The Intersection of Art and Narrative.

ADHD

by Tom W. Miller

August 5, 2016

 

 

Janine could sense that Ms. Caldwell, Clay’s third grade teacher, had something unpleasant she wanted to discuss. In their previous meeting, the young teacher had been all smiles and had made only positive comments about Clay’s progress so far and his outlook for the rest of the school year. Today, Ms. Caldwell had to force a smile, and her fidgety hands revealed underlying discomfort. Like a taut rubber band reverting to its natural state, the smile soon faded.

 

“Clay is a bright child, Mrs. Armstrong—"

 

“It’s Ms. Armstrong,” interrupted Janine. She noticed a minute scrunch in Ms. Caldwell’s eyebrows. Was it judgment, or was Ms. Caldwell only bracing herself for a serious conversation?

 

“I’m sorry,” continued the teacher. “Clay’s a smart boy, but I have to express my concerns about his behavior in class and how he interacts with the other kids.”

 

Janine felt a pit open up in her stomach. She had seen the signs herself—at home, at church, at the grocery store. She wanted to be a mother that met her son’s problems head-on, but on this issue, she knew she was in denial. Janine listened as Ms. Caldwell described multiple situations in which Clay acted “in a manner different from the other kids.” Though young, Ms. Caldwell was already skilled at parent-teacher communication. She avoided negative words like “bad” and “problem” and emphasized that she “embraced differences among her students,” yet she would be “remiss not to voice my concerns.”

 

Concerns. How Janine hated that word. She remembered Clay’s birth almost nine years ago. He weighed seven pounds, six ounces. He had a full head of hair, and the doctor declared his skin color to be “perfect.” She had a beautiful baby boy—all the nurses said so—and the delivery had progressed without a single complication. As she nursed Clay for the first time, she was awed not only at the being he was, but at the boy and man he would become. She saw a Little Leaguer, a shortstop, the cornerstone of his team. In his teens, he would have friends over to play video games, and then the girls—they would see his potential before he saw theirs. One day, something would click and he would kiss the sweetest and prettiest of these girls. They would go to a homecoming dance together. His chest, arms, and shoulders would fill out, and he would be so handsome, as well as smart and athletic. After graduating from college, Clay would marry his high school sweetheart and work his way up to vice president of a company that produced wholesome, American-made products. His family would live two hours away from her, visit at least once a month and spend every Thanksgiving, Christmas and Easter with her. As Janine approached her final years, her kind daughter-in-law would insist that Janine come to live with them in the new house addition they had just built. At family dinners, Janine would regale her grandchildren with humorous stories of their dad in his youth.

 

As soon as she rolled out the hospital doors with Clay in her arms, the concerns began. “Janey,” said her mother, “I’m concerned about this car seat you bought for Clay. I looked it up online and it’s only rated in the middle of the pack. On the way home, I’m going to stop at the store and buy him another one.”

 

“I’m concerned he doesn’t have a father figure,” said her married sister Rosemary on Clay’s third birthday. “I know there are a lot of single mothers out there whose kids turn out just fine, but maybe you should contact Big Brothers or some organization like that.”

 

“I have some concerns about Clay’s keyboarding abilities,” said Mrs. Thompson, Clay’s first grade teacher. “He is well behind the other kids. If you need financial assistance to buy Clay a laptop for home use, we have a program that can help.”

 

Ms. Caldwell was winding down her speech, and Janine snapped out of her fantasy. “I’m not a psychologist,” said the teacher, “but I have been trained to recognize some of the symptoms of ADHD.” Ms. Caldwell reached into a pocket, pulled out a slip of paper, and slid it across the table to Janine. “This is the name and number of the child psychologist that serves our school, and I urge you to call him and set up an appointment.”

 

“I really don’t think that’s necessary,” said Janine. “Just because Clay’s activity levels are a bit different than the other kids doesn’t mean he’s got ADHD.”

