As a three-year-old, Paul was screened by Child Find, a service provided by Anne Arundel County for preschool children to determine if a disability interferes with learning and, if so, whether special education services may be recommended. Their findings were inconclusive, a fact that, frankly, allowed me at the time to continue to rationalize that Paul’s differences didn’t warrant undue concern. Just as I thought, I said to myself. Nothing to get worked up about.
But by the time Paul turned four and his pattern of drifting away had continued, I took him to a psychologist, Anthony Wolff. If nothing else, I knew Paul would benefit from one-on-one attention. And I needed to check my own thinking, or at least have a sounding board. I had to admit Paul was a mystery, and I knew I shouldn’t bank on his outgrowing the distractibility that was impeding his learning.
Dr. Wolff quickly won Paul over. In fact, Paul loved going there. They played games, inside and out of the office. The results of a formal assessment, were summarized in writing:
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Paul is an affectionate, endearing child who wants to please the adults in his environment. However, his behavior can best be characterized as globally immature. We have dealt with certain psychosocial issues, such as the relative lack of involvement of his father, which are significant but in my opinion not the main issues with respect to his cognitive development or academic performance.
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Despite his episodic but quite noticeable symptoms of ADD, I have been conservative and hesitant to apply that diagnostic label to Paul on the theory that he may be on an atypical developmental course. However, Paul’s failure to benefit optimally from his pre-k class prompted me to recommend finally that a trial of medication be instituted.
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It is not my impression that Paul suffers from a serious emotional disorder per se although he certainly is at risk for developing a secondary emotional problem if his primary problems, in the cognitive and academic domain, are not improved.
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As I now read that final sentence, all these years later, it feels like the first time. I was a devoted mother to Paul. I have no doubt about that. And I have a pretty good, if not very good, memory. But I didn’t absorb the meaning of those words as maybe I should have. I was concerned about kindergarten and, beyond that, first grade. I absolutely didn’t think long-term. Instead, I was slugging it out one day at a time. And, ever the optimist, I didn’t realize the full extent of this child’s vulnerability.
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DESPITE MY INITIAL skepticism, we started down the medication route for Paul. As a school administrator, I had first-hand knowledge of children whose lives were saved by strategies that included medication. I witnessed kids whose disorganization compromised their potential and for whom a small dose of Ritalin (the most frequently prescribed medication for ADD or ADHD at the time) was a miracle. Success was noted literally overnight. Paul was not one of those kids.
Ritalin for Paul made a marginal difference in enhancing his concentration but, unfortunately, the slight and uneven boost in his productivity did not outweigh the side effects: weight loss, fidgeting, and nervousness that exacerbated his tremor, compounding his difficulty with fine motor skills. Dexedrine was tried next and, working with his pediatrician and psychologist, we experimented with the dosage before determining, some months later, that the Ritalin was more beneficial and that Paul would acclimate to the side effects.
I was fortunate to be able to stay home with my children in their early years (until Keely was seven and Paul four) and to jump back into the professional world in a way that blended with my parenting. Until Keely was born—the year I turned thirty—I had been an academic librarian at the University of Maryland, College Park, a place where I enjoyed accolades for my work and made lifelong friends.
When Keely started school as a three-year-old, I volunteered in the library at her school, a pre-kindergarten through twelfth grade independent school in Annapolis. Within a couple of years, I was on the payroll. And by the time Keely started second grade, and Paul was entering the four-year-old program, I was the librarian—a full-time position. The following year, I joined the school’s administration, working twelve months and assuming increasing responsibilities over what would end up being a thirty-year career.
The school’s campus included fifteen buildings and was located on an old estate that had been a gentleman’s farm from the late 1880s to 1940 or so. Beyond being a home-away-from-home for the three of us, the school was a place where good people joined forces, where intellectual zest and creative thinking filled the air, and where the commitment to individuality and to new ideas was exciting. Along with opportunities for tremendous professional growth, I gained a greater exposure to my children’s teachers and a greater respect for their work.
I remember going into Paul’s classroom one day at lunchtime, just as he was given his mid-day dose of medication. The little boy seated next to him said, “Why did you take that pill?”
Even though I was across the room, Paul called out to me, “Hey, Mommie—why do I take pills?”
I explained he took them to help him pay attention and concentrate.
A worried look crossed Paul’s face as he responded to me. “I hate to tell you this,” he said, “but when I take that pill, it goes down; so I don’t think it’s helping my brain.”
I didn’t think it was helping his brain either.
The summer before Paul’s kindergarten year, when he was five-and-a-half, I turned to a local organization that provided diagnostic evaluations and tutoring support. After a series of sessions with Paul, including a battery of tests, they sent me a written report that included:
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Test scores must be accepted cautiously as they are considered a minimal estimation of Paul’s true abilities. The pervasive pattern is one of attentional limitations. Until the correct dosage of medication is met, further definition of Paul’s learning style is tentative. He appears to be a creative thinker who has difficulty with sequential delineation, poor control over his pencil, and a lack of confidence for academic tasks. The result of this constellation of patterns is that Paul may try to manipulate or avoid task completion altogether as a means of disguising his undeveloped skills.
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After receiving the report, I hired a tutor to work with Paul.
The common thread in Paul’s many assessments, beyond just the poor scores, was the challenge of determining his ability level, due for the most part to his distractibility, but also to his unique approach to testing. It was understood that Paul’s scores reflected his performance rather than his ability. One of the teachers recounted the following exchange:
Teacher: “Susie had five hair ribbons and she lost three of them. How many did she have left?”
Paul: “Did she find them?”
Teacher: “No. She lost them . . . If she had five to start with and lost three, how many did she still have?”
Paul: “Did someone help her?”
Teacher: “Yes, of course . . . But my question is: How many did she have? Start with the number five and take away three.”
Paul: “Was she sad?”
As the teacher explained to me, “None of Paul’s responses were unintelligent but, in scoring the test, no points were given.”
In a different setting, Paul was asked to name things “to ride.” In the allotted time, he had just one response: “A house.” At the end of the testing, Paul was asked to explain his logic.
“My mom told me they can dig them out, put them on a truck, and move them,” he said. “How do they do that?”
When I heard this, I knew. Just a few days before, I had told Paul about a couple of houses in Annapolis that had been moved when I was young. Paul was