Advice: Diagnosis and Medication

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The Confusing Picture of ADHD
Article by Dr. Rao, Excerpt

What causes ADHD? Is it a biological disease as many experts have stated? Is there something in the environment that causes children to excessively fidget, to be distracted and unfocused? It's worth finding answers. ADHD is the most common pediatric problem facing American children.

. . . Like most medical or psychological problems, there are multiple routes to the symptoms that make up that problem. ADHD is complex and difficult to accurately diagnose. Many things mimic its symptoms, such as vision and hearing problems, learning disorders, anxiety, sleep problems, and stress at home or school. For the millions of children diagnosed with ADHD, we need to follow all reasonable avenues to accurately explain why its happening, if its happening, and for those who truly have the disorder, consider all potentially useful treatments. Read More.

Child psychologist has a simple solution to boys' hyperactivity and learning issues: Give them a break.
Interview with Dr. Rao in The Boston Globe, Excerpt

Dr. Rao: When boys enter into preschool or any learning situation, the expectations to succeed or perform don't really match where they're at. They don't make eye contact very well. They don't listen as well. Their hearing is not as acute as it is for girls, so they don't develop language skills as quickly. And they have high motor activity. You have boys being asked to sit longer or be indoors, and teachers who are at the front lines saying your child is having a problem fitting in. That translates quickly into a diagnosis and a medication.

Globe: How quickly?

Dr. Rao: Parents can get a diagnosis and medication within a 10- to 15-minute pediatric visit.

Globe: You use the word "madness'' to describe this situation. Why such a strong word?

Dr. Rao: I have a lot of emotion and deep feeling around this issue. I wanted to select a way of saying it that woke people up. I am not an anti-medication person at all. But we have a tendency to first think there is something wrong neurologically or psychiatrically and offer a quick-fix solution. Read More.

Fighting Autism, One Punch At a Time
Article by Dr. Rao, Excerpt

Parents are frightened. Recent headlines report "Study Increases Prevalence of Autism" and "Nearly 1 Percent of US Children Have Autism." Parents of boys are particularly worried. The Autism Spectrum Disorders (ASD's) are diagnosed four times more in boys than girls. In a health club outside Boston, I learned about one such seven year-old named Jake who struggles with significant developmental problems. He's slow and awkward in his movements, misunderstands requests, and can't pick up on the nuanced social signals the rest of us process without a second thought.

He's also fighting back. He's learning to move his small feet like a boxer. His little hands are wrapped in cotton strips and shoved inside swollen Everlast gloves. He stands upright and throws punches into the hand-held pads of his trainer, Carlos Hernandez. Read More.

"The Way of Boys"
Book by Dr. Rao and Michelle Seaton, Excerpt (pp. 223-224)

Diagnoses are powerful, descriptive tools to guide us toward providing the best possible treatments. When used correctly, they are invaluable. Yet, so often, the word "Diagnosis" is thrown around in a casual manner, or a diagnosis is affixed like a permanent tattoo, when in fact it can signify something far more vague and inconclusive. Some mothers come into my office and say that their son has been diagnosed with "sensory processing disorder" or "explosive disorder," or he has been diagnosed as a "spirited child." More and more I hear diagnoses of bipolar disorder and Asperger's syndrome applied to difficult young boys, even more commonly in recent years than the once very popular ADHD label. When I ask about who made the diagnosis and under what circumstances, more often than not I discover that it was a well-intentioned school administrator or a preschool teacher or a friend of the family. In some cases a parent will say that she's read a certain book and feels that it describes her son completely and now wants to have him evaluated to see if that is the right diagnosis. These are typically very caring parents critically concerned about their son and who are, in some cases, under a lot of pressure from the school system to assign him a diagnosis, sometimes to help a boy in genuine trouble, but other times to move a troublesome boy out of his classroom and into special education services. Making a diagnosis is a serious step and should be thought out carefully.

A problem with aggressively seeking a diagnosis is that it nearly always leads to treatment. That's the purpose of a diagnosis. In many cases, this will be a pill with real, potentially serious side effects. I caution parents not to think so narrowly. Pills are not the only treatment for behavioral problems, let alone developmental challenges. Nor are they always the best treatment. Many boys respond extremely well to shifting their environment, tutoring, coaching, behavioral therapy, and changes in diet and nutrition.

Even when medication is used, it is often the combination of the right medication with behavioral and educational interventions that leads to the best long-term outcome.

In this chapter [12], I want to lay out for parents what a diagnosis is, what it means, and what to expect when you go down the road toward assigning a medical label for your son's behavior. I will include in this a sampling of screening techniques and tests often given to boys of this age and what they mean and don't mean. Book Info.