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Disruptive classroom behavior in an Amish school-age child with muscular dystrophy.

CASE. Will is an Amish school-aged boy with Duchenne muscular dystrophy. After reading about attention-deficit hyperactivity disorder (ADHD) in the local newspaper, his mother asked Will's pediatrician, Do you think my son has this (condition)? She noted that Will fidgets in different settings and has difficulty focusing on his work when in school. She also reported that his teacher in the Amish school does not want him in her classroom because he is disruptive and noncompliant. The teacher tried incentives to encourage Will to complete his schoolwork but without success. Subsequently, his teacher prevented Will from participating in recess activities; at other times, she sent him home as punishment for noncompliance in the classroom. During the past week, Will did not attend school while his teacher sent assignments home with his sister. Will's mother reported that he seemed to be happy with a normal appetite and sleep pattern. She was not aware of any behavior problems with other children. Will's father, who also attended the pediatric appointment, added that he did not feel that the teacher was patient with Will. He stated that Will has friends, but may have a difficult time keeping up with them due to his physical weakness secondary to muscular dystrophy. He also believed that due to motor limitations, writing was difficult for Will. The parents did not provide consequences for Will's insistence on not attending school nor did they positively reward him for school attendance. When at home, Will did his work and kept to himself. Will was quiet and motionless in his seat. He stated that he liked school and playing with friends and that the schoolwork was not too difficult.