Case Studies

1.  The case of Nico: labelled with Attention Deficit Disorder (ADD)
2.  The case of Mary: treating "dyslexia"
3.  The case of Alexis: a gifted child with diagnosed ADHD

1. The case of Nico: labelled with Attention Deficit Disorder (ADD)

Nico is a 10-year-old boy. He is quiet but has a wide smile that lights up his freckled face. He enjoys reading and computer games but also plays cricket and he swims. Other favourite pastimes include wrestling and playing imaginary games with his younger brother. Nico was born with a clubfoot but no intellectual impairments. An IQ test given during Grade 1 showed a superior intelligence. In spite of this, he has not thrived in formal schooling. His Grade 1 teacher reported that he was not completing tasks and showed concentration problems and a lack of interest in schoolwork. She suggested that he may be suffering from attention deficit disorder as he tends to fidget quite a bit. After he learned to read, there was some improvement and it seemed that he was making a special attempt to finish his work in order to be allowed to go to the book corner. However, in following years, the slow pace of work became noticeable again. During his grade 4 year, his teacher reported extreme aggression at school towards other children and herself. School also caused Nico to suffer from headaches. These were located at the back of his head and occurred frequently, especially when he felt tired, upset or hungry. He reported that at times the headaches were so severe that he was unable to work. He had been wearing glasses since Grade 2 to help his eyes to focus but they did not seem to help the headaches. The headaches were far less frequent during vacation times.

Nico's parents believed that his slowness was related to boredom with the level of work and the headaches to frustration. His handwriting, which is almost illegible, was blamed on his lack of interest in trying harder. However, his teachers didn't want to give him work that could perhaps have been more stimulating because they argued that he was completing so little of the prescribed work that they felt it would be a waste of their time to offer him additional material.

Background information

Nico's mother reported a normal, problem-free, full-term pregnancy during which she was active and content. The birth, with an epidural procedure, progressed quickly at first but Nico became lodged in the birth canal and was extracted with instruments. His birth weight was 3.64 kg and his APGAR scores were normal. He was given oxygen after the birth because of the long delivery time.

Breastfeeding was not successful due to a problem with inverted breast nipples so after 6 weeks Nico went onto a bottle. He sucked well, seemed to flourish and slept through the night from 8 weeks. He still sleeps well, although he sometimes falls out of bed when he has bad dreams.

His club foot was corrected by two operations, the first being done at 3 months with a cast up to his knee. After the second, his leg was plastered to the hip joint and removed just after his first birthday. This meant that he was unable to crawl for a long while as he walked at 14 months. Other milestones were all within normal limits. He teethed early and also achieved bladder and bowel control at an early age.

Nico was a healthy boy but did suffer from frequent ear infections requiring many antibiotics and tubes on several occasions, the last being removed at 8.5 years. He has been through 15 surgical procedures in total, including the two for his foot, on for the removal of tonsils and adenoids and the rest for insertion of tubes. Medication was prescribed for his allergies (dairy products, cat dander, dust mites and pollen), which have resulted in an asthma attack. He uses an asthma pump to aid his breathing when necessary.

In the area of sensory stimulation, Nico shows some issues with tactility. He is very ticklish and cannot bear to have people touch him lightly; he dislikes certain foods due to their texture and refuses to wear certain items of clothing if they feel "uncomfortable." He particularly resists wearing sweaters. He was a very active toddler but his mother reports that he is less so now - perhaps because he likes to read.

Observations

Nico was very cooperative throughout the assessment and enjoyed the humour that we introduced for fun. He showed a preference for quick closure which meant that he sometimes missed details that required more careful observation.

He was able to complete all the tasks but it soon became obvious that his eyes were not working efficiently. Nico could not nurse satisfactorily as a baby and it is possible that this contributed to his visual difficulties as the act of nursing demands intense pulling with the mouth which developmentally helps the eyes to begin working as a team. On a task which involved tracing around some figures, he turned the paper so that he could draw on the vertical rather than on the horizontal or diagonal, indicating a problem with visual tracking. When faced with a design completion task involving linear line diagrams, during which he was not allowed to move the paper, he struggled to succeed and his lines were inaccurately placed and uncertainly drawn. Furthermore, he showed jerky eye movements when having to follow a moving object with his eyes. He tended to use his head to track and eventually his eyes failed to track at all. He reported that this task made his eyes very tired. In addition, he found it difficult to focus on an object at near distance, showing problems with convergence. When he was asked to wear a pair of spectacles with one blue and one red lens he said that he saw blue and red interchangeably. This was another indication that his eyes were not working together as this alternating suppression means that the eyes are fighting for dominance. He also reported a sensitivity to bright lights, glare and difficulty adjusting to transition from dark to light (as when the light is switched on in his room when he wakes up in the morning). Hard sucking during infancy strengthens the ring, or sphincter muscles and this light sensitivity could be due to his pupillary sphincter's inability to filter light well enough due to the problems with nursing. Other tasks he found easier with his eyes closed, showing that his visual system was demanding a great deal of energy and attention.

