My child's first grade teacher wants her tested for a Learning Disability and ADHD. I think my child is stressed. Could I be right?
This is a tough question to answer without more specifics, for a number of reasons. First, when a child has experienced a stressful situation, a child may experience anxiety and/or depression in response to this. If the stressful situation was traumatic, the child may also experience Posttraumatic Stress Disorder (PTSD) symptoms. In childhood, the symptoms associated with Depression, Anxiety, and PTSD can also mimic ADHD symptoms. ADHD is a behavioral diagnosis. Although we know it has a neurological etiology, the diagnosis of ADHD is made when symptoms of inattention, hyperactivity or both are observed in two different contexts. In childhood, depression, anxiety, and/or PTSD can manifest in an inability to concentrate, psychomotor agitation, and/or irritability. These symptoms mimic inattention and hyperactivity although the root of the behavior is different. A child experiencing any of these conditions, can easily look as if they are manifesting inattention and/or hyperactivity in two contexts. It is important for the assessing psychologist to investigate the child’s history. If the child did not exhibit these symptoms until after a stressful time or a trauma, this helps elucidate the symptoms because a trigger is identified. Sometimes, however, symptoms of inattention and/or hyperactivity are not noticed before a child enters school for a number of reasons. First, prior to a child entering school, often there is not as much structure in a child’s schedule so the hyperactivity and/or inattention can go unnoticed or dismissed by parents as an extremely active child. Second, sometimes it is only teachers who have the comparison of many, many students over the years that can identify when a child’s attentiveness or activity fall outside the normal range. The question of the learning disability is also a little complicated in this situation. A learning disorder as the name implies is a disorder in the ability to learn in a certain subject area. The diagnosis of a learning disorder does not indicate lower intelligence as is often and erroneously believed. The diagnosis is made when there is a discrepancy between a child’s achievement in reading, for example, and where their achievement should be if it is predicted from their intelligence. The idea is that the child is not achieving as would be expected based on their intelligence. Why the diagnosis of an LD can be tricky is that there are a number of reasons a child may not be achieving at the level you would predict from their intelligence. One reason may be ADHD. A child that is not concentrating in the classroom will not learn the material and this discrepancy between their achievement and their predicted achievement doesn’t reflect an inability to learn but instead an inability to concentrate. That is why schools are moving toward a response to intervention model which look at if the child is able to learn when remediation is provided and basis the diagnosis of LD on that. It is important for you to make sure to be as detailed and accurate as possible when discussing your child’s history with the assessing psychologist for all the reasons outlined above.
A side note to parents, if there has been a stressful situation or a trauma, it is alright for you to request that the assessing psychologist does not include all the details of the stress or the trauma the child experienced in the report given to the school. Some parents, rightfully so, do not want those details put in the child’s school record and this is a very legitimate concern. While it is beneficial to the child for the report to clearly explain why a diagnosis was reached for both diagnostic purposes and for appropriate later intervention, all the details may not be necessary.