Question: My son is a smart kid. His teacher got me really mad, though, when she said he is an underachiever. She says he spaces out in the classroom. He would get much better grades, but he doesn’t do his homework and he won’t study. Every year, his report card has comments about how his “organizational skills” need improving. I don’t know what to tell him because I was the same way. But I’d like him to do better. I think it is because he is bored in school. The teacher isn’t giving him interesting or hard enough work. When he is really interested in something, or likes the teacher, he does fine.

Anne Fenton, MD: Many children with good intelligence have the kinds of difficulty in school that you describe. They are smart, but have trouble focusing or concentrating. They often have trouble organizing their materials as well as their thoughts, especially when it comes to writing assignments. They need to be reminded over and over to do chores or tasks, they can be forgetful, and inconsistent in their academic performance. These problems become more obvious every year, peaking in middle school and high school, when academic requirements are more complex. These features are consistent with what is called attention deficit disorder. Many parents don’t think of this diagnosis, because their children, like your son, seem to be able to focus for hours on subjects or projects of interest. Parents figure that if the children can do that in one area, they should be able to do it in every area. However, like all of us, children with ADD can accomplish more and focus better on subjects they like. The contrast between “hyperfocus” and distractability on other topics is simply exaggerated. I would suggest you have your child evaluated for ADD. If that is his problem, it is a condition which is very treatable and widely treated.

Question: My child is really “high maintenance”. He has horrible tantrums and can be very aggressive. He is very intelligent, and does well in school, but at home he is a monster. Everyone tells us that it is our fault. They think we should discipline him better, but when we try to, he doesn’t respond. He doesn’t care if we punish him or take things away. And he lets us know.

We are at our wits’ end. It is especially hard because no one believes there is something wrong with him. They just think there is something wrong with us. His classroom teachers, our relatives, even his pediatrician look at us like we are the problem. We are afraid to take him to see someone who will tell us the same thing.

Anne Fenton, MD: There are children with significant symptoms which only show up at home, but not outside of the home, until much later on. We think that the structure of the school day or the public eye offers some buffer to help the child control the behaviors outside of the home, only to have a meltdown at home. It is parents of such children who have the hardest time getting help, just as you describe. Unfortunately, by the time others see the symptoms, it is too late for the early intervention so important for the child’s normal development.

Child psychiatrists are familiar with stories like yours. We understand that you know your child, and that you have already tried all the standard parenting approaches, read the self help books, and looked for answers wherever you could. A child psychiatrist will take your concerns seriously, and offer the help your child needs.

Question: I have always had certain thoughts in my head that I can’t get rid of. They drive me crazy, but I can’t get rid of them unless I say certain things over and over until they go away. It’s really embarrassing. I can’t tell anyone. I don’t think anyone else has this problem. Have you ever heard of this? Is there anything I can do about it?

Anne Fenton, MD: You may be surprised to learn that your problem is actually quite a common one. If I understand you correctly, you are experiencing symptoms to the condition that is called obsessive compulsive disorder. Most people think of this as compulsive handwashing. Some people use the term loosely to describe a person who is very neat or orderly. Actually, it refers to any repetitive activity or thought that seems to have no basis in reality, but is extremely annoying or worse, and only seems to fade or stop when the person does some repetitive action or thought to “make it go away”. Many times, people are embarrassed by the symptom because it defies logic. One hallmark of the condition is that the individual knows it makes no sense, but also can’t stop it.

There are behavioral therapies for the condition, as well as medications that can work very well to suppress the symptoms, so that they won’t interfere with daily living. Research suggests that a combination of combining the techniques is optimal for treatment.