First time I've read an Onion article and felt sad

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We all know kids don't get straight A's because they either don't care or may not be smart enough to get those grades. It's always due to ADHD, don't you know?
 
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We all know kids don't get straight A's because they either don't care or may not be smart enough to get those grades. It's always due to ADHD, don't you know?

Which, for the parents involved, also gives them something to talk about with all the other neighborhood parents whose children have "ADHD." It's not as threatening as Autism, is more treatable than intellectual disability, is sexier than learning disability, and absolves more responsibility than laziness or psychosocial factors.

Oh yeah, and for the adults who "have" it, it'll get you legal speed.
 
I have gotten so frustrated with the pressure that when I got the referral request to evaluate for ADHD in one of my patients who i have been successfully treating depression, my first reaction was, "why not give him some speed? It improves performance and will give him a little extra energy. Why even pretend to do an assessment of this since there is no real valid measure?" Of course, I am going to refer him to my colleague for an educational assessment because the kid has internalized the belief that he is stupid and no real cognitive assessment has been done. We'll find out he has some areas of relative weakness, but is not mentally defective and then give him some stimulants.
 
It always ends the same way, and ADHD conceived as a syndrome has so many potential etiologies that we probably don't really even understand. Unfortunately, "your child has ADHD, here's some stimulants" is much more palatable to parents who will not hesitate to complain about you to patient advocacy than:

(a) perhaps your child doesn't care as much about good grades as you do
(b) maybe your expectations for your child exceed his ability
(c) maybe you want your child to be super calm and busy so you don't have to actually interact with them at home

I'm starting to do something fun now that I'm out of training and can actually practice how I want. When parents complain about their kid's academic performance, I ask the parent -- in front of the kid -- how they did in school. There are sooo many other explanations. Unfortunately, somewhere along the line screening tools gained the status of diagnostic standards and allowed providers to become incredibly lazy.
 
When the article said controlled substances, I was actually thinking of benzodiazepines. Interesting that everyone else read controlled substances as stimulants.
 
When the article said controlled substances, I was actually thinking of benzodiazepines. Interesting that everyone else read controlled substances as stimulants.
Not very much pressure to put kids on benzo's. Schools like anxious kids, they tend to behave. I actually meet with quite a few anxious kids and they tend to do really well with psychotherapy. I have seen a lot of anxious kids put on stimulants though, but I am pretty good at stopping it in my practice because at least one or both of the parents are anxious, too.
 
Not very much pressure to put kids on benzo's. Schools like anxious kids, they tend to behave. I actually meet with quite a few anxious kids and they tend to do really well with psychotherapy. I have seen a lot of anxious kids put on stimulants though, but I am pretty good at stopping it in my practice because at least one or both of the parents are anxious, too.
I was very well behaved, as well. To a fault. But for me benzos were first line treatment under the idea that anxious people take anti-anxiety meds. I actually asked the psychiatrist about therapy (I didn't know about psychiatrist vs psychologist at the time) and he scoffed at the idea.
 
I was very well behaved, as well. To a fault. But for me benzos were first line treatment under the idea that anxious people take anti-anxiety meds. I actually asked the psychiatrist about therapy (I didn't know about psychiatrist vs psychologist at the time) and he scoffed at the idea.
Put quite simply, he was a fool. Several forms of psychotherapy are the gold standard for treatment of anxiety disorders. They typically involve various forms of exposure and active relaxation methods. Usually with pre-adolescent kids, probably since the anxiety is not an overlearned response yet, they can benefit just from expressing their fears in a safe environment and also having them normalized. Most adults just make them more anxious so they really love talking to me because I don't overwhelm them with all of the things they need to do to "get over it". People will say helpful things to a ten year old like, "if you don't learn to speak in public then how can you ever expect to succeed in life." I tell kids that I have some things I am afraid of too and talk about it. They are remarkably reassured by the fact that someone can succeed in life despite having fear. I also tell adolescents and adults that there are indeed some people who have no fear - sociopaths. The teens really like that line.
 
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When the article said controlled substances, I was actually thinking of benzodiazepines.

Is there an indication to put children on benzodiazepines? I've never heard of that happening. Granted I have almost no experience with children.
 
Is there an indication to put children on benzodiazepines? I've never heard of that happening. Granted I have almost no experience with children.
In my case, I was prescribed Ativan daily for panic disorder when I was 15. It's not indicated, but it happened.
 
In my case, I was prescribed Ativan daily for panic disorder when I was 15. It's not indicated, but it happened.

That was then, this is now. Things are done differently now. The common theme I hear is hanging onto the process and how dissatisfied you are with it.