He remembered four out of five animals on a worksheet directly after completing a task involving the animals, showing that his visual memory is not working to capacity.

Nico showed a tendency to support his upper body by leaning on the desk during the evaluation and this was validated by his mother who reported that he tends to prefer slouching in a chair or on a couch. Nico says he likes to sit in "big, comfy chairs at school when I can." When drawing circles on a blackboard, his low muscle tone caused uneven pressure on the chalk, resulting in faint and wavy lines.

On a midline crossing task, he became confused about which hand was doing what when engaged in conversation and he was also slightly challenged with tasks requiring integration of the brain hemispheres.

Nico also showed certain strengths during the evaluation: his sense of kinesthesia is well developed as is his knowledge of where his body is in space. He shows good auditory sequencing by being able to repeat strings of up to seven nonsense syllables and was also able to repeat a thirteen word sentence correctly and answer three questions about it.

Conclusions

Nico's reported history of a prolonged and difficult birth, ear infections and numerous operations together with his performance during the assessment made it possible to understand what difficulties his system is having to deal with. Areas of weakness are vestibular functions, tactility, muscle tone, ocular motility and binocularity, all of which are closely interrelated. A clue to mild proprioceptive issues may be that he still falls out of bed on occasion, as being able to stay in bed once asleep depends on a knowledge of where the body is in space.

The preference for having his body supported and the wavy lines indicate low muscle tone which would contribute to Nico's slow pace of work at school and his very poor handwriting.

The compensatory technique of moving paper in order to draw or trace efficiently may help him to cope with his challenged visual system but would certainly be difficult in some school situations. The fact that his eyes become very tired when having to work hard is a possible cause for the headaches as well as the concentration required to complete tasks needing interhemispheric integration. The inefficient communication between the hemispheres is another clue to why Nico cannot work at a satisfactory speed in school - he needs more time to allow incoming messages to transfer from one hemisphere to the other. It was also noted through his hesitation when having to find words to express himself and by the quality of circles he drew on the chalkboard that his right hemisphere is processing information more quickly than the left.

The weaknesses in these systems are clues to weakness in the vestibular system which is directly or indirectly responsible for efficient functioning in all systems above the level of touch, taste and smell. Chronic ear infections and the inability to perform visual tracking are clear signposts to damaged, underdeveloped or immature vestibular functioning and Nico's earlier need to move in order to stimulate this system demonstrates how it demands attention away from external stimuli - such as the teacher's instruction. Thus Nico is unable to give his full attention to classroom events. Although he tries his very best, his system cannot support him adequately and his exhaustion and frustration may well lead to the explosive aggression towards others, as described by the teacher.

Recommendations

Nico and his mother were shown certain exercises and activities designed to strengthen his weak systems, notably his vestibular system since it is needed to support the visual system and muscle tone. As his vestibular system gained in efficiency, more activities were added to develop the visual system, improve interhemispheric integration and to strengthen the left hemisphere.

In addition to the specific exercises, it was recommended that Nico use cold packs on his eyes when they felt tired after school or after homework and he was given Essential Fatty Acids to ensure that he had sufficient omega-3 in his system.

Follow-up

Nico returned eight days after the initial evaluation for an exercise check to ensure that he was following the programme correctly and that all the activities were at a comfortable level for him. His initial greeting was enthusiastic and when asked how things were going he replied: "Very well, this really, really works. I haven't had a headache at all last week!" So this motivated boy continued to do his exercises and activities faithfully each day and at the next meeting, scheduled to review the programme six weeks later, he had still further progress to report. His headaches are still very much reduced in frequency; his teacher has commented on his neater work because his handwriting is smaller and more legible and, most significant of all, he is able to write much quicker and is finishing his work.

