Letter from specialist to Moira about John

NATIONAL HOSPITAL NO.
LB:MR
PEDIATRIC CLINIC
22 July 1995

Dear

Re: John

I am writing to you to document my impressions about the situation with your son John. You will recall contacting me here directly in the recent past because of concerns raised by School Authorities that some of the long-standing behavioural problems in John could be due to an attention deficit disorder state.

You indicated that difficulties or challenges in working with Johns behaviour had really gone back to the time when he had become mobile. Certainly in the preschool years, John's causing tension in the facilities he visited with the equivalent of yellow and red cards being given to him. It was stated then that John's behaviour could be destructive and that he was unnecessarily aggressive towards other children. You regarded him as quite difficult to handle and found that he was on the go pretty much all the time. Your own home circumstances were not especially easy in these early years with John who was your fifth child. The pregnancy and birth though had been reasonably straightforward. The boys early developmental milestones have been passed normally. There had been a succession of bothers with recurring ear infections when he was young which had probably lead to a partial hearing problem thus delaying speech development. That difficulty had led to attention from Grommet's when John was about 3 and also from Speech Therapists.

You had produced a sheath of school reports which all basically sang the same song. The reports in varying ways over the years had referred to difficulties at John staying on task, the ease with which he could be distracted and could distract others, his potential to be disruptive, and problems in the way he interacted with his peers. The reports also noted the very positive intellectual potential of the boy. As the child started to move through the Primary School years, you found him harder and harder to work with on the home front. He seemed to become increasingly resistant to obeying any reasonable requests. 'He could throw temper tantrums if thwarted.' He could be destructive. There were annoying problems with lying and stealing. The circumstances for managing John took a turn for the worse when it was revealed that his father had been involved in sexual abuse of older daughters of yours. John's father who had the same name as the boy had been forcibly removed from the home in connection with these difficulties in 1991. More recently, you had formed a liaison with another man. About 18 months ago, matters though came to ahead in terms of your capacity to handle John at home. You became very alarmed that you would seriously hit or injure the boy and sought help from the Police and other appropriate authorities. The DSW became involved and your own mother agreed to take over the care and supervision of John. The boy had been subsequently living with JanieV over the last 18 months with JanieV attending the meeting here with me on the 22 July.

John was co-operative and reasonably attentive during the course of my assessment. He did display fidgety characteristics at some points though. I examined him carefully from the neurological point of view and found no evidence of anything amiss. I found no evidence of any medical problems that might lead to abnormal behaviour. His vital statistics seemed unremarkable although he presents at this time as a reasonably solid young citizen with a weight of 52 kg on the 90th centre for his age compared with a height of 151 cm on the 50th centile and a head circumference of 52 cm on the 10th centre. He is pre-pubertal in terms of his secondary sexual development at this time.

As discussed with you and your mother, I believe that John does exhibit characteristics consistent with the diagnosis of an attention deficit disorder state. I believe that he would benefit from a trial of psychoactive medication and feel that Dexamphetamine would be a reasonable drug to start him on initially. I have given you some background reading material and suggested other avenues that you could look things up in. I have promised to get back in touch with you once the special authority for the use of Dexamphetamine has come to hand.

Sincerely yours

PEDIATRICIAN