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Thursday, June 6, 2013

ADHD Case Study: The Non-Hyperactive Child

From Smart Kids with LD
By Peg Dawson, Ed.D.
June 3, 2013

Eight-year-old Kevin is described by his parents as wonderfully imaginative with a talent for building things. When playing with his sister, the third-grader can turn a couple of cardboard boxes into an entertaining adventure. He creates elaborate constructions from materials he finds outdoors and is a master with Legos, taking the interlocking blocks far beyond the designs that come in the package.

He has no trouble entertaining himself but likes playing with friends, too. And he loves to be read to. Simply put, Kevin is a delightful, creative, and well-adjusted child.

Despite Kevin’s charming disposition, he has little tolerance for schoolwork—and even less for homework.

His mother spent most of his second grade year experimenting with homework times—right after school, following a brief play period, before dinner, after dinner.

No matter when she tried to get him started, he moaned and grumbled, drifted off, tried a million avoidance tactics, and yawned and complained of fatigue. What should have taken him 20 to 30 minutes to complete routinely ended up taking two hours or more.

On top of that, Kevin began talking about how much he hated school, and it became increasingly difficult for his parents to get him out the door and onto the school bus every morning.

His parents worry that he’s falling behind his peers—and more than that, they’re terrified of the nine years left before he graduates from high school.

The Diagnosis: ADHD

Kevin is typical of children with ADHD. While many have problems with impulsivity and over-activity, there are just as many for whom the biggest obstacles are daydreaming, distractibility, and lack of organization.

Kevin’s parents were struck by the fact that he could spend hours on activities he enjoyed—building forts, making spaceships out of Legos—but he wasn’t able to spend five minutes on homework.

It’s not that kids with ADHD can’t pay attention; rather it is inordinately difficult for them to make themselves pay attention.

Kevin didn’t have to force himself to focus on building a fort, but math homework was a different story. At its core, an attention disorder is an impairment of self-regulation.

Children with ADHD have trouble regulating their own behavior. Whether it’s making themselves focus, delaying gratification, or controlling their mouths or their hands, kids with ADHD are drawn to whatever appeals to them here and now.

Piecing the Puzzle Together

Before Kevin’s appointment with the evaluator, his parents and teachers were asked to fill out several forms: a medical and developmental history, a general behavior checklist, an ADHD checklist, and a checklist to identify executive skill deficits (time management, organization, etc.).

Based on the assumption that parents know their child best— and especially parents who help with homework—Kevin’s parents were interviewed at length about his learning style and the obstacles that got in his way. Just as important, they provided insights into his strengths, talents and interests, qualities that serve as the building blocks for fostering self-esteem and self-confidence.

After the parent interview came the introduction to Kevin. Since most children are doers rather than talkers, the psychologist engaged him in tasks and activities and watched as he responded. A mix of tasks was selected, some interesting and challenging, others boring and tedious. By presenting him with both types of tasks the contrast between how he responded to each could be evaluated.

Kevin enjoyed any task with a problem-solving component, but he particularly enjoyed the puzzle tasks. In fact, he spent five minutes on a single item, figuring out how to construct the puzzle to match the picture. He was willing to try items that challenge high-school students, and persisted until he succeeded.

But with a pencil-and-paper attention task (e.g., find every letter “A” on a page full of letters), he decided he was finished in less than three minutes; when given a second sheet to work on, he barely looked at it before giving up. When given a boring listening task, he attended for a little over two minutes, and then drifted in and out for the remaining few minutes.

Based on the results of the observation, combined with the interview and behavior rating scale results, the psychologist initiated a discussion with Kevin’s parents about what an attention disorder is and how best to treat it. It was the first step in a new beginning for Kevin’s family.

Related Smart Kids Links

The author is a psychologist at the Center for Learning and Attention Disorders in Portsmouth, NH and a member of Smart Kids’ Professional Advisory Board.

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