Leo was a 9-year-old boy attending a private school in Los Angeles. His parents were frustrated and concerned because he was having problems at school. Teachers were complaining that he was disruptive in class, sometimes aggressive with other students, even his friends, and his grades were slipping. Leo’s teachers saw these behaviors as symptoms of ADHD and asked the parents to follow up with Leo’s pediatrician and discuss medication. Fearful of the side effects of medications and considering the possibility that there might be an underlying problem, Leo’s parents brought him to me for therapy. After several months of therapy, it was revealed that Leo was grieving; his behaviors were expressions of the feelings he couldn’t identify and didn’t know how to express. Leo’s grandmother, who had lived with him his whole life, had died 6 months before his behaviors began to change. At this point in the therapy, Leo was beginning to do better in school, he was no longer disruptive, or aggressive, but he was still having a difficult time focusing.
Leo had, what is known as, co-existing conditions; he had ADHD and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct. His story is so important because it demonstrates how the obvious label is not necessarily the whole picture. Had Leo been given a comprehensive evaluation for ADHD, it would have brought the underlying issues to light. A brief ADHD test or a pediatrician, relying on a teacher and parent’s perspective alone, and quick to prescribe ADHD medication, Leo’s underlying grief would have been masked, only to delay its expression in other unhealthy ways.
