Sunday, May 12, 2013

The week in ADHD news

So a study came out recently saying that the majority of pediatric specialists ignore the American Academy of Pediatrics' guidelines for treating ADHD in preschoolers. (I learned about it here; the full story is here.) Researchers at the Cohen Children's Medical Center of New York sent out a questionnaire to 3,000 specialists nationwide. The AAP guidelines, which were revised in 2011 to extend the minimum age for diagnosis from 6 down to 4 -- in other words, the age at which kiddo was diagnosed -- say behavioral therapy should come first, with medication as more of a last resort. In other words, what we did. But more than 1 in 5 specialists said they go with the drugs first.

Sigh. Any second now I expect the NY Times to weigh in on the terrible terrible overmedication of America's youth, while once again not managing to find a single child or parent actually dealing with ADHD to interview about it.

OK, why do I think doctors (and/or parents) opt for medication first? Because it's covered by insurance. Basically the reason we haven't been back to kiddo's behavioral therapist is because she dropped our insurer, and while she offered to keep seeing him at the co-pay rate, we felt like that was more of a short-term favor. Most occupational therapy facilities (and, I have a feeling) ABA facilities don't take insurance, and after our ongoing aggravation with the OT Facility That Wouldn't Quit Billing, I can understand why. They're not equipped for that level of paperwork. So what are parents supposed to do if they can't afford to pay for therapy out of pocket? They go with what's covered.

Also, behavioral therapy is a long-term time commitment. I had to come in to work late on appointment days; kiddo occasionally missed part of kindergarten. It helped, sure, and we got some good advice on dealing with him (this is most of the point). But not everyone can make that kind of commitment.

And also, I think there is such a general lack of education out there about ADHD and other mental issues/disorders that people think the meds are what you're supposed to do. Got ADHD? Oh, well, get drugs. The other (and preferable, if you can swing them) options never come up because people don't know what they are.

I do find it troubling that doctors are just throwing medication at little kids to solve the problem. But I also think doctors will just throw medication at anything to solve any problem. Case in point: Many years ago I went to my doctor looking for help and advice about my insomnia. He rolled his eyes and gave me a prescription for Ambien. I'd actually kinda been hoping for an informed discussion about what might be causing the insomnia and what I could do about it, but sure, OK, Doc, I'll just take these meds and quit bothering you. The upshot: I took it maybe three times, didn't like it and stopped. And then I had children and insomnia basically ceased to be a problem, because when you have kids you're always tired and will never turn down an hour or 15 of sleep if you can get it.

So you want doctors to stop overmedicating kids? Great. I'm with you. But how about getting doctors to stop overmedicating the entire rest of the country while you're at it?

Bringing me (tangentially) to point number 2: This is Speak Up for Kids month, according to the Child Mind Institute in New York. (And you thought it was just Mother's Day.) The institute, which helps kids with all manner of behavioral and learning disorders (and has a pretty informative website, do check it out), runs a campaign every May to inform people about these disorders and about how kids' mental health is disregarded and underserved. I can't say they're wrong. If more people (and more doctors, apparently) really understood ADHD or autism or OCD or Tourette's or any number of other issues, they'd be better prepared to help kids who have them, wouldn't they? And maybe overmedicating would be less of an issue.

Anyway, that's my four or five cents. Now I have to get back in bed so the kids can serve me breakfast. Happy Mother's Day, all.

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