April 15, 2009

A Mother's Concern: Forgetful and 15

Claire is 15, and she’s been a patient of mine for a couple of years. She’s very bright and has always been healthy. When I’ve seen her, she always asked articulate questions with an adult vocabulary. She never seemed conformist with high-school fashion or makeup. She seemed comfortable with me, though she generally avoided eye contact.

Her mom had just read my post about girls with ADHD, and telephoned. She said that her daughter was getting poor grades in school despite high aptitude. She often forgot her homework assignments and forgot to hand in the assignments she did. Her written work seemed randomly put together, with one idea not flowing naturally into the next.

Although this pattern had been noticed since she began elementary school, she has never been in trouble, and her excellent reading was always thought of as a major educational advantage.

Could this be ADHD, especially the inattentive type often found—and often missed—in girls? She seemed to meet some of the common criteria: performance notably below her potential, forgetfulness, disorganization, and her teachers often found her not paying attention. But that lack of eye contact and awkwardness in following and participating in a conversation could be symptoms of what is currently called Nonverbal Learning Disability, which is considered an Autistic Spectrum Disorder.

While these were possible, I wanted to be sure not to miss important other possibilities in this teenager. At her age, I’m particularly concerned about depression. Social isolation, bullying, harassment of some sort at school could be an issue. Is there an eating disorder? Is she hurting herself in some other way? Was there a boy the parents didn’t know about? What about alcohol or drug use?

I posed all of these questions to Claire's mother. She thought all were unlikely. They had a warm, open relationship and she didn’t think the child would hide much. Though teenagers can have very private lives as they try to find an identity independent from their parents, I thought the most important factor was the long history of behavior, observed very early in her school career. Even Claire joked with her friends about her being ‘spacey.’

Her mother wanted to know how to approach her.

Be completely open with her. Parents who aren’t usually find themselves defending their omissions or deceptions. This can have serious consequences for the credibility of the parent and the relationship with the teenager.

Tell her:
  • You read the post online, and show it to her.
  • We spoke on the phone and this plan was my idea.
  • I want to see her, to ask her opinion and to ask her screening questions.
  • I want to initiate a formal evaluation.
  • I will give questionnaires to her current and former teachers, but only to the teachers she likes.
  • Questionnaires will also go to her parents.
  • She will get a questionnaire so that she knows what questions are being asked and so she can evaluate herself.
  • She will be included in every part of the process. No decisions of any kind will be made without her.
  • All of the process, including that the evaluation is happening at all, will be completely confidential. It will not be a topic for conversation at the family dinner table, or with her siblings or friends.

It’s a mistake to assume that the teenagers who aren’t crying out for help don’t want help or wouldn’t accept help if offered. I don’t know yet if any of this will happen, or what the results will be. I’ll keep you posted.

The photograph above is by Paul Strand. It was taken in 1953.

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Please let me know what you think. Do you know a child or situation like this?