
For Suzanne, ADHD could not be confirmed because she had an anxiety disorder, and symptoms for ADHD and anxiety can overlap. Due to anxiety, she would procrastinate and withdraw from situations in which she might not perform perfectly. When she hit a “bump in the road” academically, her cycle of avoidance would begin. With college on the horizon, her anxiety increased to a debilitating level.
Suggested treatment for Derek included intensive reading tutoring, school accommodations, and possibly, medication for ADHD. For Travis, it was advised that his auditory processing weaknesses be evaluated by an audiologist and that he work with a learning coach who could teach executive functioning skills. Suzanne was recommended for therapy to treat her anxiety and, later, reconsideration of the ADHD diagnosis.
If these children merely had been diagnosed with ADHD, their true issues never would have been properly addressed. The possibility for misdiagnosis is why many pediatricians require a comprehensive psychological evaluation to be completed before prescribing medication.
Written By Leah Ferris-Yankus, Ph.D, a licensed psychologist at Spencer H. Gelernter and Associates