Dear Dr. Gottlieb,
 
My son has been anxious and distractible since he was about five years old.  So of course he had difficulty in school as he just couldn't pay attention to his work.  In addition, he was quite shy and didn't make friends easily but we thought all of this would improve with time. 

We never thought he had any kind of learning disability because he was not hyperactive. 

On the contrary, he was always a very sweet kid and did what he was told. Except with homework.  That was always a struggle as he would go to his room and emerge later having accomplished nothing. 

Eventually, he would argue with us and say that he was stupid and couldn't get it right anyway.  

Thinking the problem was primarily anxiety, he saw a therapist for two years. 

It was primarily talk therapy and he liked going, so I think it helped a bit.  But the following year when he got into middle school, things got worse.  He had more difficulty in school and became more withdrawn and started to behave like he just didn't care. 

That's when the arguing started.  I guess held of fear and frustration, I began to push him harder thinking that maybe he was being lazy. 

Of course deep down I knew this was the worst thing to do, but I felt out of control.  When his seventh grade teacher said he might be depressed, we grew very concerned and took him to the pediatric neurologist she recommended. 

After a 45 minute interview the doctor said that he had ADD and should take medication.  We were shocked at how quickly he made the diagnosis.  By now, the symptoms have been so disruptive to our family life that there is constant tension. 

My son is against medicine, yet I need to help my child focus and help him to be a successful student. I'm very hesitant to believe my son has ADD since it wasn't diagnosed until 7th grade.

Dear worried Mom,

My heart goes out to you and your son. 

I can understand your fear and frustration as it must have looked like your precious child was slipping away.  And I can certainly understand your sons feelings. 

Like your son, I was inattentive in school and began to see failing grades in elementary school.  And because I received no help, I continued to do poorly in school straight through college. 

But worse than that was the great shame I felt as a child.  Like your son, my parents called me lazy.  

Yet I knew I was trying as hard as I could, so I figured that if I'm not lazy I must be stupid.  I suffered with those feelings of shame and inferiority for many years. 

Fortunately, you realize there is a problem and have been trying to do something about it for a long time.Unfortunately, like many parents, you have been unable to find a clear understanding of what's happening and what to do about. 

First, nobody can diagnose ADD or any other learning disability in a 45 minute evaluation.  And before ADD is diagnosed, other things have to be ruled out if possible. 

Like anxiety, depression, food allergies, family conflict and dozens of other things.  In addition, not every mental health professional is trained in the diagnosis and treatment of ADD, so before you make an appointment, find out there background. 

Once other things are ruled out and you have a competent professional working with you, this evaluation should include family history, interviews with parents and school officials in addition to spending time with the child. Putting that label on any child after 45 minutes is, frankly, ridiculous.

Medication is another issue. 

For children with severe ADD and ADHD it can be life altering. 

But as we all know our children are overdiagnosed and overmedicated.  If you were to decide to give him medication, one of the side effects could be increased anxiety. 

On the other hand, there is a possibility that medication could help with his inattentiveness.  

There is even a possibility that the stimulant medication could calm him down internally and he might feel more comfortable with himself. 

But that doesn't mean he has ADD, nor does it mean he should take medication. All it means is that the medication could help with some of his symptoms but we have yet to figure out what the problem is.

When I spoke with you on the telephone, you told me that you finally took him to psychologist Richard Selznick who is director of the Cooper University Hospital learning Center in Cherry Hill who did a thorough assessment of your son and family. 

And I am thrilled with what you have told me. 

First, after getting the results of the assessment, all of you are learning more about what your son really needs to be successful. 

Many kids are not good at communicating their real needs, but kids with learning disabilities have even more difficulty.

So now that you are understanding one another better, you can all begin to plan constructive strategies including communication with school, help at home and other interventions. 

There is a very real possibility that once he gets the help he needs, you might find that his anxiety and insecurity diminishes.  If not, psychotherapy could also be included in the treatment plan at a later time. 

Richard Selznick, author of "The Shutdown Learner" will be joining me on my web chat Tuesday