David’s Shadow: Reflections on a 9-year-old’s ADHD Diagnosis

A while back I was employed as a teacher’s aide at a local elementary school. I spent each morning (from 7:45am – 11:25am) Monday through Friday working in a third grade classroom, assisting the teacher with all manner of classroom activities. My primary role, however, was to monitor and manage students’ behavior, particularly the behavior of a student named David. (All names and background information have been altered to protect confidentiality.)

On my first day of work the teacher informed me right away that David was the “problem child” of the class. School had been in session for two weeks before I started working at the school, during which time David had reportedly exhibited some disruptive behaviors. The teacher described David as a restless, impulsive child who had difficulty staying focused and on task. At nine years old, David had not yet been diagnosed with any psychiatric disorders or learning disabilities. In fact, by the teacher’s account, David was “bright” in terms of academic ability. She attributed his behavior issues to his family upbringing. “His father is a gang member,” she told me on my first day, “and his mother has a bunch of tattoos to go along with her bad attitude. They let David get away with murder at home.” My own initial impressions of David were quite different from those expressed by his teacher. I liked him right away, especially his sense of humor, which had a wry, subversive quality to it that I admired. David did indeed seem to be very bright and, when he was engaged and interested in classroom activities, he participated in discussions appropriately and made insightful contributions. He did, however, seem bored much of the time, and he would frequently express his lack of interest by making barely audible comments, like saying “Bo-ring” under his breath, or intentionally giving a silly answer to one of his teacher’s questions. David also seemed fidgety and restless much of the time while the teacher was instructing the whole class. The teacher redirected him quite frequently for behaviors such as tapping his pencil, playing with objects like erasers and paperclips, and squirming around in his seat.

A few days into my new job, the teacher instructed me to be “David’s shadow,” meaning I should focus attention on David whenever I wasn’t otherwise engaged with other students or duties. This role gave me many opportunities to observe and interact with David throughout each morning over the course of the semester. David was soon placed on a behavioral contract, which in part meant that he was to receive star-shaped stickers from school staff for each block of time he was able to show appropriate behaviors. David seemed to respond well during the periods of the morning when he received one-on-one attention (i.e., from me), but he was reportedly more prone to inappropriate behaviors during the afternoon, after I had left for the day and the teacher was in the classroom without the support of an assistant.

Over the course of the semester, I not only had the opportunity to work with David each morning during routine school days, but I also accompanied David on a field trip to see a play, I sat with him during “movie day” as we watched the animated film Monster House, I played tag with him and his friends during recess on one occasion, and I sat down with him and his mother during a parent-teacher conference meeting. In general, David seemed to be a happy child who was well liked by his peers. His sense of humor seemed to endear him to his fellow students, and to many school staff as well. In the time I spent with him, he never mentioned any problems at home or problems with peers at school. David and I mostly shared moments of humor, like when he would show me a silly picture he had drawn, or when he’d recall the fun we had playing tag the day I joined the class for recess time. David would also frequently ask me for help with his schoolwork, especially spelling. For the most part, David responded respectfully and without protest whenever he was redirected (by either the teacher or myself) for inappropriate behaviors, and he normally accepted disciplinary measures (e.g., having to write “behavior reflections” assignments, having to sit at a table by himself, or losing “privilege points”) with only a minor show of disappointment. When I would talk with him about why he was getting in trouble, David would usually say something to the effect of “I’m bored” or “This stuff we’re doing is boring.”

I noticed that David especially liked to use the technology in the classroom, which included computers, an iPad, and a large “smart board” the teacher allowed the students to use occasionally. When classroom instruction was centered around technology, David was far more likely to be engaged and on task, but he also got in trouble quite often for using the technology out of turn or at inappropriate times. He would frequently be dishonest in an effort to maximize his time using the technology, and then as a consequence his privileges became more and more restricted. It became somewhat of a vicious circle David was getting caught in, as his behavior became more disruptive the more he was prevented from engaging in the technology-based activities that he enjoyed.

