Is it attention deficit disorder (ADD ADHD)? A learning disability? Maybe it's depression or anxiety, a mild form of autism — or chronic fatigue resulting from a sleep disorder. Maybe it's a combination of things.
Getting an answer to the question "What's wrong with my child?" can be harder than many parents expect. So can arranging appropriate treatment. In fact, experts say, the process of resolving a child's behavioral and academic problems is relatively straightforward for only about one in five families.
Glenn Bevensee, of Northfield, New Jersey, counts himself among the lucky few. When the 47-year-old father of two began to suspect that his 12-year-old daughter, Kristin, had ADHD, he consulted her pediatrician. As luck would have it, the doctor knew all about ADHD, in part because he had it himself. He was able to make an immediate diagnosis. "The pediatrician talked to my daughter for 10 seconds," Glenn recalls. "He said, 'Yep, we ADDers can spot others like us almost instantly.'"
Fortunately, the ADHD medication prescribed by the pediatrician proved to be highly effective. Kristin was better within an hour.
"Off medication, my daughter was obstinate and very loud," says Glenn. "She raced around the house like a bull in a china shop. But once Kristin was on medication, her grades improved, she got her homework done, and she was much more pleasant to be around."
Twists and turns
Glenn's experience is by no means typical. "When he was in kindergarten, I knew my son, Robb, had speech problems and immature social skills," says Kristen Wheeler Highland, a mother of three living in Bloomington, Minnesota. "By fourth grade, Robb was struggling socially, emotionally, and academically. He had trouble staying on task and got caught up in minutia. Homework was a monumental problem every night."
Since Robb had scored high on aptitude tests, his teachers felt that his academic difficulties meant nothing more than "a bad attitude." Kristen knew better. "I sought help repeatedly," she recalls, "but my district special education department told me they didn't screen for ADHD." Robb's high scores also meant that testing him for a learning disability was a low priority — even though his academic performance was dismal.
Months passed, as Kristen sought help for her son. Months turned into years. One day, when Robb was 10, Kristen reached her breaking point. Exhausted and monumentally frustrated, she walked into her boss's office, sat down, and burst into tears. "I told her I was too tired to keep doing my job all day and then go home to teach my son his schoolwork at night," she recalls.
One reason it's difficult to cope with a child's behavioral and academic problems is that there is often more than a single diagnosis.
"Fifty percent of the kids diagnosed with ADHD also have a learning, language, or motor skills disability,” says Larry Silver, M.D., clinical professor of psychiatry at Georgetown University Medical School in Washington, D.C., and the author of The Misunderstood Child: Understanding and Coping with Your Child’s Learning Disabilities (Three Rivers Press). "Approximately the same percentage of these children have a comorbid disorder, such as anxiety, depression, obsessive-compulsive disorder, oppositional defiant disorder, conduct disorder, or a tic disorder."
Given how common multiple diagnoses are, it's unrealistic to think that medicating a child will solve all his problems — at least not all of them at once.
"Parents need a realistic perspective about what medication can and cannot do," says Susan Ashley, Ph.D., of Northridge, California, author of The ADD & ADHD Answer Book (Sourcebooks). "ADHD medication is presumed to be effective, so parents have excessively high expectations. If your child doesn't respond well to medication, try another type of intervention, such as behavior modification, social skills group therapy, tutoring, 504 accommodations, or special education."
Most kids do best with a combination of drug and non-drug interventions—the so-called "multimodal" approach. For some children, non-drug interventions are all it takes; they require no medication at all.