 

Ms. Caldwell nodded in sympathetic agreement. “You’re totally right, Ms. Armstrong. Like I said, I’m not a psychologist, but I do want you to know what I see going on in the classroom and pass on my concerns. Please, give Mr. Burris a call. I know him. He’s great with the kids, and of course the county pays for all of his services. I’ve seen the effect his sessions have had on past students. He’s changed lives for the better.”

 

Janine stood up and thanked Ms. Caldwell. As she walked to her car, Janine’s first instinct was to rip up Mr. Burris’s phone number and throw the pieces in the first trash can she passed. But images kept popping into her head. Clay is not alone with his grandmother right now in a dreary, two-bedroom apartment, but playing with a couple of friends in a lush, large backyard. Clay is smiling, laughing, at ease, because he feels accepted by the others, is like the others. His whole life changes and he returns to the track that she imagined for him on the first day of his life. It would be selfish of her, cruel even, not to give him that chance because it would injure her own pride. Clay should not have to suffer because of her own mistakes and choices. And for all she knew, the psychologist might give Clay a clean bill of mental health and applaud her parenting skills.

 

***

 

It seemed as if God had designed Raymond Burris, child psychologist, to be as non-threatening as possible so that kids would open up their hearts and minds to him. When he greeted Janine, Mr. Burris had to look up into her eyes. Janine figured he was about thirty, but he had the kind of face that made nightclub bouncers ask for ID. His teeth and smile were the best things about his appearance. His teeth were straight and bright, but they had some small imperfections that made Janine think good genes instead of good dentistry. His cheeks dimpled and his eyes crinkled when he smiled.

 

Mr. Burris shook hands with Clay as well. Janine pressed her lips together as she focused on the unruly cowlick atop Clay’s head. Her son liked to brush his own hair, but he did not have the patience to plaster this shock of hair to his head. Janine also noticed a small hole in Clay’s shirt just beneath the collar where the label was stitched on the inside.

 

“Thanks for coming in today, Clay” said Mr. Burris, as Janine sat beside her son. “We’re just going to talk today, get to know each other a little. Then I’m going to have you take a little survey to which there are no wrong answers. Again, this is something that just helps me get to know you. Then, I’ve got a snack for you, and I’ve got some video games and some other fun things to do here while your mom and I talk in the room next door. Sound good?” Clay nodded.

 

Mr. Burris started by asking Clay to describe a typical day. To Janine’s surprise, Clay started to talk about his routines. Although Clay’s narrative contained several long tangents, Mr. Burris never tried to steer the conversation and he interjected only to clarify details.

 

As Janine listened to Clay, that bad feeling in her stomach returned. Several times she had to resist the urge to modify Clay’s version of events. One time she gave into the compulsion to make Clay seem more normal. The sound of her own voice surprised her, as if it had a mind of its own. Mr. Burris tactfully asked Janine to let Clay tell his story in his own words.

 

Most of the time, Mr. Burris looked directly at Clay as he spoke, but he did have a clipboard on which he took notes. Every time the pen hit the paper, Janine felt a sting, as if the man’s writing instrument were a bee with unlimited lives and venom. Each mark was a criticism of her son’s behavior and upbringing.

 

Mr. Burris continued to interrogate Clay for another fifteen minutes about all kinds of topics: his likes and dislikes regarding food, television shows, sports, games, and free time; the way he felt about other kids and his perceptions of how they felt about him; his cherished memories and his future aspirations. It was agony for Janine to remain silent.

 

“Thank you so much for talking to me about all of that,” said Mr. Burris. “I really enjoyed listening and getting to know you.”

 

“You’re welcome,” said Clay, smiling. Janine felt her anxiety ease a bit with her son’s display of manners. Clay may have issues, but at least she had taught him to be polite.

 

Mr. Burris removed the notes he had just taken and handed the clipboard to Clay. “These are the written questions that I told you about. They’re not even really questions—they’re more like situations. All you have to do is circle the choice that is closest to what you would do or how you would feel in that situation. None of the choices might hit it exactly, but try to choose the closest one anyway.”

