Expert: Catherine Ridenour - 2/6/2008

Question
Hi, I am wondering if you could help me. My sister lives in LA - rest of the family in the UK. She has 2 children; girls ages 12 and 8. The 12 year old has been diagnosed with ADD but I feel that there is something more happening. She is extremely average at school and consistently appears to 'lie' about what homework she has to complete to the point that she is getting straight F's for non submissions. On top of this she also seems to lack empathy to her mother and if asked to tidy her room will disappear for an hour and return to say she has tided her room when she hasnt. My sister cannot understand why she does this and is constantly punishing her. But I see it as a complete lack of appreciation of any consequences. When my sister shouts at her she shows no emotion at all and stares at her blankly. She is well behaved in general and does have a circle of friends and appears to lead a normal social life. I am concerned as the environment for the whole family is so negative that I do not feel this is 'normal' and suppose I am trying to find a reason for it all.
The younger child is now recognised as having learning disablities and below average intelligence for her age. She has difficulty grasping basic concepts and new learning has to be repeated many many times. She now has also started to demonstrate the same Characteristics - ref the bedroom tidying and this is just adding to the burden for my sister. She sees it as lying but they are good children and I dont believe the reason would be lying.
The eldest has been diagnosed with ADD and has taken medication but my sister and her husband - both nurses - have withdrawn this due to the potential side effects. The child Psychologist she saw stated that she was lazy and this seems to be the overwhelming reason that my sister applies to her behaviour. I am really worried about them and wondered if you could help offer some guidance / advise.

I await your comments

Gratefully...........

Answer
Hi Janet,

You don't say if the ADD medication was helpful or not. Withholding medication for ADD that works will limit the child's ability to perform on a more normal level. She is not producing the brain chemicals she needs. I always looked at it this way: if my child had diabetes I would give her insulin even despite the possible side-effects. One problem for people who work in the medical field is that they see the side-effects more often than they see the majority of people who have no problems from the medication. It magnifies their fear.

Much of the behavior you describe sounds like something on the autistic spectrum to me. Failure to perform with no apparent remorse, lack of response to reprimands, saying things that are not true (versus lying on purpose) all can be symptoms of an autistic disorder.

Being branded as "lazy" often happens to ADD and autistic children. Shame on the psychologist for using that word. It makes for a scapegoat situation that helps no one. That is a value judgment, not a diagnosis. Motivating ADD or autistic children is very difficult. They are happy in their own world, pleasing others is not on their agenda. One has to find what matter to them and work with that.

The fact that the younger girl is now having similar problems can be evidence of a genetic basis. But, it can also be mimicry of the only kind of behavior she has observed in her home. I'm not saying she's playing dumb on purpose, but kids learn what they live.

If you think you can intervene without a family uproar, suggest a new evaluation with a child psychiatrist (not psychologist) who is trained in recognizing autism. This family needs family therapy even if the initial diagnosis is accurate. Yelling and punishing are not working. This can only escalate to more harsh punishment or in giving up and letting the kids run amok. Even if physical harm does not occur, emotional damage will. Your sister needs a more effective way to manage her daughters. It will greatly reduce her stress level.

Go to some of these websites and print out a description of Asperger's syndrome. Check off the behaviors that apply and show it to your sister. It may help her recognize things she has been trying to ignore or blaming on "laziness."

http://www.neurodiversity.com/main.html (many links to books, articles and resources)

http://www.patientcenters.com/autism/news/resources.html (books and resources)

http://www.ninds.nih.gov/disorders/asperger/asperger.htm (the definitions and
government links)

http://www.autism.org/temple/meds.html (about medication)

http://www.autism.org/ (many links to information)


Best wishes,
Catherine