Three months following the initial evaluation, Nico wrote the end of year exams and scored 100% for Mathematics, 100% for History and Geography; 89% for English and Science and 75% for Afrikaans (a second language). His superior intelligence is now showing itself!

There are still some remaining problems with convergence so Nico has now been referred to visual therapy, in the secure knowledge that his vestibular system is strong enough to support more intensive work on the eyes. He will continue with his programme for another few months to ensure that progress in interhemispheric integration continues.

2. The case of Mary: treating "dyslexia"

Mary was seven years old when she was referred for help. She was a very bright, articulate, compassionate and fun loving little person. She was also experiencing great difficulties in her first grade classroom.

Emotional reactions and difficulty managing change were longstanding issues for Mary. However, these became especially problematic when she started formal schooling. Her schooldays were punctuated with tears and occasional show-stopping tantrums, as she could become overwhelmed by the sights and sounds of the classroom. The fast pace of the school day proved especially distressing for her and she would sometimes retreat into an imaginary world of her own. Stress was evident as she tore papers into tiny bits or chewed her hair at her desk.

Mary's thinking was, at times, inflexible. She could get "stuck" on certain ideas, seemingly stubborn to those trying to help her. Once stuck, she found it difficult to devise solutions to her problems until she was able to distance herself from them with time. Attempts to control her environment to reduce her anxiety were construed as oppositional by her teacher.

As if tantrums were not enough to isolate Mary socially, her driving desire to touch things and others caused problems with her peers. Her ever-moving hands during instruction made her appear as if she wasn't listening and fleeting eye contact made reading social cues difficult for Mary.

Despite her intelligence, Mary was beginning to fall behind her peers academically. Of primary concern was her writing ability. Verbally gifted and with an active imagination, she took pleasure in creating stories and songs. However, committing them to paper was excruciatingly slow and physically painful due to the death grip with which she held her pencil. Even rotating the pencil in her hand to shift from the graphite to the eraser was a task for Mary. She would typically drop the pencil and pick it up again to gain access to the eraser.

She often simply refused to write. When she did write, legibility was impaired by letter reversals, uneven spacing and poor letter formation. As the rest of the class began incorporating accurate spelling into their writing, Mary didn't seem able to break away from the phonetic "invented" spelling techniques that were taught to her in preschool.

Reading and mathematics were not as problematic, but she often distracted herself during work time as she could not read or work at near point tasks for very long. Weak motor skills and disorganisation lead to additional frustration. Although her teacher appreciated her exuberance and cheery smile, Mary was described as a highly distractible and sometimes difficult child with learning problems related to dyslexia/dysgraphia.

Background information

Mary's birth was normal and she was an easy baby. She became independent at an early age, and her curiosity was evident. She met her developmental milestones early, walking and speaking in multi-syllabic words by nine months. She appeared to be developing beautifully.

As Mary progressed through toddler years, hints of a developmental derailing began to appear, only to be recognised by her parents in retrospect. Since Mary was their first child, they did not realise that her inability to dress herself, inconsistent success with toilet training, inability to peddle her tricycle, indifference to books and puzzles and formidable tantrums regarding her car seat were signs of anything more than Mary's temperament.

Although her general disposition was enthusiastic and happy, Mary could reach emotional extremes. "Terrible twos" lingered into three, four and five. Mary's mother recalls her preschool teacher commenting that, at any given moment, Mary was either the happiest or unhappiest child in the school.

"Marching to her own drum" was the theme of her preschool year, and it was recommended that Mary repeat the year to be given some extra time to mature socially and emotionally. Although her second year of preschool was much smoother, the academic demands of first grade set off a downward spiral of poor conduct and poor scholastic achievement.

Observations

Mary was evaluated in late March. She performed well on many of the tasks included in the assessment protocol and demonstrated deficiencies in others. Vestibular irregularities surfaced quickly, including the need to move frequently in a rotating pattern, and nystagmus coupled with a sense of dizziness when using her eyes to track. When asked to wear a pair of glasses with one red lens and one blue lens, Mary's view was red in one area, blue in another. In rapid succession, Mary saw the white objects in the room as alternating from red to blue, indicating a visual irregularity known as alternating suppression. Additional tests revealed that the visual functions of tracking and binocularity were not operating optimally for Mary. Her eyes tended to move in a jerky fashion throughout the tracking test and they tired easily when focussing at near point.

