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Living with ADHD: An ADHD Case Study

written by: Genevieve Van Wyden • edited by: Daniel P. McGoldrick • updated: 4/25/2011

If my son were to be enrolled in an ADHD case study, it would be for one where participants are not taking an ADHD medication. I’m going to be watching, encouraging, reminding and pushing him for longer than I did his big brother. Every day is a new learning experience.

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    Overview

    My two children are as different from one another as sugar is from salt. They are both fun-loving young men who make friends easily. One sees what has to be done and gets it done, even if he doesn’t feel like it. The other knows what has to be done, but finds creative ways of avoiding it. One has ADHD, the other does not. I realized early on, when my youngest was about a year old, that he had different reactions and behaviors than his older brother did at the same age. I held that knowledge inside, afraid of the truth.

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    The Questions

    This account is something like an ADHD case study. When my youngest was a baby just learning how to walk and express himself, I realized how different he was from his big brother. Big brother looked at situations, weighing all possibilities before deciding what to do. Baby brother rushed right into situations, seeming to lack fear. Baby brother (Robert) was in motion from the time he woke, until he fell asleep at night.

    My questions started at about that time--why is Robert so different from his big brother? I noticed he felt things more intensely; everything from happiness, sadness and disappointment to the scratch of a tag on the back of his shirt or the seams inside his socks.

    As Robert grew, I noticed he wasn’t afraid to go after his big brother if they got into an argument. Even though big brother was twice his height, Robert would rush at him, fists flailing. All big brother (Andrew) had to do was put his hand over Robert’s face and hold him at arm’s length because Robert could not reach to hit.

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    Comparing Behaviors

    When Andrew started school, he would bring his homework home--and work on it. He was more reliable about turning it in. When Robert started school, waking on time became a major issue. Where he had been an early riser before starting kindergarten, as soon as school started, he would continue feeling sleepy and refuse to get up to get ready for school. In addition, he brought homework home, but refused to do it: “I don’t like homework, mom!” This was kindergarten-level work so it was not a matter of difficulty. The work was easy for him--he was bored.

    Robert’s hyperactive, impulsive and inattentive behaviors continued as he grew older. We would go to church on Saturday nights, when less families were in attendance at Mass. He found it very difficult to sit still for an hour. He would run up and down the aisles; if we sat in the balcony, I had to choose seats away from the railing so he wouldn’t drop Missals down on unsuspecting parishioners’ heads. By contrast, Andrew sat fairly quietly in his seat and paid attention to Father.

    Sitting still to play quieter games was torture for Robert. He needed to be in constant motion. Playing a game of Monopoly? If he realized he was losing, he’d lose his temper and flip the game board, scattering game pieces and cards.

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    I Don't Want to Know

    In first grade, Robert grew a little better about doing homework, but I had to sit next to him and encourage him through every question and answer or every assignment he brought home. His grades were inconsistent. He’d bring home report cards with all S’s or A’s for one reporting period. In the next, he would have more N’s or Ds. His father and I sat him down and talked to him, letting him know how smart he was and that the work was so easy. Andrew would talk to him and tell him, “Just pull it out, do it and get it over with, man!” This was exactly what Andrew did--he would let himself in the house after getting off the bus, get a snack, turn PBS on and do homework as he ate and watched television. More often than not, his homework would be done when his father and I got home.

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    An ADHD Case Study: Robert's Life with ADHDThe mother of a young adult diagnosed with ADHD recounts the daily struggle her son deals with as he learns to face adulthood. Now that he is legally an adult, he is working to take some adult responsibilities on.
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    I Don't Want to Know, Cont.

    Because I worked in a Child Protective Services office as a social worker, Robert stayed after school in the after school program, where he got a snack and the volunteers supervised the children as they did homework and played. Robert didn’t know how far he could push the lead volunteer, so he complied when it was time to do homework.

    My questions continued as Robert grew. We left the northern part of New Mexico and moved back to our home town. I had not asked his pediatrician or teacher about any behaviors that might concern them--I wish I had.

    That all changed when we moved back home. Where Robert had been enrolled in a Catholic private school before we moved, we enrolled him in a public school after we moved. The classes were bigger, so the teacher couldn’t give as much one-on-one time. Again, grades were inconsistent. Through second and third grade, I continued to watch his progress--or lack of--and the fear grew.

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    Realizing He Needs Intervention

    Near the end of Robert’s 2nd grade year, his dad and I decided to end our marriage. It was very rough emotionally for both boys; they lived with me, but got liberal visitations with dad, which they needed. This did not make Robert’s daily struggles with home and school life any easier--I thank God for his third-grade teacher, an older, no-nonsense, but very loving woman. She advised me that she had to work to find more-advanced work for him to do, so we had him tested for inclusion in the gifted special education program. Yes, he is gifted--both of my sons are.

