My first-grade son is doing okay in school but he receives extra help in reading and speech. He has a very hard time focusing and concentrating and sometimes it seems like he is in another world when you talk to him. It can take an hour to do a short page of homework with him. He is the only one on his soccer team who has no clue what is going on. He has been going to karate for three months and every day is like his first day. He doesn't seem to remember anything and his mind is everywhere else, even though he says that he likes going.
He has no real friends and he has a very hard time socializing. He frequently jumps in place, flaps his hands and has a hard time sitting still. I am very concerned that he has ADHD or something acutely wrong with him. I have spoken to his teacher and I am working on having him evaluated but I am very worried. Any thoughts?
In your question you have provided a great deal of concerning information about your child. He appears to be impulsive, inattentive and hyperactive. You note that he appears to struggle to maintain friendships and exhibits some repetitive behaviors such as flapping his hands. On the positive side, you say he appears to be making academic progress and likely doesn't suffer from a specific learning disability.
At this point I would caution you to not think about your son's problems in terms of any specific diagnosis but rather focus on understanding his impairments, such as his problems with socialization, behavior, attention and school performance. You note that he does not appear to be aggressive, significantly depressed or anxious; nor does he exhibit patterns of odd or atypical behaviors. Here is what I suggest you do:
Ask to speak to the school psychologist at your son's school. Request that the school psychologist speak briefly with the teacher, observe your son in the classroom and have you and the teacher fill out a broad range child behavior questionnaire such as the Behavior Assessment System for Children or the Conners' Behavior Rating Scale. The psychologist should be familiar with those assessments. This will help organize the types of strengths and weaknesses your son displays at home and in the classroom and will assist the school psychologist determining what types of services and/or additional evaluation may be needed at school. A number of federal laws require that schools identify and provide supportive services for children with disabilities.
Speak to your child's doctor. Ask for a referral to a child psychologist or neuropsychologist. Typically these individuals will begin by taking a very careful history from you and communicating with your child's teachers. At that point a determination can be made as to whether further evaluation and/or treatment is needed. At this point I wouldn't start thinking about a specific type of treatment. Some of the problems you describe may benefit from certain psychiatric medications while others most certainly would not.
Educate yourself. Depending on your son's diagnosis (or even before a diagnosis has been made), consider attending a local chapter meeting of Children and Adults with Attention Deficit Disorder (CHADD) or the Learning Disabilities Association of America (LDA). Doctors, teachers, and psychologists can serve as consultants and treatment providers, but parents are most qualified to be their children's case managers. To be an effective case manager and advocate for your son, you'll need to understand the nature of his problems and the types of educational, medical and mental health interventions that can help him.
Finally, I encourage you to remember that it is a child's strengths and abilities that ultimately predict the life he'll lead as an adult. You may want to read about the power of human resilience, starting with articles on my Web site, www.samgoldstein.com and my colleague, Dr. Robert Brooks' Web site, www.drrobertbrooks.com.
Sam Goldstein, Ph.D. is a Clinical Professor of Psychiatry at the University of Utah, a Research Professor of Psychology at George Mason University and Director of the Neurology, Learning and Behavior Center in Salt Lake City, Utah. He is Editor-in-Chief of the Journal of Attention Disorders, author, co-author or editor of 26 books and dozens of book chapters and peer reviewed research articles.
Advice from our experts is not a substitute for professional diagnosis or treatment from a health-care provider or learning expert familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your child's condition.