Tammy, an 8-year-old third grader, was halfway through the second grading period when her parents asked for another conference with her teacher. Her grades were very low with failure to complete class assignments and inconsistent performance on homework.

This wasn't the first time the school had raised concerns. Tammy was struggling with reading at the end of first grade in spite of testing by the school guidance counselor which showed very good ability. At the time Tammy complained that all the noises in the classroom were distracting. Further evaluation at that time through her pediatrician had suggested a possible diagnosis of ADHD, primarily inattentive type. Since there were no problems with hyperactivity her parents, especially her father, were reluctant to consider any medications. They got some self-help books to learn skills to help Tammy with her school assignments and address her "smart mouth" responses to adults. There was progress but her father complained that Tammy's mother was not consistent with discipline. Her mother argued that it didn't seem right that Tammy was always grounded and prohibited from all of her favorite activities.

To help identify Tammy’s difficulties and to address the disagreement between the parents regarding the correct approach, Tammy was referred to a child psychiatrist. That evaluation confirmed the diagnosis of ADHD. The parents’ efforts at providing Tammy with structure for her schoolwork were helpful, but they all agreed this was not enough. Her father's position had softened after he talked with his sister whose son also has ADHD and had a good response to treatment with medication. She also reminded him of the struggles he had in elementary school and all the times he was sent to the office.

In a session that included her parents Tammy talked about how tired she was of being in trouble all of the time and about how discouraged she was about her school efforts. She cried herself to sleep many nights.

A decision was made for treatment with stimulant medication. Tammy had an expected response. She was especially pleased when she was moved to a higher reading group and she was picked for her school basketball team. Her medication was tailored for school time since her evening and weekend behaviors were not a problem.