ADHD Case Study 2

The Girl With A Passion For Tennis and Running
Paige – ADHD, inattentive subtype, 15y F

Rae Tattenbaum, MSW, CSW

Identifying attention issues in girls appears to be side stepped by the educational leadership in some schools. For some of these bright, attractive adolescents demonstrate, what has become known as, the Shadow Syndrome. In his recently published book “The Shadow Syndromes” Dr. John Ratey describes how many peoples lives are serious impacted by the undiagnosed condition which impacts their entire lives. At Inner Act, I have developed a sub specially in diagnosing the more subtle but devastating forms of attention problems.

Paige is an attractive 15 year old girl who has achieved better than average grades in primary and middle school. She enjoys a circle of friends and is considered a grounded adolescent. Her favorite activities are running and tennis. In her freshman year at the local high school, Paige became increasingly frustrated. To her the quality of teaching was not as good as she had experienced and many of the classes were boring. She went from an honor student to nearly failing. Upon her return from the Winter vacation, she conveyed to her family the extent of her unhappiness. She was developing an anxiety disorder about school and her approaching tests.

When we first met, Paige shared with me that she studied for hours. It seemed like she suddenly had no ability to remember. Also, she found school boring. I asked Paige to come back the next day to talk some more which she did willingly. It was during this next session that the initial diagnosis began to tae shape. Within days, this diagnosis of ADHD primarily of the Overfocused type with inattention was apparent. I still perceived a possible mild left hemisphere processing problem as well as the possibility some sizing.

The Visual TOVA provided additional information. This is a visual computerized continuous performance test for the diagnosis and treatment of attention disorders. The patient is given a practice period followed by a 22 minute test which uses non language based, non sequential stimuli with both vigilance and disinhibition subtests to measure: Inattention (Errors of Omission), Impulsivity (Errors of Commission), Response Time, and Variability. The first half of the test is target-poor (2/7 of all items are targets), assesses inattentiveness primarily. The second half of the test is target-rich (5/7th are targets), assessing impulsivity.

1st Half
2nd Half
Total Test
Inattention
55
106
96
Impulsivity
56
95
89
Response
103
116
114
Variability
71
114
100

The omission errors were excessive and supported my suspicions of a neurological impairment. After much effort, the family was convinced to have a set of sub tests for an abbreviated Neuro cognitive. Preliminarily it is apparent that there is a left hemisphere processing deficit.

Paige was taught breathing and relaxation techniques. I suggested that I train her to hypnotize her self before studying and prior to tests. Paige responded to the relaxation and willingly learned how to travel to a safe internal place. The EEG protocol was C3-FP1 and C4-FP1. After 20 sessions, Paige received a great interim report from school and was feeling terrific. She had made several changes in her studying and in her test taking. The first half of the test is target-poor (2/7 of all items are targets), assesses inattentiveness primarily. The second half of the test is target-rich (5/7th are targets), assessing impulsivity.

1st Half
2nd Half
Total Test
Inattention
105
108
108
Impulsivity
78
94
91
Response
110
120
120
Variability
103
117
111

The effect on inattentiveness halves of the tests are shown below.

After the TOVA, Paige was exhausted and it reinforced some of my initial intuition about the possibility of photic sensitivity and seizing activity. This story about a real person is being shared because there are so many adolescents similar to Paige who go through school undiagnosed.

Get your inattentive daughter to a good practitioner using multiple modalities especially EEG Biofeedback.

Rae Tattenbaum, MSW, CSW
68 South Main Street
West Hartford, CT 06107Tel: 860-561-5222
RTinneract@aol.com

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