An auditory sequencing task indicated a decrease in processing upon hearing specific sounds, and the HANDLE practitioner noted that she retained last segments best. Overflow movements of her fingers, head and mouth were detected and a whole body reflexive response, which should have been integrated several years earlier, were observed. Mary lost track of her writing when her eyes were closed and she was unable to internalise, through muscle memory, a simple repetitive, movement pattern. Additionally, the assessment revealed a weakness in the integration of the two hemispheres of the brain.

Conclusions

A complete profile of Mary's neurodevelopmental strengths and weaknesses was developed using her reported history and reflections on her general behaviour and performance of the assessment tasks. Areas of concern were identified.

Several factors were identified as contributors to Mary's difficulties. Central were multiple ear infections and associated high fevers causing weakness in the vestibular system. The vestibular system supports and regulates audition, balance, dynamic use of our eyes, feeling at ease with our bodies in space (proprioception), and having an appropriate state of readiness in our resting muscles. Mary's history of motion sickness, as well as problems with balance, proprioception and visual functioning reinforced the conclusion that the vestibular system was faulty.

For Mary, this translated to physical awkwardness and she displayed timidity in the performance of motor activities. Consequently, she avoided many typical childhood games, retreating instead to the safety of solo fantasy play. In this, she missed important opportunities for social learning and did not stretch herself to enhance vestibular functioning as most children do naturally through play.

Mary did not spend a significant amount of time in the crawling stage, which is a crucial period for the development of strong integration between the two hemispheres of the brain. This undeveloped area could well have accounted for the many emotional shifts that Mary experienced, and was holding her back from reaching her full learning potential.

Mary also had unresolved tactile hypersensitivities, many of which interfered with normal grooming. Her parents reported an aversion to tickling, and roughhouse play almost always ended with her physically striking out in a manner inconsistent with the intensity of the game. It was not uncommon for Mary to hit or act aggressively toward other children as a preschooler. She was particular about what she wore, seeking out comfortable clothing rather than fashionable ones. Socks often came home in her backpack rather than on her feet.

Tactile, kinesthetic and proprioceptive irregularities were also found to impair Mary's abilities to express her thoughts in writing. She had difficulty sensing where her hand was and what movement it had made unless she monitored each movement visually. If she paid close attention to her hand, then she became frustrated at losing the ideas she had wanted to capture.

A weak suck reflex as an infant, coupled again with vestibular weakness, interfered with the healthy development of her visual functions. Academically, she sometimes lost her place while reading, her eyes tired quickly and she had a vexing practice of reversing letters and numbers. The systems supporting vision and her sense of position in space were not strong enough to support reading, mathematics and general organisation in an efficient way. Visual inefficiencies also caused Mary to be somewhat oblivious to her surroundings. This, coupled with reduced muscle tone, diminished her ability to interpret facial expression and body language so integral to social interaction.

Recommendations

Mary and her parents were taught a program specifically designed to address each deficiency in her neurodevelopmental profile. The program was dynamic, changing over time to accommodate Mary's progress. Recommendation was carefully chosen to treat lower levels of neurological subsystems first, to ensure that higher level systems did not become stressed by having to function without sufficiently strong supporting systems. So exercises to first strengthen the vestibular system, such as rolling slowly backwards then up again from a sitting position on the floor and from one side to the other, were amongst the first on her programme. Simple activities such as drinking water (sucking) with closed eyes through a straw manufactured with three loops along its length were recommended to help her gently and naturally practice eye convergence, as well as helping to integrate her two brain hemispheres. Specific massages were taught to her parents to help her tactile sensitivity and improve her sense of proprioception.

Follow-up

For Mary, the downward spiral that began in first grade slowed, then stopped, and then gradually shifted direction. Tears and temper tantrums began to diminish. By the end of first grade, she could read for longer periods of time and, consequently, her reading skills began to flourish. By summer, the child, who previously cried at the prospect of getting her face wet, was jumping off the diving board and swimming. She learned to ride a bicycle without training wheels, and an 800-mile car trip was noticeably devoid of stops for car sickness. With the foundation set, she and her parents decided to give the local public school another try in the upcoming fall.

