CASE: Julian, an 11-year-old boy in the sixth grade with a compliant disposition and a positive attitude, has had a significant decline in his academic performance over the last 2 years. He spends much of his time in the nurse's office with headaches and fatigue. He reports that he cannot concentrate or follow along in class. Vision and hearing screenings were normal.
Julian's teachers report that although he has no behavior problem, he is inattentive and does not put forth the effort she feels he is capable of giving. He does not seem to be listening, and he is distracted by everyone around him. He often claims that he did not hear or understand the things that teachers explained several times. When teachers talk to him directly, he starts an assignment and usually finishes his work on time. Teachers observe that he has “attention-deficit hyperactive disorder (ADHD) like tendencies.” A recent psychoeducational evaluation qualified Julian for special education services under specific learning disability in the area of auditory processing. An individual education plan will be developed within the next 2 weeks.
Key indicators used to make this determination included the following: average standard scores on nonverbal tests of cognitive development, a below-average score in overall auditory processing (with particularly low scores in auditory reasoning and auditory memory), average scores in the areas of general memory and attention/concentration, and below-average composite scores in reading and written expression.
Following a review of the assessment report, Julian's parents remain concerned about the possibility of ADHD. Prior to the special education assessment, the school provided the Vanderbilt Assessment Scales for Julian's parents to share with his doctors; it revealed elevated scores in ADHD symptoms (predominantly inattentive subtype). Julian's parents would like to learn about options for treatment that might improve his attention.
*Learning Resources Department, Preuss School, La Jolla, CA;
†Speech and Language Pathologist, Pruess School, La Jolla, CA;
‡Audiology Department, Rady Children's Hospital, San Diego, CA;
§Division of General Academic Pediatrics and Child Development, University of California San Diego, Rady Children's Hospital, San Diego, CA.
Disclosure: The authors declare no conflict of interest.