At the parent-teacher conference meeting, David’s mother agreed with the teacher that something more needed to be done about David’s impulsive and disruptive behaviors, which apparently were also problematic at home. A plan was set in motion to get David tested for attention deficit hyperactivity disorder (ADHD), and within a few weeks David was (according to his teacher) taking medication for the condition. I was surprised and saddened to learn that David had been placed on ADHD meds. I recognize that I am neither a doctor nor a school psychologist, and because I was not part of the treatment team charged with making decisions on David’s behalf, I was never made aware of all the information that may have been pertinent to David’s situation. My response is a personal one, and my opinions are presented here simply as part of my own reflection process.

My sadness had to do with my strong sense, based on my experiences with David, that his problematic behaviors were not an expression of pathology or a disorder of any kind, but rather they were simply David’s way of expressing his general lack of interest in and engagement with the methods of curriculum delivery most commonly utilized in the classroom. I sat next to David the day the class went on a field trip to watch a play. The play was very humorous, and David was well behaved and thoroughly engaged throughout the performance. He seemed to be “in his element,” as he did on the occasions when he was enjoying recess on the playground or engaging with the classroom technology. David’s abundant energy and active sense of humor—two of his most prominent qualities—were not particularly engaged during periods of the school day when he was required to sit passively in his chair and stay relatively silent. Compounding David’s problems, he would often lose his recess privileges (and therefore his opportunity to run around on the playground) as a consequence for his misbehaving, thus setting him up for more difficulties later in the day as he struggled to regulate his energy level.

David’s situation reminded me of an article we read in our School Counseling class that same semester about the possible trend among certain physicians to prescribe stimulants to struggling students, particularly students from lower income families, whether or not those students meet the criteria for ADHD (Schwarz, 2012). More than one of the doctors mentioned in the article lamented that we as a society have been unwilling to invest the time and funds necessary to optimize the success of struggling, lower income children, and therefore we are putting increased pressure on healthcare and other professionals to use the most cost-effective approach at their disposal—that of medicating children. As one doctor chillingly put it: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.” (Schwarz, 2012, para. 3). Comedian Stephen Colbert (2012) satirically referred to this pharmaceuticals-first approach as “meducation,” a method of behavior modification that I find particularly disturbing, especially now that (in my opinion) I have directly seen it applied to a child.

Many people disagree about what constitutes appropriate psychiatric diagnosis and/or use of psychotropic medication with children, and this is an issue that caused me a great deal of concern in my experience working with David. Soon after David started taking medication, he started complaining of stomach pain, and he seemed to lack his usual appetite and ebullience. He slumped in his chair looking ill while the class watched Monster House on “movie day.” The class had brought treats and snacks to enjoy with the film, but David uncharacteristically declined to have anything to eat. The teacher told me afterwards, “The doctor raised his med levels yesterday. He’s probably taking a little too much.” As we discussed David’s progress in school, the teacher made it clear that both she and David’s parents had noticed a remarkable improvement in his behavior since he started on his medication. While it may have been true that David’s behaviors were not as disruptive after he was put on medication, I couldn’t help feeling that these gains came at too great a cost. If only David and students like him could receive a bit more one-on-one attention and individualized instruction, perhaps improvements in behavior could be realized without having to risk the possible side effects of pharmaceuticals.

I thoroughly enjoyed my experience working with David and the other students in his third grade classroom. Children at this developmental level are particularly open to learning, and their boundless energy and enthusiasm make it fun to engage with them. It was sobering, however, to see first-hand the various social issues—such as poverty, racial bias, and suboptimal parental supervision—that affect many of the children school-wide. David seemed to thrive when he was given the increased attention that I was able to provide during the few hours each school day I was with him in the classroom. I have no doubt that he could continue to thrive and maximize both his developmental and academic potential if only the school environment could adapt to his needs by providing more staff support for him throughout the school day.

Of course, extra support costs extra money that is not available to many schools, and I am sympathetic to David’s parents and his teacher, who likely were doing their best under challenging circumstances to help David succeed in school. Although I was disheartened by the decision to modify David’s behavior by modifying his brain chemistry with psychotropic medications, I am still hopeful that his fiery spirit will burn brightly as he finds his way through this difficult process.

References
Colbert, S. (2012). Colbert Nation website. Retrieved from http://www.colbertnation.com/the-colbert-report-videos/420013/october-10-2012/the-word—meducation

Schwarz, A. (2012, October 9). Attention Disorder or Not, Pills to Help in School. The New York Times. Retrieved from http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html