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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

It Is Not All Psychological

Allan N. Schwartz, LCSW, Ph.D. Updated: Mar 6th 2009

 I was reminded this morning, while listening to National Public Radio, one of my favorite early morning past times, that just because something looks like a psychological problem does not mean that it is. In this case, something that looked like ADHD in a ten year old boy, was not ADHD. What was the story?

The story was that this ten year old boy was never a good student in school. However, he recently became a management problem at home. His mother became alarmed when he became irritable and oppositional at home, something that never happened before.

At around the same time his school teacher contacted his mother and reported that she suspected that he was suffering from ADHD.

The mother brought her son to his pediatrician who, in answer to his question about snoring, admitted that he did snore. The Pediatrician having seen this type of thing before in other children, referred the mother and her son to a Medical Doctor who was a specialist in sleep disorders in young children.

The specialist did a complete examination of the ten year old and discovered that he was experiencing Sleep Apnea, something associated with middle aged people. Further examination revealed that he had very enlarged tonsils that were interfering with his sleep. Surgery was ordered and performed. Within weeks, the boy returned to school and academically moved from the bottom tenth of his class to the top tenth.

At home, he returned to being the wonderful child that his mother had remembered and he reported to his mom that he was amazed at how much better he felt everyday.

Not everything is ADHD, depression or some other psychological problem. What is to be learned from this?

Always take the medical route first in order to rule out a medical problem. The fact is that symptoms of a medical disorder can mimic many psychological problems. In those cases, therapy will not help much at all, at least not until the physical problem is corrected.

Your comments are welcome.

Allan N. Schwartz, PhD.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
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AD(H)D - start with physical medical exam first - - Apr 18th 2009

Thank you for your "its not all psychological".  My son was tested for ADHD when he was 11. At the time I didn't think he had the condition because he did not fit my mis-informed stereotype of a child with ADHD i.e. bouncing off the walss, low grades & behavior problems. Since I recognized that I didn't know much about ADHD and his teachers had so much experience with it I had him tested. He just happened to be a normal 11 year old boy who preferred to look out the window at school on 75 degree days in May and I came to find out he had never paid attention in class during primary school because he is so bright he could learn on his own.  Now at 17 the school psychologist retested him at my son's request & with my permission and is certain he does have ADD & wants him to seek treatment.  The method used was having his teachers, myself, and my son rate him on ADD related indicators.  I didn't think my son had 'developed' ADD.  I believed he was exhausted from working 24 hours most weekends, not leaving enough time for sleeping, socializing, and school work.  Surprise:  the scores from the teachers of classes he excelled in showed no evidence of ADD while those in classess he was failing did.  My son loves history & English but does not like math & science. His lack of attentiveness and low grades are caused by fatigue, over-scheduling and disinterest in math & science.  My son will be going to an internist for a complete physical to be certain that there isn't a medical condition contributing to his underachievement in school and his lowered self-image as a result.  Because I have chronic depression and mwas diagnosised with moderate ADD 5 years ago, I will also have him see a mental health professional to get the full picture in the event behavioral changes -- less work, more sleep, more effort -- does not improve his grades and self-perception.     

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