When will you make the jump?
 
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Is there an indication to put children on benzodiazepines? I've never heard of that happening. Granted I have almost no experience with children.
Benzos haven't been well studied in kids. I recall one source saying that an open-label study of Klonopin showed promise (for school avoidance? or anxiety?) but then in an RCT it didn't separate from placebo.

You'd think that benzos should be effective in kids as with adults but that's dangerous thinking that can lead you astray.
 
That was then, this is now. Things are done differently now. The common theme I hear is hanging onto the process and how dissatisfied you are with it.

When will you make the jump?

It's very nice that you care. And I imagine anything I say will probably sound like a deflection.

I have made two cuts which I've maintained. I was already in tolerance withdrawal before the cuts. I tried making another cut and started having what seemed to be minor convulsions. I am now tapering the Seroquel instead to get rid of one drug that lowers the seizure threshold and might possibly be a contributor to some of my autonomic issues.

If it were a matter of jumping, I would have done it a long time ago. I am 33 and have been on these drugs more than half my life. My standing blood pressure on medication is already too high, and I have mild thoracic aortic ectasia, so I need to be careful. I can't make a jump, as satisfying as that would be. I feel that each decision I make minute to minute is the right one. In the long term, they don't seem that way, but when you look in the long-term you don't have to deal with minute to minute. In everything I've done, I've thought I was protecting myself. I may have been wrong and may be wrong now. My survival instinct is very strong and that's what I follow. Whether it's right or not is another question.

I know it's not a satisfying answer and you probably can see a lot of ways in which I am thinking wrongly about this, but either way, I do appreciate you caring enough to ask a motivating question. In my dream world, I would be going off right now. I'd be in a hospital, with an EKG and EEG monitoring me 24/7 and a nice, responsive doctor who was controlling my blood pressure and risk of seizure as I went down. But I have to deal in reality. I haven't found a place that I trust for taking on such an endeavor. With the brain shocks and weird things I have and how high my blood pressure gets when I stand, I live every day worrying I'll die. Of course that was true even when I was a child, but I now actually have real, scary symptoms that really are borderline dangerous. I think that I do the best I can with the resources available to me. If there were some really great opportunity to make a sea change, if there were some doctor I was avoiding seeing, I could blame myself more (not that I don't already blame myself). I just don't see a fast or even feasible way out yet.
 
That was then, this is now. Things are done differently now. The common theme I hear is hanging onto the process and how dissatisfied you are with it.

When will you make the jump?

It's very nice that you care. And I imagine anything I say will probably sound like a deflection.

I have made two cuts which I've maintained. I was already in tolerance withdrawal before the cuts. I tried making another cut and started having what seemed to be minor convulsions. I am now tapering the Seroquel instead to get rid of one drug that lowers the seizure threshold and might possibly be a contributor to some of my autonomic issues.

If it were a matter of jumping, I would have done it a long time ago. I am 33 and have been on these drugs more than half my life. My standing blood pressure on medication is already too high, and I have mild thoracic aortic ectasia, so I need to be careful. I can't make a jump, as satisfying as that would be. I feel that each decision I make minute to minute is the right one. In the long term, they don't seem that way, but when you look in the long-term you don't have to deal with minute to minute. In everything I've done, I've thought I was protecting myself. I may have been wrong and may be wrong now. My survival instinct is very strong and that's what I follow. Whether it's right or not is another question.

I know it's not a satisfying answer and you probably can see a lot of ways in which I am thinking wrongly about this, but either way, I do appreciate you caring enough to ask a motivating question. In my dream world, I would be going off right now. I'd be in a hospital, with an EKG and EEG monitoring me 24/7 and a nice, responsive doctor who was controlling my blood pressure and risk of seizure as I went down. But I have to deal in reality. I haven't found a place that I trust for taking on such an endeavor. With the brain shocks and weird things I have and how high my blood pressure gets when I stand, I live every day worrying I'll die. Of course that was true even when I was a child, but I now actually have real, scary symptoms that really are borderline dangerous. I think that I do the best I can with the resources available to me. If there were some really great opportunity to make a sea change, if there were some doctor I was avoiding seeing, I could blame myself more (not that I don't already blame myself). I just don't see a fast or even feasible way out yet.