Starting second grade has been a new beginning for Mary. She claims that "second grade is a lot calmer," but clearly it is she who is calmer. Well integrated into the rhythm and routines of her day, school is a much less stressful place for Mary. Hair chewing and paper tearing are no longer recreational pastimes. Instead she is listening, reading, writing and computing. Writing is still her biggest challenge, and so she continues with specific activities to strengthen this skill.

3. "Attention Deficit Disorder" renamed: The case of Alexis

The HANDLE approach holds a view that differs from the one implied by this "diagnosis" of having a "lack" of attention. It contends that no one has an attention deficit. Rather, everyone is always attending to something, and individuals who show difficulties in sustaining attention may be blocking certain types of stimulation and seeking others; they may have difficulties adjusting attention flexibly to meet varying demands from the environment. Therefore, a more accurate name for this set of behaviours is Attentional Priority Disorder (APD) , and the condition is neither hereditary nor irreversible. HANDLE clinicians incorporate information gleaned from the evaluation session to discover where a specific individual's attentional priorities lie. Usually the answer is found in one or more of the interactive neurological sub-systems and APD can thus be treated at its origin, yielding permanent changes in the nervous system. That is, by resolving issues that focus the child's attention to more basic and pressing needs, such that those needs are met, HANDLE frees the child to attend to social, academic, and other demands from the environment.

While there may be genetic predispositions to neurodevelopmental disorders, such disorders arise not through heredity but rather through interactions with the environment. Drugs are not used as part of the HANDLE program so symptoms are not masked but instead problems are treated at their root causes..

Common patterns of APD

Most people who have difficulty sustaining their attention and/or adjusting easily to the demands of changing situations show irregularities in specific neurodevelopmental functions on both input and output levels.

hypersensitivity to at least one modality such as touch, vision and/or sound;
weakness in the vestibular system which supports and regulates such functions as listening, eye functions, balance, knowledge of where our bodies are in space, muscle tone and so on.

insufficient integration between the two sides of the body and brain
immature reflex integration and irregularity in differentiation of movement/response

The case of Alexis: a gifted child with diagnosed ADHD

Alexis was 7 years and 10 months old when she was referred for help. She was in Grade 2 and had been diagnosed with ADHD, as well as auditory and visual-motor perceptual dysfunctioning by a psychologist, neurologist and occupational therapist. She had also received vision therapy. In spite of some scatter amongst the scores of an IQ test, she still managed to fall within the superior range of intelligence. The school described her as a strong-willed child who struggled with a very short concentration span, and who was unable to sit still and listen or focus on her work due to distractibility. They considered her to be a very clever girl who was not reaching her potential.

On a modified Conner's Rating Scale, her teacher gave her the highest rating of 3 ('Very much') for restlessness/overactive; excitable/impulsive; disturbing other children; failing to finish things/ daydreaming; constant fidgeting; temper outbursts/unpredictable behaviour; and a rating of 2 ('Substantial') for quick and drastic mood swings and frustration if demands are not instantly met. The neurologist had prescribed Ritalin and her teacher was very supportive of this.

During the HANDLE assessment, Alexis' mother expressed the wish that Alexis could get along better with her friends and be less selfish and jealous. Alexis wanted to be able to concentrate better and complete tasks before going on to the next one, but showed a developing low self-esteem with her doubts that she would ever be able to do this or please everyone.

Background information

After a normal, easy pregnancy, Alexis' birth had some complications. She was a big baby, weighing 4.21 kgs. After 3 hours of labour, she showed signs of distress so was delivered with the help of forceps. She had passed and inhaled some meconium in utero, which was suctioned from her lungs. However, her APGAR scores were 8 and subsequent development was incident free, except that she did not have much movement stimulation as a baby. Her mother was content to leave her in her cot or carry her around in a baby chair for most of the early months. As long as there was something to look at, Alexis seemed to be happy to be mainly immobile. She achieved normal motor milestones (crawling and walking) and early language development. After experiencing colic during the first three months, she was a healthy child with no ear infections or other significant illnesses.

From toddler days, she showed an ever-increasing liking for movement and constant activity. She enjoyed wild roundabout rides as well as running and jumping, and spent long times walking on her hands, which she mastered at 5 years. She also liked rocking on her school chair - backwards, forwards and sideways and did occasionally fall over. She went through phases of being clumsy, and got numerous bruises on her legs from bumping into chairs, walls, doors and even people. However, she was a slow starter in the mornings, showing little urgency to begin the day, and often spent a long time just gazing at herself in the bathroom mirror.

