Andrew was 10 years old and in the fifth grade when I first evaluated him. He was diagnosed with ADHD in first grade and had been taking medication since that time. Andrew did well in first through third grades. But he struggled through fourth grade, and was having greater academic problems in the fifth grade.
During my assessment, I found that on ADHD medication, his hyperactivity, ability to stay on task, and organization improved. However, on or off medication, he had difficulty with reading. He could read, and he could understand what he had just read, but he did not always retain the subject matter. He also had trouble organizing his thoughts when doing a writing assignment. An evaluation confirmed that, in addition to his ADHD, he had Learning Disabilities (LD).
Melissa was an eighth-grader. She was failing her courses. Her teachers reported that she often did not pay attention or stay on task. They "hinted" that her parents should discuss the possibility of an attention problem with her family doctor. The physician referred her to me. Melissa found it challenging to pay attention when she had to do independent schoolwork in class and while doing homework. She couldn't retain what she read, nor could she do writing assignments. She had no difficulty staying on task when she did chores or when with her friends. She didn't have problems with attention in elementary school.
Her inattention began in middle school. I decided that she did not have ADHD, and I looked for other reasons for her problems. My informal assessment suggested that her reading, writing, and math skills were weak for her grade level. She also struggled with organization (of materials and of information) as well as with time management. These clues suggested that she might have LD. Formal psychological and educational testing confirmed that Melissa did indeed have LD.
Between 30 and 50 percent of all individuals with ADHD also have LD. The reverse is also true. Between 30 and 50 percent of individuals with LD also have ADHD. This high level of comorbidity requires that parents have their child evaluated for LD.
Melissa's case illustrates another problem that confuses parents and teachers. If LD are not addressed, a child will become insecure and anxious in school, fidgeting or doodling or misbehaving. We often think these are signs of ADHD. Such behaviors might also reflect anxiety because of difficulty doing and keeping up with the work.
So, how do you tell which it is? If such behaviors are the result of ADHD, they will have been observed in previous grades. That is, they are chronic and pervasive. However, if these behaviors start at a certain time (started no sooner than fourth grade) or occur only in certain situations, such as when asked to work independently at one's desk, the possibility of LD must be considered.
If your child reminds you of Andrew or of Melissa, you need to know precisely what the problems are and insist on the proper services to help. Don't blame the victim or hand over all responsibility to the teacher.