"There’s something else, though, that’s been niggling at me”
Yosef: It’s hard to talk about scary things
Shifra: I was so stuck on Yosef’s “learning disability,” I never considered anything else.
Rebbi: I was floored by Yosef’s scores. They don’t seem to match the child I see in the classroom. I’m glad, for his sake, that his mother’s seeking help.
“S
o?” Shifra prompts, as soon as I call. “Does he have ADHD?”
I give a short overview of the CELF and LCT tests I used. The results: Yosef scored above average in all area, and performed well on all informal tasks.
“But that doesn’t make sense! His rebbi said he doesn’t sit still or follow directions or get what’s going on. Does that mean the rebbi’s making it up?”
“I highly doubt that. Look, I’m an SLP, so I can tell you pretty definitively that he doesn’t have a speech or language issue. I’m not qualified to comment on ADHD — for that you need a psychologist — but I didn’t see anything that would indicate it. There’s something else, though, that’s been niggling at me.”
“The bus,” Shifra guesses immediately.
“The bus,” I confirm.
“I asked him about the bus,” she says. “It sounds like he’s scared of the bus driver. He yells at the kids… He threatens to make them get off if they don’t behave. But I don’t think that has anything to do with his ADHD.”
I take a deep breath. “Let me describe what I saw. At first, Yosef was shy, closed, and reserved [As a speech-language pathologist, I’m not qualified to either diagnose or rule out ADHD, and neither is the rebbi.] So I schmoozed with him to put him at ease and get him to open up. Once he was relaxed, he tested very well [Establishing rapport with the client is important, so that the client’s natural discomfort or anxiety doesn’t interfere with their performance]. But when I showed him the card with the bus on it, he froze.”
“But what does that have to do with his issues in school?”
“Everything. If the bus is causing Yosef distress and anxiety, then by the time he gets to school, he’s already suffered and is off his game. Additionally, he knows that in a few hours he’s going right back onto that bus. This can affect other areas of his life, which is what seems to be happening. I think this is something that needs to be explored.”
“Anxiety?” Shifra’s voice is full of disbelief. “His rebbi said ADHD!”
“The rebbi described symptoms that are consistent with anxiety but can masquerade as ADHD. Many problems have similar symptoms, but the root cause is very different. It creates an illusionary effect. You can have two kids limping; one has just stepped on a piece of Lego and one has a broken leg.
“What are the common symptoms of ADHD? Lack of focus, fidgeting… And what happens to a kid who is living in fear of a twice-daily bus ride? Can he focus on schoolwork? Can he sit calmly? I know I can’t focus or sit still when I’m anxious about something. Same symptoms, different disorder.”
Shira considers this. “So what do I do next?” she asks.
“See if Yosef will open up to you, and if you can resolve the problem. If not, it’s time to seek help from a mental health professional. Because, like you said, Yosef is bright, and has no learning issues. Don’t buy into that illusion.”
Take It Home There’s a lot of overlap in the symptoms of a wide range of mental-health issues. Below are some common symptoms that may be attributed to both ADHD and anxiety:
Self-focused behavior
Lack of focus, fidgetiness
Impulsivity, interrupting, trouble waiting for a turn Inability to sustain quiet play
Apparent emotional turmoil
Inability to complete tasks
If your child is struggling, it’s important to investigate thoroughly and not get attached to a diagnosis that may present similarly but have very different causes. Always seek a thorough evaluation by a qualified, licensed practitioner.
Originally featured in Family First, Issue 651. D. Himy is a speech-language pathologist in private practice and creator of the Link-It and STARPower curriculums. The fictional characters in this column represent typical client profiles.
