Modules

Mental health

Behaviour disorder: Attention deficit disorder (ADHD)

A mother has brought her daughter to the physician for follow-up on her asthma, but her real concern is that the girl is not doing well at school. She has trouble focusing, cannot sit still and struggles to finish her work. The teacher has called the mother several times and is finding the child very disruptive. The mother is worried.

  • Physician: So Maddy, how’s your new asthma medication working?

    Maddy: Pretty good, but sometimes I feel like I can’t breathe, only I’m not having an asthma attack.

    Physician: What do you mean you’re not having an asthma attack?

    Mother: Um, it seems like she maybe gets claustrophobic. She can get sort of panicky and then she feels like she can’t breathe. I’m worried about Maddy. She’s having trouble settling at school and … it’s just, it’s just getting worse.

    Physician: Have the teachers expressed concern?

    Mother: Yup, the teacher called again this week. She feels that Maddy should be doing better than she is but she is very disruptive … she has to sit beside the teacher now and she still can’t seem to finish anything.

    Physician: What do you think is happening at school Maddy? Do you think that this has anything to do with the difficulty that you are having with your breathing?

    Maddy?

    Mother: Maddy, honey, please answer the doctor.

    Maddy: Can I listen to my heart on that?

    Physician: Later …

    Mother: Maddy, the doctor asked you what you think is happening at school.

    Maddy: School is boring. My teacher is mean and she yells all the time.

    Physician: Does she yell just at everybody or does she just yell at you?

    Mother: Maddy?

    Maddy: You don’t have to yell at me! I can hear you!

    Physician: Are there concerns that she’s um, not able to do her work?

    Mother: She seems to understand things when I work with her and her teachers think she is very bright and should be doing better than she is. It’s just her desk is a mess and she can’t keep track of anything and … we have the same trouble with her at home.

    Physician: Well, Maddy has always had a lot of energy. Is this the first time that it seems to interfere with her ability to get her work done?

    Mother: She’s always had trouble sitting still, we’d thought she would just grow out of it but yeah, this is the first time her learning has been affected. And on top of that, she is having trouble sleeping and that can’t be helping anything.

    Physician: Maddy, why are you having trouble sleeping? What’s going on with that?

    Mother: (looks at her daughter) She’s afraid to be in her room alone … Honey …

    (Maddy jumps down from the table)

    Maddy: Can we go now?

    Physician: Maddy, Maddy, I really want to be able to help you with this. And um, I just need to ask you a few more questions. It won’t take long. Is that okay?

    (Maddy nods)

    Maddy, do you ever find that you have trouble getting along with the other kids at school, get into fights or anything like that?

    Mother: No, no, I mean … she can be very challenging, stubborn mostly … she doesn’t get into any fights. It’s just so hard for her to get anything finished. And … (sighs) But until lately, she’s always been a happy kid.

    Maddy: I’m happy if I don’t have to go to school.

    Physician: Well, Maddy school can be boring. Work can be boring but we all have to learn how to do it.

    What would you think if I arranged for you to have some tests done to see if there is anything that we can do to help you with school?

    Maddy: Okay.

    Physician: So can you explain to me what you think is going on at night when you are having trouble falling asleep?

Reflective exercise

Think about the information the physician obtained about Maddy’s behaviour.

  • How much of it was obtained from the mother?
  • How much of it was obtained from Maddy?

Maddy’s physician is not sure about her diagnosis and does not want to prescribe medication unless necessary. She wants to learn more about ADHD and goes to the internet for information.

Perform your own search for information about this condition. Here is one source.

  • How will you critically appraise the quality of what you find?

 

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