 

Mr. Burris looked at Janine. “Ms. Armstrong, if you could wait right outside that door, I would appreciate it.” He motioned to a door on the opposite side of the room from where Janine had entered. Next to the door, a large mirror hung on the wall. “There’s a sitting area in there, with magazines and coffee if you’d like it. I’ll be in to talk with you in a few minutes.”

 

Janine stood up and followed Mr. Burris’s instructions. Sitting with Clay as he took a test would be worse than listening to him talk. In the silence, she would conjure images of foreboding questions, Clay’s deviant answers, and the psychologist’s concerned interpretations. Maybe some coffee and a copy of Redbook could divert her fears for a few minutes.

 

When she entered the waiting room, Janine discovered that she could see through the mirror and into the room where Clay was sitting with the clipboard. Janine poured herself a cup of black coffee, but she could not take her eyes off of her son. She held her breath when he fidgeted in the seat, drummed his fingers on the clipboard, or tapped his feet on the floor.

 

After about ten minutes, Clay handed the clipboard back to Mr. Burris. They both stood up and Mr. Burris turned to indicate the sitting area behind him. In front of a television and video game console sat one of those special chairs that enhanced sensations for the player. Beside the television was a bookshelf that held dozens of games and accoutrements for those games such as steering wheels, joysticks, and guitars. Clay walked over to the bookshelf and starting looking for something that he liked.

 

Mr. Burris walked into the waiting room and closed the door behind him.

 

“How did he do on the test?” asked Janine.

 

“It wasn’t really a test, Ms. Armstrong. It was more of an assessment tool,” said Mr. Burris. “We are going to talk about what I’ve seen today, but first I’d just like to observe Clay for a few minutes.”

 

Ready to document more evidence of Clay’s abnormal behavior, Mr. Burris had moved a clean sheet of paper to the top of his clipboard. Janine picked up a magazine, but put it back down without opening it. She felt like she was on the sidelines, watching one of Clay’s soccer games last fall. She wanted to yell directions to him, to get him to do what he should be doing, but such an effort would be just as useless now as it had been on the soccer field. She listened as Mr. Burris’s pen scratched across his clipboard.

 

The psychologist finally capped his pen and sat down in a chair on the other side of the magazines. For a moment, Janine thought he was going to reach out and clasp her hand, as a sensitive doctor did when breaking bad news to the next of kin. “I’m ready to talk now, Ms. Armstrong,” he said. “The American Psychiatric Association’s Diagnostic and Statistical Manual lays out the definitive parameters for diagnosing ADHD, and what I’ve seen from Clay fits within those parameters.”

 

Janine took a slow, deep breath. She knew other parents who claimed their kids had ADHD, but she never could quite accept that ADHD was a bona fide disorder. She had always thought that the “condition” was a crutch that people used to justify their substandard parenting techniques. Janine knew the symptoms and had seen some of them in Clay, but that was just Clay. He was the person he was supposed to be, and she saw no need to put a label on that. Now here he was though, already in third grade, and still struggling academically and socially. She would be remiss as a parent now if she did not seek help for Clay and get him back into the mainstream before it was too late.

 

Mr. Burris recognized Janine’s inner distress. “Actually, I think that’s good news,” he said. “Now that we’ve identified Clay’s condition, there’s a lot we can do to help him. There’s behavioral therapy, there’s medication. I know several other kids with this, and these things have helped so much.”

 

Janine felt resistance simmering within her, threatening to boil. She imagined herself taking Clay out of there right now, calling Mr. Burris a “quack,” and pulling Clay out of public school altogether so that she could teach and nurture him at home. The realistic part of her, though, knew that this was a fantasy. She could not quit her job and stay home with Clay. In fact, she was looking for a second job that would help make ends meet. She was seriously considering hosting parties at which she sold attractive, over-priced baskets.

 

Instead of fleeing the scene, Janine bit her lower lip and nodded. “So what needs to happen now?” she asked.