She was not an extremely restless sleeper but liked company in bed. She covered her head with her blankets when she slept. She was very sensitive to light and disliked sunlight, torchlight or waking up in the morning with her bedroom light burning. She had a very sensitive scalp and thought that her fingertips were also very sensitive to touch - hating having her fingernails trimmed. She was extremely ticklish and disliked having anyone pretend to tickle her. Her favourite foods were salads and french fries or fish. She was not very fond of meat and particularly disliked the texture of chicken and some vegetables. She was very conscious of smells and seemed to be more sensitive to odours than most of her friends and family members.

Observations

Alexis did not move very much during the evaluation but soon expressed a liking for eyes-closed activities because she said that her eyes get tired very quickly. She showed some uneven saccadic movements when asked to follow a moving object with her eyes and also said that it made her dizzy. Her eyes could not converge easily at close distances either. Low muscle tone was suspected when she displayed an untidy handwriting and also showed a preference for having her body supported by the chair or the desk. Her mother further supported the conclusion of low tone by commenting that Alexis was often rebuked for "slouching'. She showed a dominant right hand and right eye and it seemed that her left brain hemisphere processed information more rapidly than the right. She used a technique known as 'cognitive override' to cope with demanding tasks. For example, she quickly used counting to help her master a finger tapping task.

When given a series of nonsense syllables to repeat, Alexis had some difficulty accurately recalling syllables with the plosive "K" sound, and she also forgot some details from a sentence read out to her.

Conclusions

Alexis' sensitivity on her scalp and fingers and her ticklishness are indications that her sense of touch is irregular. This, coupled with a hypersensitivity to smell and light, can be very distracting to a child in a classroom. Her need to move, difficulty processing the "K" sound, issues with visual tracking as well as her lowered muscle tone showed that her vestibular system was weak and unable to support the many functions for which it is responsible. Her slow adjustment to the morning and her tendency to bump into things pointed to a weak sense of proprioception. Alexis' vision was still compromised, in spite of vision therapy. Her light sensitivity and problems with tracking and convergence caused her to experience dizziness and headaches, and she preferred eyes-closed activities because they give her eyes a chance to rest. Because of poor proprioception, however, she found it necessary to depend on her eyes, which became increasingly strained. Alexis needed a great amount of energy to sustain her weakened systems during the day and her short temper and frustrations were making it hard for her to maintain interpersonal relationships. One reason why she found it difficult to attend to language and directions from others is that their words interfered with her own thoughts through which she was directing her movement.

In spite of the problems Alexis was experiencing with so many irregular systems, she had been compensating well. She was thus using her superior intellect to her advantage, but she did not have the underlying support systems for focussing and sustaining her attention flexibly and for completing tasks. These were leading to distress in her relationships with schoolwork as well as with friends and adults and ultimately to her failure to realise her potential.

Recommendations

The program designed for Alexis concentrated on activities to strengthen weak underlying functions and to enhance the connections among the various functions. Her program included several activities to strengthen her vestibular system. These, as well as the special massage that was recommended to reduce Alexis' hypersensitivity to touch, were also targeting her muscle tone issues, to help strengthen this crucial function.

Other simple, non-taxing activities were suggested to strengthen her visual functions and reduce her light sensitivity, without stressing her weak vestibular system or relying on muscle tone and differentiation of eye movements from head movements. One of these was drinking through the "crazy straw" with its many loops and small diameter. Alexis was also encouraged to supplement her diet with omega-3 fatty acids, to ensure myelination of those neural pathways which the exercises were creating and strengthening.

Follow-up

Alexis' initial assessment took place in September. By late in November, her mother reported much progress. Alexis was beginning to make friends with girls with similar intellectual interests as her own as was coping better socially, with less aggression. She also showed an improvement in her manners and behaviour at school and home. According to reports from the school, she was sitting still and finishing her work, and this improvement was substantiated by the school awarding her certificates of excellence. They no longer thought Ritalin was necessary.

Alexis is continuing her HANDLE programme. It is gratifying that the improved ability to focus and sustain tasks has already helped to reverse her lowered self-esteem. She now feels proud of who she is and is rapidly forgetting that she was ever labelled as having ADHD and related learning problems.

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