Friday, June 6, 2008

ADHD


Oh how these four little letters can stir up so much debate!! Speaking of debate, I won't address politics anymore; it made me feel too weird. Next time I am lacking ideas, I'll simply talk about the weather or nail polish colors.

So, do you think this kid in the cartoon was actually listening to Dad reading the story, or thinking about the DVD he watched, the new video game he learned, etc.? But he clearly has a skill, even if it's one his parent doesn't have!

As a pediatrician, I get lots of questions from families, friends, and patients about ADHD. Having worked in early intervention in the 90s when the diagnosis was becoming quite fashionable, I had a non-medical perspective, one that was more influenced by families and preschool/daycare teachers. From this view point, I saw children who were quite intelligent, but parents and teachers had a hard time working with them due their distractability and/or inattention. These children were often in classrooms with many children, some typically-developing, some with special needs. The challenge in the classroom was huge. As an early interventionist, I would try to work with the teachers and the child in the classroom to help them learn to work together. Often, I would request that a child be put in a smaller class or a different center all together. However, this was not always an option.

Then, I went to medical school. In my pharmacy class, I learned how the different stimulants affect the brain and the body; I obediently learned the different dosing schedules, half-lives, metabolites, etc. I was exposed to pediatricians who felt that the diagnosis was a farce, an excuse for poor parenting and teaching, as well as pediatricians who were committed to the diagnosis. During residency, I worked with one pediatrician who felt that pharmacotherapy was most indicated when a child's self-esteem was affected by the ADHD - this has really stuck with me, and I continue to use it as a guideline in my practice.

Now I am a pediatrician, simply with a background in early intervention and special education. I was also diagnosed with ADHD during medical school, in case you hadn't guessed already! I love taking care of these patients who tend to be quite imaginative and often questioning of authority; it is incredibly rewarding, yet quite frustrating at times. I spend a lot of time discussing non-pharmacologic ways of dealing with ADHD, including regular exercise, good sleep hygiene, healthful diet, and strength-based learning, as illustrated by the cartoon at the top of this blog. However, as we all know, these strategies don't always work; parents do not always have the option of putting their child in a private/charter/alternative school, and homeschooling can be difficult as often the parents have ADHD themselves. And incredible results can be obtained sometimes with the right medication, in conjunction with everything else. Ultimately, my goal is to teach kids how to cope with school and ideally to excel in school, how to live with rules, and how to navigate in a tremendously busy world with many distractions. Unfortunately, I know that some will try self-medicating, some will struggle with depression, but I remind myself that with help, many can be successful, bright, innovative leaders.

There are lots and lots of resources out there for ADHD, but here is a website that I find is a good place to start: http://www.help4adhd.org/index.cfm?varLang=en.

2 comments:

manoj said...

Social communication or pragmatic impairments are characterized and illustrated as involving inappropriate or ineffective use of language and gesture in social contexts. Three clinical vignettes illustrate different pragmatic impairments and the wealth of diagnostic information that can be garnered from observation of a child's social communication behavior.
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Dinesh

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