Sam is a 7-year, 10-month-old boy who was referred to his pediatrician in March of his second grade for assessment because he is behind academically and his teacher wonders if he has attention-deficit hyperactivity disorder (ADHD). Both parents came for the initial interview. No special assessments have been completed by the school except that the mother recalls that Sam was given a language screening in kindergarten because he had trouble pronouncing the sound "r." Sam was enrolled in a reading tutoring program last year but has not received extra tutoring or supplemental school services this year. Sam has good gross motor skills and has many same-age friends. He has difficulty with handwriting. He has always been considered compliant and good at following adult directions until this school year. Sam is considered noncompliant by his current teacher. He often fails to start or complete assignments that have been given to the class but has no aggressive or significant externalizing behaviors. Spelling, writing, and reading are considered to be below grade level by his teacher, but math skills are considered to be at grade level. Teacher and parental questionnaires and parental history were not suggestive of ADHD.
Sam lives with his parents and older sister. There is no family history of learning disabilities, ADHD, or psychiatric conditions. Both parents completed college and are employed outside the home. There have been no recent significant changes for the family. Birth history is unremarkable. Sam has had no loss of consciousness or episodes of otitis media. He has normal sleep and growth and no history of bedwetting. Sam's early development was considered typical except for slight articulation errors noted in kindergarten which resolved spontaneously. The screening test completed by the speech therapist at that time was informal and no records were kept.
On examination, Sam is a cute, compliant child with a normal physical and neurological examination except for mixed hand dominance and mild overflow movements. Sam's height and weight are 50th percentile for his age. His conversation is typical. When he was asked to read an easy Dr. Seuss book, he frequently guessed at words and seemed to use the pictures as cues. He was clearly not a fluent reader. His pediatrician considered referring Sam to a psychologist for more comprehensive testing, but Sam's parents worried about their ability to pay for such testing. Because Sam is having significant difficulty at school, Sam's pediatrician wonders how she can help Sam access evaluation and treatment services through his public school.