Easy to miss: Problems of ADHD teatment compliance

Image source: http://www.wendykeller.com

*MM, a 13 year highly gifted girl at her middle school, was happy with her summer school doing her favorite subject about computer engineering. This is one of the most popular summer school programs for the gifted and talented offered by Johns Hopkins University. This summer, she had a good time learning advanced knowledge and meeting mental peers with comparable abilities.

After the summer program, MM decided that she would not sleep in the class anymore when she returned to Hong Kong. She would rather take the advantage of boring classes, which was too easy for her and lacking any intellectual challenge, to do programming on her laptop.

Last week, she came to see me and looked completely exhausted after school. It is just beginning of the school year. I haven’t ever seen her as tiring as such.

MM comes to see me regularly since treatment of ADHD two years ago. She has some self mentalizing difficulties that it is so hard for her to process feelings and regulate her mood. She was used to getting angry and fighting back whenever she got into social conflicts with her peers.

Over the past year, her parents complaint that MM refused to turn off the computer late at night. She appeared to be increasingly addictive to internet. In the beginning of this summer, she told me that she slept around 6am and woke up around 3pm. Her mother was so fed up with all the fierce but endless quarrels in the middle of the night urging her so badly to go to bed. She thought that her daughter didn’t listen. She just wants to give up. She thought that her husband would be able to coerce MM to turn off the computer and put her to bed, he came home very late though. The mother didn’t want to get involved anymore.

MM told me that the internet game made it possible to escape from thinking about all the unresolved problems. When she turned off the desktop, she would turn on the iPad to watch videos while lying on the bed with her headphone on. It would help her shut off from heated conflicts, if any. Nonetheless, sleep problem is always an issue so disturbing to her. It often takes almost an hour for her to fall asleep. Obviously, she relied so much on watching videos on the iPad to soothe herself.

This afternoon, seeing MM so exhausted and sleepy, I asked her if he took her ADHD medication. She said that she quit medication since end of the summer school. I asked her whether she found anything different after withdrawal from the ADHD medication. She didn’t notice it.

I contacted her mother to cross check the situation. Like MM, she said that she did not notice any difference. She added that MM would make a bit scene when she was asked to stop doing any computer and to go to bed. She didn’t think medical fee for ADHD treatment worth it as far as she didn’t make any improvement regarding her computer behavior.

It is crystal clear that MM would not be able to express her feelings about her school and family. She will likely be inattentive and lack of motivation to do anything mentally effortful.

I ask her if she wants to do programming on her laptop when she gets bored in the class. She yawned and stretched her arms without answering my question. I then repeat that question. I am not sure whether he doesn’t pay attention to my question or it’s too overwhelming to think of school classes without much mentally stimulation to her.

The paradox is concerned with withdrawal from ADHD medication in a way to desensitize her frustration and picking up the treatment for realizing her vocational aspiration of computer programming.

Anyway, very few people will notice the silent suffering that MM is going through. I pray that God will bless her more.

Note*: MM is a pseudo name and modifications are made to formulate this story.


Whose Vulnerabilties? By Jo Ho

Image Source: http://drdivaphd.wordpress.com/2012/08/04/there-is-power-in-being-vulnerable/

CK doing Year 10 in the Eastern Coast spends time with his family for this summer holiday in Hong Kong. He studied overseas a year ago and learnt a lot from peer interaction, teacher-student relationship, interactive learning, academic and school adjustment and so forth.

CK couldn’t imagine his growth in confidence and social leadership over the past year. He admits that frequent quarrels and fights between family members since childhood have shaped his withdrawn behavior. He finds unresolved conflicts very overwhelming. He tends to present himself as outgoing, competent and high achiever. Specifically, he can’t handle all the communication problems in the family.

This summer, he starts talking to his elder sister and mom as an adult and stating clearly that he wants them to communicate their true feelings. He doesn’t want them to hide their feelings behind the smart phone, iPad or other forms of technology. He feels unhappy about all the temper tantrum or unnecessary fights improperly channelling personal feelings through personal criticism, complaint about domestic chores and the like. In several incidences, CK urges his family members to admit their feelings and openly share with family members.

At the end of this summer, CK comes to see me for a review of his personal growth. He says that he is able to turn the family interaction to be more meaningful and effective than before. While he feels capable to reshape the pattern of conflicts in his family, he is concerned about his sense of loneliness and fear. He is worried about the family dynamics without his presence as the facilitator in the following 4 months as he will be staying in the U.S. until Christmas.

He admits that he knows what and when to help people close to them. Few people will know that he is so exhausted and depressed inside.

He is so vulnerable. He tells me that he is eager to help vulnerable people. I know. The truth is, it’s easy to divert our pain from oneself to others who are vulnerable. That’s why true friends are meant to be companion with shared joy and pain therefore no one is left behind along the journey of personal growth.

Vulnerabilities can be a great teacher who helps us recognize that we grow from shared vulnerabilities. Over-identification as a helper, over the course of lifetime, may well be an alert.

Alerting us from a time bomb.

After all, I wish KC a content and fruitful school year in 2014-5.


Social Stories & CBT 社交故事及認知治療

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Social Stories & CBT 社交故事及認知治療

有些聰明好學的學生,偏偏社交技能較弱,在別人眼中可能很有才華活像一個 「小專家」,但與人溝通時郤重覆出現一些難題 。

教導他們可能很費力,因為可能講但他們無聽,聽又未必明,明又未必做,做又可能 做錯,錯又未必認,認又未必肯改,改又未必服,服又未必講得出個道理,師長未必察覺這些難題的急切性。更何況這些學生可能成績表現理想,豈料這種較為 「自我」 的特性原來是急需改進的 , 否則將來難以獨立,更遑論應付將就業和社會的各種要求。



對於天資聰穎而又有亞氏保加症(一種自閉症) 特質的孩子的幫助更大。



– 智力常在卓越或以上水平 ( IQ 120 以上 )

課堂次數: 12次一期 (視乎個別需要)

時間: 每堂1小時,適宜每星期一次

做法: 個別形式學習


– 幫助他們按以下的層次提升社交情緒的技能
1. 遇到不如意事情,引發負面情緒時,只懂得發脾氣,或作反叛性行為
2. 透過漫畫圖象化事件
3. 敢於憶述事件
4. 一起重溫當事人的感受
5. 師長能跟他討論問題的關鍵
6. 留意主觀的看法,學習擴闊自己
7. 感到被別人了解
8. 改進個人管理情緒的能力


你們瞭解我嗎?(Gifted with Depression/憂鬱症/抑鬱症)


語錄:「智力高又如何 ! 學歷再高都沒有人認同我, 我越來越沒動力, 生存
    正面價值, 什麼也不想做, 我生於世上根本沒意義, 根本就拖

   「我努力也沒用, 父母也講過我沒用, 他們為何把我帶來這個世界 ? 」


   「我也不想見朋友, 怕他們發現我與他們的差距, 因為我一事無成。」




( 來自ICGT網站: http://www.gifted.hk/chi/professional-services/true-stories.html )

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