Should My Son Be Evaluated?

Do you need a doctor to tell you that your teen has ADD, when you are already convinced that he does?
I've always thought my 14-year-old son has ADHD, but because we haven't wanted to medicate him, he hasn't had an evaluation. Blood work (a complete panel with thyroid evaluation) and an EEG were done. All were negative. Do I need a doctor to tell me he has ADHD when I know in my heart that he does?

When we look at checklists online, we see that he has a very high percentage of the symptoms for it, but I know that they shouldn't be used as a substitute for a medical opinion. His grades have never been good, but this year, he may not even pass eighth grade. Teachers have done everything to help me help him, but it's as if we care more than he does.

His teachers know he's more than able to do the work, but he's unable to focus and behave when anything is going on around him. He doesn't complete or turn in assignments. He disregards reminders and threats, makes a joke out of everything, and is very disruptive in class. When consequences occur, he's moody and disrespectful, tending to behave in a way that makes it appear he really doesn't understand (or care) about the results of his behavior. He's never been able to take responsibility for his actions. He's not hyperactive in the least.

My husband and I are very involved with our boys' lives, and very confident that substance use/abuse isn't going on, but he's definitely at risk for that. I think about home schooling him all the time, and I honestly think he would be relieved to be away from the peer pressures and constant stress of doing so poorly. Have I been neglectful by not having him evaluated?

If you believe that your son has ADHD (without the hyperactive component), it seems reasonable for you to get a professional opinion. I don't think you've been neglectful, but it won't do your son any harm to find out if he has this condition. I can appreciate your hesitation about medication, but if he has ADHD, it's your choice to use medication or not if your doctor prescribes it. While I believe that medication is overprescribed for ADHD, I also know that when properly diagnosed, medication helps many children with this condition if it's appropriately administered and monitored.

If qualified professionals agree that your son has ADHD, then in addition to considering medication, you should make sure that:
· His classroom is organized.
· His teacher has clear expectations.
· Those working with your son understand that some of his behaviors may be a consequence of this condition.

However, there can be many other reasons for the behaviors you describe. If your son is doing poorly in school, has low motivation, a poor attitude, peer pressures, and stress, you absolutely must rule out a specific learning disability by getting your son a comprehensive evaluation. If he's at risk for not passing eighth grade, the school should already be looking into this possibility.

If he has done poorly for a long time, he may see no purpose to school. His "I don't care" attitude may be his way of minimizing his difficulties, and avoiding the frustrating work of school. Is he capable of doing the work? Has he ever been able to do what's expected in school? When did things change? Does he do the work for at least one teacher with whom he has a good relationship? If so, this could be a case of kid/teacher mismatch. Is he a gifted and talented kid who's bored silly with school? Is he a kid who's seeking attention by shirking his responsibilities? Is he responsible and trustworthy outside of school? If so, then he has the ability to be this way in school. There's something going on that's getting in his way.

The moodiness, lack of motivation, and unwillingness (inability?) to assume responsibilities could be symptoms of drug use, but they can also be symptoms of depression. It is very important that you have a comprehensive evaluation to rule out all possibilities. Guessing, wondering, and feeling guilty will only prolong his misery.

Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.

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