Patient Name: Arnold A
Diagnosis: ADHD, Combined Type: Inattentiveness, Hyperactivity, Impulsivity
Arnold was a nine-year-old boy referred by his school public health nurse with the following complaints: "disruptive classroom behavior, a discipline problem at home. Outbursts of misbehavior -- seems to lack self-control, especially when not under direct supervision of teacher (hits other children for no reason, rolls on the floor, jumps off chairs). Even under his teacher's direct supervision, he talks out, makes facial grimaces. He gets out of his seat frequently. Even during his 'quiet moments,' he seems tense; cracks his knuckles, plays with buttons on clothes, can't sit still. Has no close friends at school; seems to reject other childrens' attempts to make friends. He has above average ability, but not working up to that level now." The boy's behavior problems and academic problems had been aggravated by a family move and entrance into a new school. Reports from his previous school revealed, however, that Arnold had never been well adjusted; he had "spit, hit, and had temper tantrums . . . his behavior fluctuated drastically . . . sometimes he was moody and at other times exceptionally mean." By his mother's account, which his father tended to contradict, Arnold had always been very active, had been "always into things and on the go," had "no interest span," attentiveness, stick-to-itiveness, and had blown up easily and cried readily. He had marked sibling rivalry; his eleven- year-old brother had always been a model student and son.