Wednesday, October 1, 2008

How much is it costing to PAY Attention?

Back in August 2000 or 2001 Dr. Adrian Angold and others at Duke University published an epidemiological study of the rate of diagnosis of Attention Deficit Hyperactivity Disorder in the western part of North Carolina in the Journal of the American Academy of Child and Adolescent Psychiatry. That study discovered that thousands of school aged children had been misdiagnosed and NEVER should have been medicated at all. Few people reference that article.

I have four important true stories about real children to tell you.

More recently than the next post, I saw a 7 year old from another county. This boy was clearly terrorizing his class and his teacher. He would never sit still. He grabbed a scissors whenever he could and would cut his own clothes, hair, and the hair of other students. The referral was for an evaluation of ADHD and other behavior, as you could well imagine. One of my favorite developmental questions is frequently left out of routine interviews concerning child development. It needs to be included. I always ask when a child first began to sleep through the night. This case was one of only a few where a child had never slept through the night. His nightly sleep was always interrupted, and not for using the bathroom. The simplest way to treat sleep problems is to establish a nightly sleep routine. This child had one. I strongly recommended that the parents try giving him Melatonin. He slept the night through for the first time. The next day he brought home his first "A" for behavior. The teacher thought that he had certainly been given a stimulant like Ritalin. The problem with any stimulant medication is that it would have bypassed the sleep deprivation/interruption and delayed correct treatment. Follow-up reports have indicated continued good behavior as the result of a complete night of rest.

I recently saw a 6 year old boy who had significant behavior problems in school that included biting one teacher, hitting another teacher, kicking a child, and punching another child. This boy was often out of his seat to the point where one note described him as doing cartwheels in class. One of my more recent concerns about small children displaying behavior and attention problems has been sleep. This boy was going to sleep at 11 PM and waking up at 6 AM to go to school. His teacher also reported that he would fall asleep at school. We know from research that 6 year old children need 11 hours of sleep per night. We also know that sleep deprived children are inattentive, active, and aggressive. I recommended that he get more sleep, and provided suggestions. His mom called back recently (12-4-08) and told me that he had two consecutive days of on task, appropriate behavior after going to sleep at 8:30 PM rather than 11 PM. It is likely that most psychiatrists would have put him on medication that kept him up, rather than working on the sleep problem

One child, a boy, attended a Christian school. His physician thought that he had ADHD, so he prescribed Cylert (Pemoline Magnesium), a very dangerous drug, despite published articles warning that it was harmful, in addition to an FDA warning. The boy also had Celiac Sprue, a digestive disorder in the same category as a cluster of irritable bowel disorders. He was not permitted to consume wheat products. The school psychologist that saw him three years earlier had warned his parents that Cylert was dangerous and gave them literature about its harmful effects on the liver. The physician did not change the medication despite the parents conveying the concerns to him. I was told, when I got to the school, that the teachers wanted him to take more medication. I saw a boy with yellow tinged skin. The "whites" of his eyes were yellow. I gave the parents a computer print out of an article that listed the dangers of Cylert, with the parts describing liver damage and potentially fatal results highlighted. I told them what I saw, without diagnosing anything else ("Your child has yellow skin and yellow eye whites"). I told them that it was critical to give the boy's physician the information. I tested the boy.

I went back to the school three months later. The parents of the boy saw me. They ran over to give me a hug. They exclaimed that I had saved their child's life. They also told me that their son's teachers congratulated them on increasing his medication after it had, in fact, been stopped, because he was paying attention and working harder at school than ever before.

A young girl's grandmother called me and begged me to test the child. The school in Texas had claimed that she had ADHD. The parents gave permission for the assessment. The principal at the school had called them once too often. They told of how often their child got out of her seat without permission. Her mother described how her daughter began to tap her feet while standing outside of the principal's office, with principal saying something like, "Will you look at that! I told you she has ADHD!" I accepted the case. The grandmother paid for her granddaughter's airfare. I saw an active, busy nine-year old. She had to use the bathroom twice while I tested her for about an hour and a half. My interview also revealed that this child's hand hurt after writing for a short time. I advised the mother to obtain a complete physical, being certain to give the physician a copy of my report (which explained the physical problems that I - a psychologist, not a physician - observed). The child had an arterio-venous (blood vessel) jumble that was causing her significant kidney problems - resulting in a frequent need to use the bathroom. The teacher, who limited bathroom breaks for students, was very concerned about how fidgety she was, and thought that this child had ADHD. It also turned out that the child had a bone malformation in her writing hand that caused pain. The symptoms of ADHD magically disappeared after the appropriate medical treatment of both problems. Ask yourself this: How many psychiatrists request a complete physical before they prescribe medication for ADHD? Think about it. See if you can obtain a copy of a book written by a psychiatrist about the usual failure to check for medical explanations of active behavior. The Hyperactivity Hoax is the book written by Dr. Sydney Walker, III. I hope that you find it and read it.

There are many drug-free programs to treat attention problems. The drug companies (they like to be called pharmaceutical manufacturers) have much more money to publicize their products than authors of drug-free treatment programs.

You could also check out something that I've written as a suggested program for all children:

No comments: