Janet's parents brought her to see me because they were worried about how she was uninterested in her school work. The bright 13-year-old girl, who was in Secondary 1 at a prestigious school, was doing poorly.

She was wearing her school pinafore when she came to my clinic and had an engaging smile. But she was very fidgety in the swivel chair. Although she was seeing a psychiatrist for the first time, she showed no apprehension and was instead distracted by the office furniture and wall plaques.

When I asked about her school work, she became withdrawn and blurted out that she did not like doing it. She was having problems focusing and was not completing her homework on time.

Her tutors reported that Janet had a short attention span and needed close monitoring to get her to complete her tasks. Still, the girl said that she did not want to change her school as she had made some friends in her new class.

Janet's parents said she was a bright girl but had been hyperactive and disruptive in the initial years of primary school. She managed to score well in her grades and her restlessness was now much better, although she was still fidgety and having problems concentrating.

The main issue was her lack of confidence and her disdain for school work. Her parents spent much of their time with her but their admonishments seemed only to provoke more anger and resentment.

Her teachers wanted to send Janet for in-house counselling but she felt embarrassed about it.

Punishments, such as being made to stay back and being excluded from some activities, made Janet feel alienated from her classmates.

Her parents resorted to physical punishment but this made her more sullen. Meanwhile, they were realising that, by focusing so much on her, they had virtually ignored their two younger children.

Formal testing showed that Janet has Attention Deficit Disorder (ADD) but with a superior IQ.

That same day, eight-year-old Ashvin was brought to see me by his parents with the classical symptoms of hyperactivity, impulsivity and poor concentration. Psychological testing showed that he, too, has ADD.

Ashvin is a typical case, though, with such problems showing up in the first years of primary school. Although he had been disruptive during an earlier placement in a tightly structured kindergarten, his parents managed the situation by putting him in a private Montessori-type playschool.

However, all primary schools are similar and Ashvin had problems adjusting to a more structured environment.

Placing him near the front of the class plus remedial lessons helped improve the situation, although medication was needed initially to help him focus better.

Ashvin now enjoys school and is confident in his studies. He has good friends and the support of his teachers.

Cases like Janet's, however, are now surfacing more regularly.

ADD affects girls too, although boys vastly outnumber girls at a ratio of around 2:1 for the more inattentive group to 9:1 for the more hyperactive cohort.

As they progress through school, the hyperactivity and impulsivity symptoms usually improve spontaneously and what occur in secondary school are more inattention, fidgeting and day-dreaming.

Those with superior intellect may cope in primary school despite their symptoms. But, with streaming and in the more competitive secondary schools, they may have increasing difficulty meeting the same academic standards as their peers.

The problems presenting in this older age group have much to do with low self-esteem and lack of interest in studies. For boys, behaviour problems and refusal to go to school arise too.

These students feel that they can no longer meet the expectations after obtaining entry to the secondary school of their choice. Meanwhile, their parents and teachers feel they are not achieving their potential.

Some patients later develop depressive symptoms and with the background of ADD, they are more prone to impulsive or disruptive acts.

The aim of assessment is to understand the condition and not to pin any blame. Attention deficit symptoms do get better with time and one should not be overly concerned with the child's current grades.

Such students, with the school's help and cooperation and with treatment and medication, do adjust well. Some may want to switch to a less stressful environment.

In any case, education is an ongoing process and the focus should always be on the child's confidence and emotional well-being, finding a suitable compromise between the level of stress and the child's ability to cope.

Dr Brian Yeo is a consultant psychiatrist in private practice and an adjunct associate professor at the department of psychological medicine at the Yong Loo Lin School of Medicine, National University of Singapore. He is also a certified master substance abuse counsellor and is currently the Singapore Medical Association's representative to the Board of Management, Singapore Anti-Narcotics Association.

This article was first published in Mind Your Body, The Straits Times.