Dr. Henry Paul, MD

Psychiatrist, Author and Educator

PROBLEMS IN SCHOOL? ONE OF THE TOP REASONS PARENTS CALL ME

July 16th, 2015

“Under the Individuals with Disabilities Act, or IDEA, public school districts nationwide are required to provide a free and appropriate public education to all students diagnosed with a disability. The mandate requires schools to identify students who may have learning impairments, and to develop a plan to educate them appropriately at no extra cost to parents.” Public Schools Delay or Deny Special Education Services for Most Vulnerable Students (NBC News)

Schooling and education are a major focus of adolescence and are one of the most frequent reasons that parents call me for a psychiatric consultation for their children. Teenagers spend most of their time during the day at school. It is easy to understand why problems at school then become such a major focus for parents – not to mention the anxiety that the teen is feeling. It is also easy to understand that problems in school are often an indicator of problems elsewhere, and it is important that parents be able to differentiate the two. As with athletics in some families, school performance becomes a major focus of parents’ anxieties, ambitions, and vicarious living. Also, they may project problems in their lives on their children’s performance.

It is normal for teenagers to experience some problems at school that are not particularly serious, especially during what are called the transition years, moving from middle school to junior high school or from high school to high school. It’s unusual to find teenagers who don’t experience some degree of stress at these times. But when school problems persist long past these transitions and become more deeply entrenched, there is a problem.

Here are some simple things to do if you suspect problems at school:

Contact your teenager’s guidance counselor and set-up a meeting. If there is a specific clas, that seems troubling for your teenager you should contact that teacher and ask to meet. You may want to set-up this meeting to include the guidance counselor.
Often an undiagnosed learning disability may be the underlying factor. Learning disorders can have a serious impact on a teen’s performance and their self-esteem. Many of you have most likely heard the terms ADHD (Attention Deficit Hyperactivity Disorder), ADD (Attention Deficit Disorder), PTSD (Post-traumatic Stress Disorder), OCD (Obsessive Compulsive Disorder), ODD (Oppositional Defiant Disorder), Spectrum Disorder (including Autism), and many more.

Special education is part of the public school system in the United States, and its function is to make sure that children who are diagnosed with learning disorders or medical conditions that affect learning get the services they need. Navigating the waters of the special education system can often be complicated for parents. There are both Federal and State mandates that affect special education services. Key players in making sure that your child gets the proper services include the child’s pediatrician and/or psychiatrist, the school CSE (Committee on Special Education), the school’s guidance office and teachers, and you. Sadly, there are schools who will fight or delay the services. In that case, you may need to hire an attorney or seek out a special education advocate.
Here are some resources to help you understand the rights of children with disabilities.

Robin’s blog. She was the mother Jarrod in the NBC story.

The Disability Rights Education and Defense Fund (DREDF), founded in 1979, is a leading national civil rights law and policy center directed by individuals with disabilities and parents who have children with disabilities.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

ADD/ADHD DIAGNOSIS & TREATMENT

December 17th, 2013

Now that you suspect that your child may be suffering with ADD or ADHD it is important to get a proper diagnosis. The diagnosis of ADD or ADHD is best made by a child psychiatrist. There is no particular psychological or blood test to diagnose the disorder. The most effective way to diagnose ADD or ADHD is by gathering a history about your child from you, your child’s teachers, and others who interact with your child on a regular basis including coaches, tutors, childcare personnel, and so on.

Thus a lengthy history gathering is necessary. Care has to be taken to rule out other disorders that can look similar, especially anxiety disorders, depression with agitation, and post-traumatic stress disorder. Also remember sometimes children can react to situations that exhibit some of the symptoms of ADD or ADHD, but these symptoms are only short-term and passing and do not make the diagnosis.

Once the diagnosis is made, a multimodal or combination approach is usually necessary including some form of therapy such as:

Behavioral therapy
Individual talk therapy
Educational help
Family therapy
Parent education
Skills training
Medication

It is important to remember that therapy for common secondary effects of ADD/ADHD such as feelings of isolation, alienation, depression is every bit as important as treating the syndrome itself.

Once you have the proper treatment in place there will be ongoing monitoring to make sure that your child is responding well to treatment. This is the beginning of treatment for your child and you will be working closely with your child’s psychiatrist over however long a period of time is needed to make sure that your child is responding well to treatment.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT IS ADD & ADHD?

