Today I did an assessment on a 13 year old boy presenting with symptoms of ADHD. He refuses to go to school. He says he can't concentrate, he's distracted, can't do the work and dislikes the teachers telling him what to do. His Pediatrician said he has ADHD and maybe needed some counseling to see if anything else is going on. The mom said that when she goes to wake him up from school he cries uncontrollably and refuses to go. The Pediatrician wrote out an excuse and need for home instruction until he saw a psychiatrist.
When exploring further this child had no problems until 7th grade he's now in 8th. They switched schools in 7th grade because he was being picked on there and didn't accept him. He said they had a "click" and would shun him because he didn't live there, his mom put him in that school because she thought it was a good school. Mom said when he was in kindergarten and first grade his teachers humiliated him in front of the whole classroom and he began disliking teachers ever since. When asked if he respects teachers now he said no and he doesn't like them telling him what to do.
The more the mother and child talked the more it sounded like a case of bullying. He said a kid at school calls him names but wouldn't talk any more about it and mom said she thinks he's holding back because he doesn't want his mom calling the school and making a scene because he will get teased more. The client disagreed with mom and said it's only one kid. He became agitated with his mom and it appeared he was hiding something.
The family dysfunction is evident mom and dad do not agree on child rearing. The mom is dissatisfied with her relationship with her husband. The client and his dad do not get along, dad drinks all the time and the client doesn't like being around him. The father does not think the client needs counseling he thinks the client is just making up excuses because he doesn't want to go to school.
I had difficulty diagnosing him with ADHD inattentive type. I diagnosed him with Depression NOS as well because he said he is sad most of the time, he cries all the time, he isolates himself from his friends and will not go to school. He is currently on Strattera 25mg and this is not helping. I think something else is going on besides ADHD.
What I hope other counselors can get out of this is that bullying can be masked by certain conditions such as ADHD, and bullying can lead to depression and school phobia. It is important to get a thorough background of what is going on in the life of the client before making any kind of decision about diagnosing.
Kimberly Beck is a counselor and a doctoral candidate with a special interest in Self-injury. Other interests are PTSD, trauma, and Borderline personality disorder