“He is not Working up to Potential”: Atypical Attention Deficit Hyperactivity Disorder with Executive Weaknesses

Abstract

Robert was referred for neuropsychological evaluation because of concerns regarding his academic achievement. In fact, he had reportedly demonstrated inconsistent motivation in school for quite some time. In early elementary school, he had not shown any difficulty acquiring basic academic skills. However, he was occasionally distractible or inattentive. In fifth grade, his parents become concerned about his relationship with his teacher. They said Robert clashed with his teacher, developed more negative emotions about school, and struggled with classroom performance. He began therapy with a social worker, which appeared to enhance his coping skills, and he showed some improvement in the classroom, but his academic performances continued to be variable. He would “freeze” on certain tests, and his mother described him as learning faster when things were presented in a song or pattern.

As Robert progressed through school, he appeared smart but did not seem to care about school, was nonchalant, and would not work to his potential. He had difficulty attending at times, inconsistently turned in assignments (even if he completed them), and would not complete work even if he was able to do it. In the year before he was referred for an evaluation, Robert completed ninth grade in a new school. The transition to the new school was difficult for him, as he had to make new friends while also adjusting to the high school environment. He did well initially, but his grades declined over the course of the year. As a result, he failed two math classes and was placed in summer school. The summer school teacher quickly indicated that Robert knew all of the mathematical content of the class, and the teacher reported being confused as to why he had not passed the class in the first place. Robert 's mother became increasingly concerned about his academic difficulties. She began to realize how much assistance with structure she gave him in the home environment, including help with planning and lists. She decided that it was time for a professional opinion about his development.