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ADHD or Attention Priority Difference?

Woman2A few years ago I worked as a school psychologist.  One day the mother of a 12-year old boy, who we’ll call Pete, explained to me that upon the urging of one of his teachers, she took him to his pediatrician to be evaluated for ADHD.  The pediatrician asked this mother a few questions, diagnosed Pete as having ADHD, and then wrote him a prescription for Ritalin. After reading the possible side effects of the drug, the mother became concerned and spoke to Pete’s father.

ritialin newsweekPete’s father and mother were divorced. Pete lived with his father on weekends, and the rest of the time he lived with his mother.  Upon hearing about the prescription for Ritalin, Pete’s father was very much opposed to his son taking any drug for treating this concern.  And so, now the mother wanted to know what I thought should be done.

I explained that before I could make any recommendations, I would have to carry out an evaluation. As a student in the district that I served, there would be no cost to the family.  Pete’s mother agreed to the evaluation.

First, I requested that the mother, father and each of Pete’s teachers fill out standardized questionnaires. The results indicated that Pete’s physical education teacher, art teacher and his father viewed his activity level and ability to pay attention as falling within the average range.  Pete’s mother and academic class teachers generally saw him as having some problems paying attention.  His math teacher, who had been the one to urge Pete’s mother to take him to the pediatrician, rated Pete’s ability to attend to his assignments as being way below average.

man speakingAfter looking at the results of the standardized questionnaire, I spoke to Pete’s father.  He confirmed that it was his impression that Pete had no difficulty with either his activity level or paying attention.

“Do you mind describing a typical day that you have with your son?” I asked.

“Well, let’s see.  Last Saturday, when we woke up, we went to play golf.”

golf course“Do you walk the course, or ride in a cart?”

“We walk.”

“Pete doesn’t mind?”

“Not at all.  He loves doing physical stuff like that.”

“After golf, then what did you do?”

basketball“We went back to my place, I made some sandwiches, and then I read the newspaper while Pete worked on his drawing.  He loves to draw, and he’s pretty good. Then we went in the backyard.  I have a basketball hoop set up there and we shot around for a while. Then we started to get supper together.”

“Does Pete help you with that?”

“Yes.”

“Does he get distracted in any way when you two work on supper?”

ping pong“Not at all.  He’s very helpful.  Then we ate supper, went down to the basement and played ping pong for maybe an hour.  Then we went upstairs and watched a movie.”

“When he watches a movie with you, does he appear to have difficulty sitting through it?”

“Not usually. Occasionally, the movie strikes him as boring. After the movie, he went to bed.”

“Does he have any trouble sleeping when he stays with you?”

“No.  We do a lot of physical stuff that tuckers him out, and he ends up sleeping soundly.”

I then spoke with Pete’s mom. Consistent with how she filled out the standardized questionnaire, she confirmed that it was her impression that Pete did have difficulty paying attention.

“Do you mind describing a typical day that you have with your son?” I asked her.

school bus“Well, yesterday, I got him up at 7 so he could catch the school bus on time.  He complained the whole time he got ready.  He hates the ride to school.”

“How long a ride is it?”

“An hour, and he says he doesn’t get along with the kids he rides with.”

“I see.  He has to sit on the bus for an hour with kids he doesn’t like, then he’s in school sitting most of the time doing school work.  Then he takes the bus home, sitting for another hour with kids he doesn’t like.  For a boy his age who loves to do physical activity stuff, I could see how this could be hard for him.”

“Yeah, but other kids do it.”

“Most do.  Please tell me what happened when he got home.”

homework“Well, I got home a little after he did. I started preparing supper, and that’s when I have him doing his homework.  I sit him at the kitchen table where I can keep an eye on him while I prepare the meal.  And he gets very distracted.  He starts an assignment one minute, and I look over and I catch him doodling.  Over and over again he gets distracted.”

“I see.  After sitting most of the day, you have him sit and do his homework?”

“Yes.  That’s when I can best keep my eyes on him.”

“How about the rest of the evening?”

clean room“He’s fine then.  Besides doing his homework, the only other time I have trouble with him is when I try to get him to clean up his room.  He starts to do it, but when I look in a few minutes later, he has become distracted with something else.”

Next, I interviewed Pete. After some pleasant discussion I said, “Your math teacher says you have trouble paying attention in class.  What’s up with that?”

“Aaaaa, he makes us fill out these worksheets doing the same problems over and over again.  If I know how to do it, why do I have to keep doing 20 more of them?  It’s so boring.”

“I see.  Say, I hear that you like to draw.  Would you mind drawing something for me.?”

Pete’s eyes light up.  “Sure.  What do you want me to draw?”

“Anything you like.”

child drawingPete begins, and I notice he appears to become completely absorbed in the task.  I start to try to distract him by making some extraneous sounds.  He glances up to see what the commotion is all about, sees it’s nothing serious, and resumes work on his drawing.

A half hour later, he shows me what he has created.  It’s an imaginative otherworldly drawing with spaceships and fascinating creatures.  There is an excellent sense of shadowing.  It’s far superior to anything I can create in the drawing department.

When I finished my evaluation, I informed the parents that in my opinion it is not in Pete’s best interest to view the concern that has been expressed about his attention as due to ADHD. A more apt description is to view Pete as having an “Attention Priority Difference.”  School work was not a huge priority for him.  He much preferred to draw and do more physically active tasks then is currently  provided at school.  These preferences may turn out to be his greatest values.  He may someday find work that he truly loves in a field where his artistic interest and talent are crucial.  And his interest in physical activity may keep him far more healthier than the many sedentary Americans who are at an increased risk of a number of real illnesses.

“Well,” said the mother, “will Ritalin help Pete with his Attention Priority Difference?”

physical edTo which I replied, “Consider an analogous situation.  Suppose we identified a group of children who are not doing as well as most kids in physical education.  Would it make sense to make up a pathological sounding term for these low-performing students, such as “Muscular Deficit Disorder” and then have doctors prescribe steroids for them?

artists“In my view, people have different interests and talents.  This is a wonderful thing, not something that should be pathologized.  We don’t just need every person in America sitting in ivory towers.  We need, as well, artists, computer experts, magnificent athletes, hairdressers, and on and on.

stomach and head pain“When I hear of a child placed on Ritalin, I become concerned about the child’s stomach, nerves, and brain. Drugs that have been said to be safe have turned out to be far more toxic than anyone ever dreamed of.  I become concerned about the social misery that goes along with being singled out as a child that must take a pill to fix him.  More than a few kids have told me that this became a dreaded experience.

“I believe that teaching children to turn to drugs when they are dissatisfied with their behavior or mood runs counter to a healthy lifestyle.

healthy“I prefer to put forth a view that encourages us to teach our youth about the blessings of keeping our bodies in lifelong possession of its full youthful state by keeping their blood free of stimulants and narcotics.  I wish to teach our kids that it is possible that the morning sun, air and dew can be sufficient powerful intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being—these are the directions I wish we would point to when we guide a child toward a more fulfilling life.”

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

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