Mental health

Behaviour disorder: Attention deficit hyperactivity 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 Maddie, tell me how is that new asthma medication working?

    Maddie: Pretty good but sometimes I feel like I can’t breathe but only it’s not an asthma attack.

    Physician: Oh? What do you mean not an asthma attack?

    Mother: I think maybe she feels claustrophobic like she gets sort of panicky and like she feels like she can’t breathe. Really, what’s worrying me though is that she seems to be having difficulty at school and it seems to be getting worse.

    Physician: Have the teachers expressed concern?

    Mother: Yes, they’ve contacted me on a few occasions and they are worried that she should be doing better but she’s disruptive and even sitting next to the teacher, she’s still not successfully finishing her work.

    Physician: What’s going on at school Maddie? What’s going on when you’re having difficulty breathing, Maddie?

    Mother: Maddie, honey?

    Maddie: Can I listen to my heart on that?

    Physician: We can do that after, okay?

    Mother: Maddie, honey, the doctor wants to know what’s going on at school?

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

    Physician: Oh is she yelling at everybody or is she only yelling at you?

    Mother: Maddie?

    Maddie: Mom, I can hear you.

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

    Mother: Well, she seems to understand things when I work with her and the teacher thinks that she’s very bright. She should be doing better than she is. Her desk is an absolute mess and she definitely can’t stay organized and we’re having the same problems with her at home.

    Physician: I guess, Maddie has always had a lot of energy but is this the first time it seems to interfere with her ability to do her work at school?

    Mother: She’s always had trouble kind of sitting still but we thought she’d grow out of it eventually but yeah, it is the first time she’s had trouble with her schoolwork. She’s also having difficulty sleeping right now which I mean, certainly isn’t helping things obviously.

    Physician: Why are you having difficulty sleeping, Maddie? What’s going on with that?

    Mother: She’s afraid to be in her room alone.

    Maddie: Mom, can we go now?

    Mother: Honey, honey…

    Physician: Maddie, Maddie I really want to help you with this. But I just have a couple more questions to ask you, okay. It won’t take long I promise, all right?

    Maddie: All right but after can I listen to my heart on this?

    Physician: Of course. Maddie, do you find sometimes you’re having trouble getting along with the other kids at school? Do you get into fights sometimes?

    Mother: Fights, no, no, no. She doesn’t get into fights. I mean, she can be difficult, yes, stubborn mostly. I mean, it’s just that she’s just having trouble finishing her work and up until recently she was just a really happy kid, you know?

    Maddie: I mean, I would be happy if I don’t have to go to school.

    Physician: Oh… I know school can be boring but you know what, work can be boring too but we all have to do it. So Maddie, what if I were to arrange to have some tests done to see how we can help you at school, would that be okay?

    Maddie: All right.

    Physician: Great. So now tell me what’s going on at night when you’re 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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