Discussion point

[Psyclops]

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Anyone catch this? http://www.npr.org/templates/story/story.php?storyId=5474674 A discussion on NPR about the prescription or overprescription of psychotropics. If not you can check it out at the link.

Thoughts?

 

[MBK2003]

Anyone catch this? http://www.npr.org/templates/story/story.php?storyId=5474674 A discussion on NPR about the prescription or overprescription of psychotropics. If not you can check it out at the link.

Thoughts?

I heard the story and read the article in the archives
http://archpsyc.ama-assn.org/cgi/reprint/63/6/679

I have mixed feelings about the prescription of atypicals in kids. On one hand, I have seen some REALLY out of control kids in Disruptive Behavior clinic who are only tolerable on Risperdal BID and max doses of stimulants. Clearly these meds are the only things keeping some of these kids from residential treatment facilities. Those are the extreme cases though, and for the more typical cases there aren't enough re-imbursed psychosocial treatments for these kids or their families, and not enough people to provide parent skills training and family therapy for these kids. It's always easier for the bottom line (Medicaid or insurance) to give the kid Risperdal and Adderall once a month, than to engage in the intensive, possibly in-home services that would allow you to taper the kid off atypicals. Sometimes we do medicate kids with atypicals, when more intensive services might be a more effective and better long-term option but frequently you know those services will never happen.

MBK2003

 

[Poety]

MBK, in your experience, how much of this is attributed to poor parenting? The extreme behaviors I mean. Do you think a lot of the kids would have done better had their parents been more involved/more consistent/more disciplined in their ways?

 

[MBK2003]

MBK, in your experience, how much of this is attributed to poor parenting? The extreme behaviors I mean. Do you think a lot of the kids would have done better had their parents been more involved/more consistent/more disciplined in their ways?

I think "poor parenting" can become a pejorative term that gets applied to families of low socioeconomic class and minorities. I think that consistency and discipline are important in parenting kids, but I see parents who are completely worn out from the sheer amount of redirecting they need to do with some of these kids.

I can give you a personal example from my life. My oldest child is a very easy-going kid and I could be a lazy, inconsistent parent with few limits and he'd still turn out to be a well-behaved child. It's just his nature to not want to do things wrong. My second child is the complete opposite. I try to be (and usually am) a consistent, strict yet fair parent to him and yet there are some days when I take him out in public and he acts like he was raised by wolves. Other days he's a perfect angel and there's no clear precipitating trigger for either behavior. So much is underlying temperment, frustration tolerance, and stimulus sensitivity which drive the behavior and impulse control, or lack of.

Parents of kids with moderate to severe ADHD and ODD have an enormous task of parenting these kids and frequently get little support from extended family members who blame the parents or the kid. I have seen parents who have clear evidence from the other kids in the family that they are good limit setters and had a good pattern of rewards/contingencies, but with the ADHD kid they've managed to let things slip after the years because they are tired of constantly battling the kid. It's a monumental task raising some of these kids. I might also see a select set at a tertiary care center where the parents frequently self-refer for treatment (unlike the juvenile justice system where I don't intend to work).

MBK2003

 

[50960]

Yes, but ODD is highly correlated with bad parenting as is ADHD. The research shows this...... 😳

 

[Doc Samson]

Yes, but ODD is highly correlated with bad parenting as is ADHD. The research shows this...... 😳

Just checked with the boss (i.e. my wife who's a child psychiatrist), and while ODD is strongly correlated with adequacy of parenting, ADHD is not. Wonder if "bad parenting" results in more tangible sequelae of ADHD (bad grades, trouble at school, etc.) than in an increase in the dx itself.

 

[Anasazi23]

Just checked with the boss (i.e. my wife who's a child psychiatrist), and while ODD is strongly correlated with adequacy of parenting, ADHD is not. Wonder if "bad parenting" results in more tangible sequelae of ADHD (bad grades, trouble at school, etc.) than in an increase in the dx itself.

Your wife's a child psychiarist?
Cool.

 

[Doc Samson]

Your wife's a child psychiarist?
Cool.

Yeah, when we met I was applying for medicine, and she was applying for plastics... we talked each other into psychiatry.