I've quoted Shikima's post above so you can re-read it. I don't think the observation of you being dissatisfied with the process and asking when you'll make the jump is actually talking about your process of tapering, and questioning why you don't just 'make the jump' and come off the medication. And of course Shikima can correct me if I'm wrong, but I felt more like the post was intended to bring to your attention the fact that (and I personally think this is right) you appear to be stuck in a transferential pattern based on a mistake that happened the past, where you're transferring your anger and feelings of being mistreated onto potential future providers. From what you've said about your current Psychiatrist, it goes without saying I think you should get as far away from her as possible. But you've also posted about trying to find other Psychiatrists and granted they haven't been willing to continue the tapering schedule as its already been set up for you, but you've also spoken about wanting to be in control of treatment - perhaps too much in control? You have a Psychiatrist misprescribe a medication to you, which leads to dependence and long term issues for you, so now you feel like you have to dictate the parameters of treatment to what you feel 'safe' with. And that's fine to a degree, it's understandable, but have you ever thought of just letting go of that need to 'protect' yourself from Psychiatry by being so stuck in what you will and won't accept as treatment, and see if you can perhaps find a new Psychiatrist and negotiate treatment with them. To me the therapeutic relationship with a Psychiatrist is a two way street, I wouldn't stay with a Psychiatrist who tried to make it all 'their way or the highway' with me getting no say in my treatment, but on the other hand it wouldn't do me any good either just to dig my heels in and say 'You treat me the way I say I want to be treated, or else I don't want to be your patient'. Look, you know I get where you're coming from, you got misprescribed a drug of dependence by a Psychiatrist, I got...'mishandled', shall we say. And I did a lot of the same things I can see you doing now - I wanted to set the parameters of treatment, I wanted to dictate who I would and wouldn't see not based on their skill set but purely on their gender (or in your case their approach to benzo tapering), I cut off a large population of potential treatment providers because I wouldn't budge from these internalised 'rules' I had set in place, and when I finally reached the point where I did have to break my own 'rules' or parameters I spent another 2+ years faffing about while I went through this whole BS dance of 'I trust him, I trust him not' when I could have spent that time actually engaging properly in therapy. For all those years I was transferring what had happened to me in the past, because of one rogue psychopathic Doctor, onto the Psychiatric profession as a whole, and then onto my current Psychiatrist, and it held me back and wasted so much time that I could have used getting help. Just be careful that you don't make the same mistake.
 
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I've quoted Shikima's post above so you can re-read it. I don't think the observation of you being dissatisfied with the process and asking when you'll make the jump is actually talking about your process of tapering, and questioning why you don't just 'make the jump' and come off the medication. And of course Shikima can correct me if I'm wrong, but I felt more like the post was intended to bring to your attention the fact that (and I personally think this is right) you appear to be stuck in a transferential pattern based on a mistake that happened the past, where you're transferring your anger and feelings of being mistreated onto potential future providers. From what you've said about your current Psychiatrist, it goes without saying I think you should get as far away from her as possible. But you've also posted about trying to find other Psychiatrists and granted they haven't been willing to continue the tapering schedule as its already been set up for you, but you've also spoken about wanting to be in control of treatment - perhaps too much in control? You have a Psychiatrist misprescribe a medication to you, which leads to dependence and long term issues for you, so now you feel like you have to dictate the parameters of treatment to what you feel 'safe' with. And that's fine to a degree, it's understandable, but have you ever thought of just letting go of that need to 'protect' yourself from Psychiatry by being so stuck in what you will and won't accept as treatment, and see if you can perhaps find a new Psychiatrist and negotiate treatment with them. To me the therapeutic relationship with a Psychiatrist is a two way street, I wouldn't stay with a Psychiatrist who tried to make it all 'their way or the highway' with me getting no say in my treatment, but on the other hand it wouldn't do me any good either just to dig my heels in and say 'You treat me the way I say I want to be treated, or else I don't want to be your patient'. Look, you know I get where you're coming from, you got misprescribed a drug of dependence by a Psychiatrist, I got...'mishandled', shall we say. And I did a lot of the same things I can see you doing now - I wanted to set the parameters of treatment, I wanted to dictate who I would and wouldn't see not based on their skill set but purely on their gender (or in your case their approach to benzo tapering), I cut off a large population of potential treatment providers because I wouldn't budge from these internalised 'rules' I had set in place, and when I finally reached the point where I did have to break my own 'rules' or parameters I spent another 2+ years faffing about while I went through this whole BS dance of 'I trust him, I trust him not' when I could have spent that time actually engaging properly in therapy. For all those years I was transferring what had happened to me in the past, because of one rogue psychopathic Doctor, onto the Psychiatric profession as a whole, and then onto my current Psychiatrist, and it held me back and wasted so much time that I could have used getting help. Just be careful that you don't make the same mistake.
Ahh, it's so funny after reading what you wrote and then what Shikima wrote, I'm kind of wondering how I read his/her post the way that I did. Even more so that I spent days pondering the question posed.

