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Dysthemic and Anxiety Disorders
Q: My daughter is l5 years old and was first found eligible for special education in 1991. Present placement is home hospital instruction due to dysthemic disorder/anxiety disorder. A neuropsychological exam in 1997 found her reading level to be grade 5.2 with no clear evidence of dyslexia.
My question is if the child is not dyslexic and does not have ADD, what is happening? The reading, writing, and spelling are seriously inadequate and disorganization is a major day-to-day problem. The result has lead to chronic school failure, which I believe has lead to the emotional diagnosis.
Remediation has not worked and has lead to more failure. I cannot get the school to help as they see the child as bad, lazy, stupid, and choosing not to do the work. I cannot get an IEP because the school is unwilling to provide anything but remediation. I live on a rural island without professional services and therefore treatment has not been available.
I was told by the advocate that he didn't feel this child was worth the effort because in his opinion it is a motivational issue. Over the last year my relationship with my daughter has become very strained as she sees my advocacy on her behalf as the problem. She wants to drop out of school because she thinks it's hopeless.
This is a very bright child whose major interest is the performing arts. Is it hopeless or is there something I can do? Do you have any suggestions? Thanks.
A: Your question underscores the importance of an early and accurate differential diagnosis. The emotional and behavioral symptoms you describe could certainly be the consequence of a misdiagnosed learning disability or attention deficit disorder, but emotional difficulties can also be at the root of your daughter's learning difficulties. You say that your daughter was found eligible for special education in 1991 (when she was about 9), yet the school is unwilling to provide her with an IEP. This is a bit confusing, since IEPs must be generated for students with special needs.
The professionals who assessed your daughter are attributing her academic difficulties to her emotional problems and poor motivation, which may be the case now. However, you say she has had chronic problems learning in school. I would like to know more about how your daughter was taught when she was young and whether she exhibited more emotional problems or more educational problems in preschool and in early elementary grades. If she's always had emotional difficulties (or there is a history of emotional difficulties in the family), then it's likely that this is the root of her problems. If, on the other hand, she started school as a happy, well-adjusted child (and she did not experience any significant traumas), but couldn't handle the schoolwork, then it's more likely that her primary problem was learning or attentional difficulties. (This is especially likely if a close relative also had LD or ADHD, since these conditions often run in families.)
What's as important as the correct disagnosis is her teachers (and even her advocate) perception of your daughter as "bad, lazy, stupid, and choosing not to do the work." None of these descriptions are appropriate for professionals to use to describe the behavior of a child who has been diagnosed with dysthymia and anxiety disorder, and who is so upset that she must receive instruction at home. Do the teachers not agree with the current diagnosis? Then it's up to the professional who made that determination to set them straight. Either the diagnostician is wrong or the teachers are wrong! (Or they are both wrong and you are dealing with a child with a misdiagnosed LD or ADHD).
If you disagree with the school's assessment, then you should ask for an independent evaluation by someone outside the school system who is qualified to tell you whether your daughter's difficulties are caused by (or the cause of) her emotional problems. In your case, this might involve going off-island, and it probably should involve having your daughter evaluated by a multi-disciplinary team (special educator, psychologist, psychiatrist and others) because of the complexity of your question.
You might also want to seek family counseling to help you cope with the conflict that has surfaced between you and your daughter about this issue. She might be the kind of child who would do very well at a boarding school that has a therapeutic component that can address both her emotional and her learning needs (and one that has a theater department). If you are in a school system that is governed by the U.S. Dept. of Education, then the school might be obligated to pay for such an education if they are unable to provide it themselves. Let us know how this turns out.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.