    Robert had the misfortune to be assigned to a fourth-grade teacher with whom he immediately went cross-wise. Neither liked the other. What little liking for school Robert had quickly vanished; homework became even more of a struggle.

    His teacher approached me, saying she was “concerned” about his behaviors and activity level in her classroom. While I didn’t like her either, I had no choice but to listen because she was echoing what I had been fearing for most of his life. She initiated the referral for ADD/ADHD testing. I filled out a lengthy parent questionnaire; she filled out an equivalent one for teachers. The district diagnostician tested Robert and sure enough--we received a diagnosis of ADD/ADHD.

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    Receiving the Diagnosis

    The school/district psychologist and diagnostician met with me and explained the findings from the tests Robert took. He has Attention Deficit Hyperactivity Disorder, primarily Inattentive type. He did have some issues with over-activity, but as he has grown into adulthood, he has learned to control this.

    He received a prescription for Ritalin, which he took for about one year. He was then changed over to Dexedrine, which he took for roughly 5 years. He took the medication at breakfast; because the earlier prescriptions were short-acting, he was required to report to the nurse’s office at school and take a second dose. Because he didn’t like appearing “different” from peers, the doctor changed his prescription to a longer-acting stimulant.

    When he was in the 7th grade, he tried taking Strattera, but his made him physically ill and he refused to take it any more. As he grew older, he questioned the need for stimulant or non-stimulant medications. We talked and I explained what beneficial effects the medications were intended to offer. “Mom, after I take my medication, I get drowsy. I sleep the whole first period away and that’s not good for my grades!” he told me.

    In addition, his dad is anti-medication. Robert picked up on this viewpoint, telling me the medications he took could have significant ill effects on his health. By that point, he was past the age of 14, when children in New Mexico are legally able to refuse treatment. We talked about his diagnosis and the impact it has on his every day life in school, at home and with friends and family. He wanted to learn to address his ADHD without being in a medicated state. We spoke to our family doctor, and she agreed to wean him off Dexedrine, IF he would learn to use other coping skills.

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    How One Family Deals with ADHD: An ADHD Case StudyRobert received a diagnosis of ADHD at the age of 9. Eleven years later, he is perceptive about the condition and how it impacts his life. His mother recognizes mistakes she made when Robert was younger.
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    Understanding His Viewpoint

    As far as the risks to health that Dexedrine poses, I understand Robert’s point of view. I read studies and package inserts about the need for regular blood work to ensure his liver continued functioning normally. I also understand his desire to be as “normal” as possible--and if that meant functioning unmediated, I would support his efforts to find other methods of doing so.

    However, I see him struggle with his inability to concentrate on work (writing) and college-level work. It’s not that he doesn’t understand the course material. He does, but because his executive function is impaired and he cannot pay attention consistently, his school and work performance suffers.

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    Today

    Seeing how Robert views life and functions today as a young adult would make an unusual ADHD case study. He’s gifted, and gets bored easily when he’s confronted with something too simple for him. Even when he is given more-challenging work, he procrastinates. He is a very engaging, friendly and loving person. He can be highly perceptive or as oblivious as a rock.

    I made mistakes. The first one was not getting him in with a therapist, mentor or coach who could help him identify why he avoids doing school work. The second mistake was being too soft on him.

    He is also a gifted musician. He began playing violin in 6th grade and loves this instrument. I confess, I thought he’d find it boring and would want to learn to play drums or electric guitar rather than violin. Instead, he loves learning new violin music AND wants to learn the trumpet, drums and electric guitar. He is a member of a semi-professional mariachi group in our home town. He is a talented singer. Even though he is one of the more junior group members, he has been given a complex violin solo on a “clasico” mariachi composition.

    He is a freshman at the university in our community; because he blew off school work, he has been forced to take a break from school so he can pay back school grants. Why did he blow work off? Boredom. I realize now that I am going to have to help him meet and interact with the dean of the college where he wants to find his major so he can identify professors and instructors who are willing to help him. He also wants to talk to the dean so he can find out which instructors offer more interesting classes.

    I just read an old psych evaluation. The psychologist who administered the tests identified Robert as “perceptive” and “insightful” about his condition. Those descriptions are accurate as far as they go. Robert fails to see how his persistent procrastination hurts him. This is why I am pushing him to earn his own money, so he learns to recognize the feeling of accomplishment and understand he can do it. I am refusing to do things for him that he can do for himself--making himself something to eat, for instance.

    I don’t know if it’s too late or not, but I am backing away from “doing for” him so he can become more self-sufficient. I will be continuing to guide and supervise him; I’m working to get him to the point where he takes over the job of “finishing raising” himself.