"That's fifth grade?"

"Fourth. We held her back a year."

"Tell me about her problem."

"She's a smart girl. She really is. Some of the things that come out of her mouth…" Examples vanished from Diane's mind. "But she has this attitude… And she's lazy. She doesn't try. She won't do her homework. She fails her tests. I was reading this book? Your Hidden Child." She paused, waiting for Dr. Parker to approve the paperback. The doctor lifted her eyebrows quizzically, which gave Diane the impression she didn't think much of the book. "It said that children sometimes behave badly because they want attention."

"You said she's smart. Do you know her IQ?"

"I don't remember," Diane said, flinching. This was something she should have looked up. "I'm sorry. I -"

"It doesn't matter. We can get it from the school."

"But she acts hostile, she acts stupid, she has temper tantrums. And you know what happens? She gets attention. I think that's a lot of why she seems to be slow. We have another child – Sarah's the second – so we think that she feels jealous. Which is crazy because we spend lots of time with her. Much more than we do with Jamie. I don't let her get away with it. I don't put up with any nonsense from her. But she doesn't listen to me anymore. It's like she tunes me out. So what I'd like you to do is talk to her. If you tell her -"

"Has she ever seen a therapist or counselor about this?"

"Just a counselor at her school. The New Lebanon Grade School. He recommended that book to me. Then I talked to our pediatrician about it. Dr. Sieving? He's an expert with children?"

Dr. Parker apparently did not engage in the practice of confirming parents' opinions. She looked at Diane pleasantly and said nothing.

"Anyway we went to Dr. Sieving and he prescribed Ritalin for her."

"For attention deficit?"

This gave Diane a burst of relief, thinking that at least dottering old Sieving had diagnosed the problem correctly.

Dr. Parker continued. "Was she behaving in an unruly way, overly active? Any compulsive behavior – like washing her hands frequently?"

"Oh, she's restless a lot. Jittery. Always running around. Nervous. She drives me to distraction."

"Did Dr. Sieving give her any psychological testing?"

"No. He took a blood sample." Diane was blushing and looked away from the doctor. "But he's known her all her life… I mean, he seemed to think it was the best form of treatment."

"Well," said stern Dr. Parker, "if attention deficit is the diagnosis what brings you to see me?"

"I think the medicine's working." Diane hesitated. "But not too well. In fact sometimes I don't think it does any good, to be honest with you. It makes her very, I don't know, spacy at times. And it upsets her stomach and seems to make her more jittery. She says it gives her the tummy squabbles." She looked down at her hands and found to her astonishment her knuckles were white as ivory. "The truth is she seems to be getting worse. Her grades are still terrible. Yesterday she tried to run away. She's never done that before. And her temper tantrums are more violent too. She talks back more than she ever did. She also talks to herself."

"Let me ask you a few things…"

An avalanche of questions followed. Diane tried to understand where the doctor was headed. But it was useless; just when Diane would think she understood what the doctor had in mind, she would throw a curve.

"Does she watch much TV?"

"Two hours in the evening, only when her homework's done. Actually she likes movies more. She thinks most sitcoms and commercials are stupid. She calls them yucky."

A miniature smile made a reappearance. "I'm inclined to agree. Go on."

"She pretends she doesn't learn things quickly… I know she's, I don't want to say, faking…" Diane realized she just had. "Well, she picks up some things so fast that when she acts stupid, it rings false."

"What's easy for her?"

"Remembering movies and stories we've read to her. And the characters in them. She can act out scenes perfectly. She can remember dialogue. Oh and guessing the ending of movies. Dressing up in costumes. She loves costumes. But it's all things like that – pretend things. Anything having to do with real life – school, cooking, gym, bike riding, games, sports, sewing… All that seems beyond her." Diane looked away from the doctor's eyes. "The other day she wet her pants in front of the class."

Dr. Parker's mouth tightened and she shook her head. Diane watched her record in a tiny, cold notation a fact that would probably dog her daughter for the rest of her life. Diane took a Kleenex and pretended to blow her nose then twined the paper between her strong fingers and slowly shredded it into confetti.

More questions. This was hard. Diane tried, oh she did, but her way was to keep family flaws hidden like her mother's jewelry – anything real, anything diamond, anything gold was to be trotted out only on rare, vital occasions. It took all her strength to give this sleek, chic-suited stranger these facts – about Bill, about Jamie, about the grandparents, about Sarah's shyness and her wily manipulation. Dr. Parker glanced at her watch. Is she bored?

The doctor asked, "When you were pregnant did you drink or take any kind of medication?"

"I didn't drink, no. Occasionally I took a Tylenol. But only a couple of times. I knew it wasn't good."

"How is your relationship with your husband?"

"Excellent. Good."

"Do you quarrel openly? Have you ever talked about divorce?"

"No. Never."

"Do either of you drink now or take drugs?"

"We drink socially is all," an offended Diane said. "We never do drugs. We go to church."

There was a pause while the doctor's hand sped along the page. Diane said. "So we were thinking that if somebody like you, a doctor, told her she should cut out this nonsense and get down to work, well, then…" Her voice tapered off.

The doctor chewed her thin lower lip, lifting off a fleck of lipstick. The expensive pen got capped. The teeth released the lip and the doctor leaned back in her leather chair. "I've worked with learning disabled children before -"

"But she's not disabled," Diane said quickly. "I told you, her IQ -"

Dr. Parker said, "A learning disability isn't a function of IQ. It's -"

"Doctor," Diane explained patiently. "Sarah is a smart, shy little girl. She's learned a…" Diane remembered a phrase from the Hidden Child book. "… pattern of behavior to get attention from my husband and me and her teachers. We've played into her hand. Now we need an expert like you to tell her to buckle down and get to work. She's gotten away with too much from us. She'll listen to you. That's why I'm here."

Dr. Parker waited a moment then spoke. "I want to say something to you and you can think about it and talk it over with your husband. First, I should tell you – based on what you've told me – I'm not sure your daughter suffers from attention deficit disorder. Some psychiatrists feel that ADD is a condition different from hyperactivity. From my own research I think they're intertwined. If I understand correctly, Sarah doesn't show general overactivity – what we call hyperkinetic behavior. Her restlessness may be secondary; she has other problems and they in turn make her jittery and anxious. Ritalin is a temporary measure at best."

" But Dr. Sieving said it would help her to learn now and that she'd retain what she did learn."

"I understand and there's something to be said for that. But with all respect for your internist, I feel doctors are prescribing Ritalin a little too quickly. Many parents prefer a diagnosis of ADD because they'd rather see a physical than a psychological explanation for their children's troubles."

"Sarah is not crazy," Diane said icily.