Your post is very transformational for me. I appreciate it a lot. That makes a lot of sense, and what Shakima said now makes a lot of sense, too, about not applying an old situation to a new one. You're very right about me wanting to hold onto control, and in particular with psychiatrists. I'm taking it in. And I will re-read this again. Thank you.
 
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Ahh, it's so funny after reading what you wrote and then what Shikima wrote, I'm kind of wondering how I read his/her post the way that I did. Even more so that I spent days pondering the question posed.

Your post is very transformational for me. I appreciate it a lot. That makes a lot of sense, and what Shakima said now makes a lot of sense, too, about not applying an old situation to a new one. You're very right about me wanting to hold onto control, and in particular with psychiatrists. I'm taking it in. And I will re-read this again. Thank you.
I read shikima's post the same way as Ceke and I just wanted to comment that her conceptualization and insight into the dynamic is pretty impressive work. :)
I also want to state that I made the mistake of pushing a patient too much a few weeks ago and it still bothers me. It is extremely important for the patient to set their own pace with anxiety work. It's actually my rule number one with trauma patients, but I did it anyway. :oops: It was really about my own anxiety, insecurities, desire to help/save, and the resultant need for control. Sometimes we forget that in individual treatment there are still two human beings in the room and then there are the people from outside the room that we bring with us.
 
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I read shikima's post the same way as Ceke and I just wanted to comment that her conceptualization and insight into the dynamic is pretty impressive work. :)
I also want to state that I made the mistake of pushing a patient too much a few weeks ago and it still bothers me. It is extremely important for the patient to set their own pace with anxiety work. It's actually my rule number one with trauma patients, but I did it anyway. :oops: It was really about my own anxiety, insecurities, desire to help/save, and the resultant need for control. Sometimes we forget that in individual treatment there are still two human beings in the room and then there are the people from outside the room that we bring with us.

What sort of therapeutic relationship do you have with this patient, and are you treating them from trauma based anxiety attacks? (if you can answer that of course). Are they the sort of patient you can speak fairly openly with? Without pole vaulting over any ethical boundaries of course. The reason I ask is that as someone with a past history of childhood trauma I was more used to having people dismiss me, or shut me down when something was wrong and no one wanted to, or was willing, to listen and take me seriously (they always say 'speak to a trusted' adult, well I tried that when I was a child and got told to stop making things up). So when my Psychiatrist and I had a bit of a blow out a few years back (walls going up all over the place in a session, things being misread, really uncomfortable silences because neither one of wanted to speak, etc) and he actually apologised after the fact and allowed me to speak my piece, first via a few emails and then again next session, as well as fully admitting his fault in what had transpired and offering an explanation, it turned out to be a bit of a revelation for me and ended up helping to strengthen the therapeutic bond that little bit more.
 
It actually had more to do with me getting embroiled in the unhealthy family dynamics. I can't or won't say much more other than I don't know if patient will come back so don't know if I will get chance to address. Also, I am certain it was not patients decision to end therapy. I don't know if I could have done much differently as it was an uphill battle from the start, it that doesn't stop me from second-guessing and learning to handle the next situation better.
 
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It actually had more to do with me getting embroiled in the unhealthy family dynamics. I can't or won't say much more other than I don't know if patient will come back so don't know if I will get chance to address. Also, I am certain it was not patients decision to end therapy. I don't know if I could have done much differently as it was an uphill battle from the start, it that doesn't stop me from second-guessing and learning to handle the next situation better.

I'm sorry things turned out that way. Perhaps instead of second guessing though you should maybe be reflecting - second guessing to me implies negative rumination. Sounds like you were up against it from the start with the family dynamics, go a little easy on yourself.
 
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I'm sorry things turned out that way. Perhaps instead of second guessing though you should maybe be reflecting - second guessing to me implies negative rumination. Sounds like you were up against it from the start with the family dynamics, go a little easy on yourself.
Hehe I'm not immune to negative ruminations, that's for sure. Don't worry I'm not too hard on myself. Some people tend to externalize too much and others internalize too much, I used to be the former so a little bit of the latter isn't a problem. It's actually pretty healthy for me. When I start to go into blame everyone else angry self-righteous mode that's when I really have to watch out. :eek:
 
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Hehe I'm not immune to negative ruminations, that's for sure. Don't worry I'm not too hard on myself. Some people tend to externalize too much and others internalize too much, I used to be the former so a little bit of the latter isn't a problem. It's actually pretty healthy for me. When I start to go into blame everyone else angry self-righteous mode that's when I really have to watch out. :eek:

Fair enough :cool:
 
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