An "Aha" Moment

An “aha” moment—
brought on by reading answers to an online question.

The questions and responses upon which this verbal meandering is based is found below said verbal meandering:

So…if a young man of 14 or older (not the young man this questioner is asking about)—or 12 or 10 or so develops problems paying attention in school and to homework, this is most likely NOT AD/HD. Hmmmmmm.

But it could be caused by anxiety. And anxiety could easily stem from having a mother unjustly imprisoned…from living with a father who molests him sexually, as well as abusing him in other ways—physically (punching him in the stomach or the crotch, for example), verbally (telling him the father will burn down his mother’s house, with him and his mother in it), emotionally (depriving him of love and respect), or in any other way the father can think of.

In short, a child older than 7 who develops symptoms of AD/HD “needs an evaluation by a mental health professional who specializes in evaluating adolescents.” [See below]

“Developmental strain, depression, drug use, family issues all should be considered before medication is prescribed.” [See below]

Or, life being what it is, and an abusive father being what he is—what the heck—go ahead and give the kid amphetamines, whether he needs them or not. Tell people he has been diagnosed ADD or AD/HD.

A teenage boy has enough stress in life as it is—“The normal developmental anxieties of a 14-year-old relate to peer concerns, body and sexuality issues, and separation from parents as leaving home and going out into the world comes closer. Performance related to school or sports may be a worry. Identity issues related to divorce or other losses may show up at this time.” [See below.] Add in a few things like molestation and a variety of abuses, and difficulty concentrating would seem quite logical.


The question:

My 14-year-old son has recently developed difficulty paying attention in school. He is actually quite bright, but his grades are beginning to suffer. His teachers believe he has Attention Deficit Disorder and suggest I ask for medication from his doctor. We have not seen any of these problems until quite recently. I have heard that anxiety can also cause difficulties with concentration. Is this true? If so, how do we figure out what the problem is?

Two answers—that say essentially the same thing:

You are correct that attention problems that belong in the Attention Deficit Disorder (ADD) category show up at a much earlier age, specifically by age 7. ADD is sometimes diagnosed after the symptoms have been present for a number of years. ADD is officially called Attention Deficit Hyperactivity Disorder, or AD/HD. Symptoms of inattention, hyperactivity or impulsivity must persist for at least six months and be maladaptive and inconsistent with developmental levels. Symptoms are present in at least two of the three areas of school, social and family functioning. You are also correct that anxiety can cause difficulties with concentration. Anxiety disorders are the most common mental illnesses in the country with more than 19 million people affected each year. The normal developmental anxieties of a 14-year-old relate to peer concerns, body and sexuality issues, and separation from parents as leaving home and going out into the world comes closer. Performance related to school or sports may be a worry. Identity issues related to divorce or other losses may show up at this time. Your son, with the problems you mention, needs an evaluation by a mental health professional who specializes in evaluating adolescents. Developmental strain, depression, drug use, family issues all should be considered before medication is prescribed.

Kaye Bock, MSW, BCDChild and Adolescent PsychotherapistBrentwood, MO314-961-2312

Poor concentration can result from many factors. Although Attention-Deficit/Hyperactivity Disorder (AD/HD) is found more often in boys than girls (affecting 3% to 5% of school-aged children, with inattention symptoms present for at least six months), it usually is diagnosed much earlier than age 14. Therefore, a complete physical and emotional evaluation is recommended. Assuming the child is in good physical health, the therapist sees if symptoms fit with AD/HD, depression, anxiety or adjustment. For example, has the child been sad, lost interest, shown sleep/appetite problems? In considering anxiety, has the child been distracted due to excessive worrying? Also, a family history reveals genetic or biochemical predispositions to mental disorders. The therapist assesses the child’s overall adjustment. How is he relating to the family? How is his adjustment to early adolescence and sexuality issues? Are there stressful situations affecting the child such as moving or switching schools? Has the child shown signs of drug or alcohol involvement? Has the child’s peer relations changed (including bullying or violence)? Once these questions have been answered, the therapist will be more equipped to make a correct diagnosis of the problem and then suggest a treatment plan to address the specific source of the concentration difficulties.

Donald F. Sloane, LCSWDirector, Center for Cognitive Behavioral TherapySt. Louis, MO314-432-3166