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Case Study Gonzalo

A false ADHD diagnosis
Cynthia Cabaas Gonzlez

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Table of Contents
What is ADHD? .................................................................................... 3 Gonzalos Case .................................................................................... 4
Family Background ................................................................................................... 4 Gonzalos Personality ............................................................................................... 5 ADHD Diagnosis ....................................................................................................... 5 Medication ............................................................................................................... 6 Ethical Implications On Medication ...................................................................... 7

Critical Thinking................................................................................... 7
My Opinion On The Case ........................................................................................ 7 What I Have Learned From The Case...................................................................... 8

Appendix A ........................................................................................... 9!
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What is ADHD?
According to the DSM-V, ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and disorganization entail inability to stay on task, seeming not to listen, and losing materials, at levels that are inconsistent with age or developmental level. Hyperactivity-impulsivity entails overactivity, fidgeting, inability to stay seated, intruding into other people's activities, and inability to waitsymptoms that are excessive for age or developmental level. It often persists into adulthood, with resultant impairments of social, academic and occupational functioning. Its prevalence in most cultures is about 5% of children and about 2.5% of adults. See appendix A for the list of Diagnostic Criteria in the DSM-V. Regarding, its development and course, many parents first observe excessive motor activity when the child is a toddler, but symptoms are difficult to distinguish from highly variable normative behaviors before age 4 years. ADHD is most often identified during elementary school years, and inattention becomes more prominent and impairing. The disorder is relatively stable through early adolescence, but some individuals have a worsened course with development of antisocial behaviors. In most individuals with ADHD, symptoms of motoric hyperactivity become less obvious in adolescence and adulthood, but difficulties with restlessness, inattention, poor planning, and impulsivity persist. A substantial proportion of children with ADHD remain relatively impaired into adulthood. In preschool, the main manifestation is hyperactivity (e.g.: running and climbing). Inattention becomes more prominent during elementary school. During adolescence, signs of hyperactivity are less common and may be confined to fidgetiness or an inner feeling of jitteriness, restlessness, or impatience. In adulthood, along with inattention and restlessness, impulsivity may remain problematic even when hyperactivity has diminished. On gender-related diagnostic issues, ADHD is known to be more frequent in males than in females, with a ratio of 2:1 in children and 1.6:1 in adults.

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Gonzalos Case
Gonzalo is an 18-year-old boy who was diagnosed from ADHD when he was about 6 years old, same time he started going to therapy. Family Background Gonzalo now lives in Madrid but has moved from his house three times due to his fathers job (who serves in the military). Moving houses is already a very significant stressor for anyone, but to him it meant more than just changing addresses. He first lived in a house where, when he was a little boy, he could climb trees, run, etc. (what many children would love their childhood to be). Then they moved to a flat, where he had to change all his customs and former games, as he had no possibility to climb anymore and thats the moment when his parents started to worry because they started to see him as a troublemaker. As he himself confesses, he was bored so he would take out all the boxes he found in his house, or play with the sockets. Gonzalo has a good relationship with his father, but acknowledges he didnt get to see him much when he was little. His father was always away, traveling for work. Practically, his mother had to raise all the children. Gonzalo has two older siblings, a boy and a girl, which he finds have had a different treatment from his parents than he had. Now, his brother is away in university and her sister is the prototype of perfect student. These factors have also contributed to the vision his parents began to have of him, in particular his mother. Usually, when parents have their first baby they take more care of them, have more illusion, because they have no experience and are fearful of anything happening to the baby. Gonzalo is the third son in the family, so he might have been left a little more on his own. His parents already had had the experience; they knew what and what not to do. Gonzalo blames his mother for a great part of his problems. He says shes too old now to be a mother. But as you can conclude from the description he gives of her, he loves her. He says they dont have a bad relationship, but that she actually never listens to him, so neither does him. Still, he wants to make her happy, as he

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knows he has been a true troublemaker when he was younger. Now, he has matured, and is more calmed and formal. Gonzalos Personality As already mentioned, he is a person with a lot of energy, who feels he needs to burn it down. He has had some problems at school because of this. When he went to school he didnt feel like paying attention to the teacher, but he thinks this is happens to every child. He was just being forced to going to a place he didnt want to go, where he had to be still for several hours learning about things he, for the moment, didnt care about. This doesnt mean Gonzalo is not intelligent or has no cultural interests. He loves reading and can really concentrate and read a thick book in a few days. His psychologist describes him by as being very sincere but also a little intransigent and choleric maybe. In this sense, he lacks assertiveness when trying to communicate things. He even insulted a teacher because he felt like she didnt know what she was saying and didnt listen to him. Gonzalo, on the other hand, describes himself as very lazy for things hes not interested in, as for example his studies. He claims hes not lazy when having to help others, as he says he never thinks of himself. Hes really altruistic in a sense. ADHD Diagnosis There are many signs in Gonzalos story that would make you think he probably has Attention Deficit and Hyperactivity Disorder. Its easy to take the diagnosis criteria in the DSM-IV or DMS-V and tick off criteria as you read or listen to what he says. But, can we say a child has a disorder because he is not interested in what a teacher is saying but obviously prefers to be outside playing in the sun? Not to me. Education has always tried to make fit every child into this prototype of student they find normal. What stays out of the mold, is abnormal then. Gonzalo was first raised being able to burn all this energy some of us have, and some of us dont. From my point of view, its not a problem but how he is, hes nature.