December 13th, 2013

The number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) continues to climb, according to new data from the Centers for Disease Control and Prevention. http://thechart.blogs.cnn.com/2013/11/22/adhd-diagnoses-rise-to-11-of-kids/

Today, 6.4 million children between the ages of 4 and 17 – 11% of kids in this age group – have received an ADHD diagnosis, according to a recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry, which is based on a survey of parents. That’s 2 million more children than in 2007. http://www.medicaldaily.com/adhd-diagnoses-reach-64-million-us-35-million-children-prescribed-medication-cdc-report-263545

The links above show the new numbers that were released in November showing a significant rise in the number of school aged children diagnosed with ADD (or ADHD).

Attention Deficit Disorder (ADD) ranks among the most frequently diagnosed behavior disorder today. ADD affects about eight percent of school aged children in the United States. There are three types of ADD:

Attention Deficit Hyperactivity Disorder (ADHD) where the hyperactivity/impulsive characteristics predominate.
Attention Deficit Disorder (ADD) where inattention predominates and there are fewer behavioral problems characteristic of children with ADHD.
Combined Type where there are both inattentive and hyperactive/impulsive characteristics.

The syndrome is characterized by more than expected degrees of:

INATTENTION

Trouble focusing on activity
Trouble sustaining attention
Seeming not to listen
Trouble following instructions
Easily distracted
Easily bored
Trouble Organizing
Making careless errors
Not finishing or not doing homework
Losing things
Having to have things repeated

IMPULSIVITY

Inability to wait her turn
Blurting out answers in class
Interrupting
Bossiness
Acting like the class clown
Having little control of his actions and not being able to put thought between feelings and actions
Having hair-trigger tempers
Bullying

HYPERACTIVITY

Trouble sitting still
Fidgeting
Rarely slowing down
Talking too much
Rarely finding quiet time

It’s true that many of these characteristics, to some degree, are common to all children. This in no way lessens the validity of the disorder. A child’s ability to focus, sit still, follow commands, control activity, show patience, and manage feelings develops at different rates. There is no such thing as a perfectly normal timeline and because of this, it’s important not to jump to conclusions. A good measure is that by kindergarten these areas of development should be growing, and by the end of first and second grade, they should be well along. If not, then chances are your child is in a great deal of discomfort and might be suffering from ADD. Don’t be fearful of an ADD diagnosis. There are many ways to treat it and children can find success in school and their daily lives with the proper help and support.

In my next blog I will discuss diagnosing ADD, what causes it and how it is treated.

HOW TO CHOOSE A THERAPIST FOR YOUR CHILD

December 4th, 2013

Once you realize that your child needs professional help the next step is finding that help. There are various types of therapy that are generally recommended for specific psychiatric disorders. At first glance, those therapies cover a bewildering range not only of the conditions they are designed to treat but of the philosophies and techniques they employ to treat them. What criteria does a parent use to choose?

Help is relatively easy to find; through your doctor, your child’s school, your local hospital or medical clinic, your religious organization or the local mental health organization in your municipality. Ideally every child or teen should receive a broad based clinical mental health evaluation. This entails the family and child being interviewed. A child/teenage psychiatrist (one who has done a residency or fellowship in child/adolescent psychiatry) is the most broadly trained of all the child mental professionals and can spot the need for possible medication right away. They can also provide psychotherapy if needed. Many locales do not have a psychiatrist, and in that case other mental health professionals can perform the evaluation and therapy as well. Licensed psychologists, social workers, psychiatric nurse specialists and mental health counselors all work in this area. The important thing to remember is that they need to have had special training and experience in working with young people. Do the research before you choose.

The next thing to consider is recommendations from others who have sought help from the individual. Did it help? Was he/she available when needed?

Lastly, trust your gut. After meeting with the therapist ask yourself how comfortable you and your child are. What was the atmosphere? Was he/she flexible regarding times? Ask about his/her understanding of the problem. How long should the treatment last? What will you look for as far as progress is concerned? Ask all you can if medication is prescribed– side effects, how to take it, what symptoms are being targeted and how to go off it.

Sometimes just one visit can be clarifying – the therapist may have so much knowledge of your child’s minor problem that direction can be given on the spot, and that may be all the therapeutic advice you need. Maybe just the parents need some education and counseling. For more serious issues, longer-term therapy for the child/teen might be needed. The family is usually included especially for pre-teens. Ask about fees and insurance, too.