 

“Well, first I write up a report with my diagnosis and recommendations,” said Mr. Burris. “Then we will get together with Ms. Caldwell and an administrator to set up an Individualized Education Program for Clay. In the IEP, we will list any accommodations we need to make for Clay in the classroom, and, if you would like, we can devise a schedule to pull him out of class for therapy sessions, which I would conduct.”

 

“You mentioned medication?” asked Janine, looking down at her lap.

 

“I myself don’t prescribe medication,” said Mr. Burris, “but I can refer you to a psychiatrist who could. The county would pay for any physician visits that I recommend.”

 

Janine looked up and studied her son again. As she watched him, alone in the room, in front of the television and video games, she admitted to herself that the psychologist’s diagnosis was correct. Clay had been like this since he was young, but could a present father have changed that? Janine tried to convince herself that Clay’s problems were the result of a chemical imbalance in his brain. The more she told herself this, though, the more the nagging voice inside her protested. She had made choices before Clay had come into being. She had done this. To redeem herself, she had to do everything possible to help Clay and endure the labels and the guilt. She had prided herself that she had never gone to the government for assistance despite her precarious economic status, but pride was now another thing that she would have to set aside for Clay. Her son had a disability, and as soon as she got home, she would find out how to apply for Supplemental Security Income so that she could give Clay everything he needed.

 

“Yes—I would appreciate that recommendation,” said Janine.

 

***

 

In her classroom, Ms. Caldwell sat at her desk and opened the inter-office envelope from Ray Burris. Technically, Ray was not supposed to provide her with this, but Ray knew that Clay Armstrong was her student, and the psychologist was a bit sweet on her as well. She had told Ray that her only interest was to start helping Clay as soon as possible. The child had urgent needs that could not wait for meetings and other bureaucratic procedures to take place.

 

Ms. Caldwell laid the report on her desk and began to read Ray’s comments:

 

During the oral interview, Clay never once left his seat to wander around the room. He fidgeted minimally. He seemed to attend to every word I was saying.” Ms. Caldwell nodded, because she had seen the exact same thing in her classroom. While the other children moved from learning station to learning station every five minutes without having to be told, she always had to remind Clay, immersed in his subject, to get up. Whenever she gave the students instructions, she always did so in a variety of ways: orally, visually on each child’s computer, experientially, by acting out examples, and tactically, through a kind of Braille system for those children with a tactile learning style. Clay was often overwhelmed and confused by the barrage. He would need noise-cancelling headphones to block the cacophony that most children needed to learn.

 

Ray’s notes on the written assessment were just as troubling. Not only did Clay fail to get up during the test, he never even raised his head from the paper. Ms. Caldwell remembered only a couple of weeks ago when she had to send Clay to the office after he refused to accompany the rest of the class outside on one of its two ten-minute test breaks. Clay had insisted on completing his test in a single sitting, even though she had told him that such a thing was bad for his health. Ms. Caldwell had heard of other teachers having this problem with an occasional student. A series of behavioral therapy sessions with Ray usually solved the problem.

 

The final part of Ray’s assessment, though, suggested that Clay Armstrong’s disorder was on the extreme end of the spectrum. When Clay was in a room alone with a bookshelf full of video games, he never even turned on the console. He had opened one of the video game boxes, but instead of treating himself to a feast of sensations, Clay had pulled a booklet out of the box and begun to read the game’s back story. Few of the other games on the bookshelf even had instructions, let alone a back story, but Clay had picked up the oldest selection available. Moreover, the story was not twenty-five characters, or twenty-five words long, but twenty-five pages. In Ray’s opinion, only medication and therapy in tandem could provide relief from such a crippling level of the disorder.

 

In a History of Education class that Ms. Caldwell had taken in college, she had learned how teachers once tried to force children to remain silent, to stay in their seats and to pay attention for as much as thirty to forty-five minutes at a time. She lived in a more enlightened time, though. Classroom practices had aligned themselves with children’s true biochemical makeup. To do otherwise not only inhibited learning, but was cruel to the children.

 

Ms. Caldwell reached the end of the report and read the diagnosis that Ray had made with “extreme confidence”: Attention Deluge Hypoactivity Disorder.