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Since he was thought to have problems when he was 6 he has been going to therapy. The psychiatrist diagnosed him with ADHD and he has been to 4 different psychologists apart from Elisabeta. He hated these other psychologists because they didnt know how to establish rapport with him. They just sat in front of him and they expected him to tell them about his life, without having any confidence. He just couldnt do that. He would lie to them as much as he wanted, as he could also do with the psychiatrist and the test he was carried out to diagnose him a disease he doesnt have. Many other factors in his life, as the three moves of house he has lived, his older siblings, the fact that her mother is already tired and feels shes too old for more troubles because she has raised the children on her own, contribute to his mothers idea that ADHD suits his childs problems. Insisting on this may help her feel less guilty on having the fault of whatever happens to Gonzalo. ADHD, thought to be a brain disease (neurodevelopmental disorder) and thought to be cured with medication affecting neurotransmitters, would mean its neither Gonzalo nor fault. Its easier and less painful to believe this. Medication Gonzalo has been on medication since he was 6 years old, when he was prescribed Rubicen. He took this until 2nd ESO, because it gave him tachycardia and diarrhea. Then he was prescribed another different drug which made him be a zombie all day long. He would just look to the wall in class, completely still, but couldnt pay attention to anything. He couldnt even sleep and would stare to the ceiling for hours incapable of sleeping. When he was changed to another drug, this one gave him feel sick all day and gave him headaches. Then he was prescribed Rubicen again, which is what he is taking in this moment. The quotation marks mean he isnt actually taking the medication because he feels he doesnt need it. He says medication changes his personality, makes him have a lack of appetite!

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Gonzalo says he feels better without taking his pills. Is medication not needed when someone is diagnosed ADHD? Or has he cured from ADHD? Did he ever have ADHD? His mother doesnt approve this. He forces Gonzalo to take the pills, and cries and makes he feel guilty by saying she only wants him to be all right. Nobody doubts this. And although, his father and his psychologist, Elisabeta, have tried to change her mind about this issue, it wont work. This leads Gonzalo to lie to his mother, even having learned to keep the pills in the back of his throat so that she believes he took them.

Critical Thinking
My Opinion On The Case The problem I see with his mother and society in general is the lack of knowledge and awareness of the issue. At this moment, in society and in the medical community, ADHD is thought to be a real brain disease. This is a matter I wont discuss here about, as Im dont really agree with ADHD being a disease. What I want to highlight is that psychological problems related to physical components in the brain feel an explanation much more acceptable for many people, as it de-stigmatizes them in a way. Physical components dont seem as our fault whereas psychological components do. They seem mental health weaknesses. To me, its not that Gonzalos mother doesnt love his son as much as she loves his siblings. Its not that she wants him to be a zombie or anything but that she wants him to be fine under any circumstances and she finds this is the only way. As mentioned before, this might be a way she has to feel less guilty about whatever happens to Gonzalo. It might be a way to take away the burden of him not being the perfect prototype of a student and son. Another problem that arises from the fact that Gonzalo is forced to take his medicines is that he isnt really let to be himself and deal with things the way he would be without medication. He needs to learn to deal with things from his own

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baseline, which is different in each of us. Thats what psychologists can do for him. Help him discover these strategies he needs to use to deal with real life without medication. Another issue to point out is that Gonzalo, although knowing he doesnt suffer from ADHD, takes a little advantage of this diagnosis. He has a pretty high percentage of learning disability, so he is given more time do exams. Might we see this as a little reprisal or vengeance from what he has suffered for 12 years? We definitely cant blame him for this, as he isnt hurting anyone. What I Have Learned From The Case I find it very positive that Gonzalo came to our class to explain us his story. It has helped me have an understanding of what really happens in daily life with people that are diagnosed from ADHD. We were able to ask him whatever doubts we had, which is much more information than you can get from a book or from the Internet. A really interesting debated arised also: many people in class started giving their personal (and not professional) opinion of what they thought Gonzalo should do or what his mother and father should do. They seemed to give him moral lessons of what to do. But who are we to this? In my opinion, were no better than him. Psychologists are not gods to judge and teach people what is right or not to do. On the other hand, Gonzalo gave us a very useful lesson on what psychologists should do to establish rapport with their patients. You just cant ask for something youre not giving: you cant ask them to open up and be honest when you are not doing the same. They wont feel like talking then. A balance must be found between professionalism and being able to create a special relationship with our patient so that you can be really a support to him, and he is willing to tell you things. If I ever had a consulting room, I definitely wouldnt want to be one of those psychologists Gonzalo complained about. If I ever taught classes, I would want my patients to be willing to come to my class and explain their stories with the naturalness and confidence Gonzalo did.

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