I have a fourth grade student that is academically doing find. He is a wonderful pianist and is very happy if he is doing something of his own choice. He has had a shunt in place since Kindgarden. His level of alertness is quite low in production of amount of work. Since he is capable of completing the work the teacher is modifying the amount of work he has to produce.

However, I observe this to only decrease further the amount that he will complete in the allotted time. He is in RSP to support and his ability to complete work is not effected by incentives, rewards, choice time, visual timer, auditory timer, verbal redirection. he does do better if a task is new, novel and he is interested. he even will even forget he is playing a game of his choice and need to be called back to task.

He is currently on no medications. And we send him to the office if he gets a headache. he sees his Neurosurgen for a yearly check. Julie his mom reports that both JR's brother and father have ADHD/ADD. She also reports more difficulty getting him to complete homework- no matter the amount. She is willing to try other options.

Thoughts and ideas please?

Regards and thanks for your time.
Ovieda Elliott , MA SLP, /RSP teacher

Answer:

Hi…. I am a bit confused by the description of this youngster but the scenario you present worries me a bit. The first thing I would want to check out is if his neurosurgeon is aware of his low “level of alertness” and what sounds like fluctuations in his ability to complete a task. This could represent some episodes of his intracranial pressure increasing or being mildly elevated all the time. This certainly should be ruled out as the cause of some of his problems.

I would also want to get a careful history about his difficulties with motivation. Could he be preoccupied with problems or depressed? Did he have the same difficulties from the start or have they significantly worsened recently? Did these motivational difficulties appear or worsen at the time of the shunt? (the neurosurgeon might want to know that as well) What have other teachers noticed in prior years? Attention Deficits usually start, by definition, prior to age 4 or 5. The history is, therefore, very important in determining what the diagnosis might be.

Other information that I would want to know about is:

Why did he have increased intracranial pressure in the first place? This is important to determine if he has other neurological abnormalities to consider.

What about this boys psychological testing as well as speech and language testing? Does he have processing difficulties? You say that his academics are OK but it seems that he is not finishing homework and not motivated by much of anything. Could this mean that it takes him more time to process or write down the information necessary to complete his homework?

As you can see by this response, your question has a complex answer and requires in depth investigation to determine what interventions, from neurosurgical to medication to counseling, might be indicated for this young man. When you have some of these answers, I would love to hear. You could refer him to us as well, after the neurosurgeon has been made aware of these difficulties and if all his testing is up to date and has failed to identify a reason for these difficulties.

Kay S. Browne MD