Friday, September 9, 2011

People think I'm crazzzy...


My pediatric clinical rotation is in full effect, and I love that it coincides with the start of the school year.  Every day is jam packed with parents propping their kiddies on the table and coercing them to say one of two statements 1. "I need a refill on my ADHD meds" or 2. "My ADHD meds aren't working".  I then reply with the same question for every patient "why do you think you need ADHD medication?"

My question usually causes an immediate look of dissatisfaction from parents. I mean, children need to know why their parents are giving them 20 mg of Vyvanse every morning and 25 mg of Strattera every night.  The children usually respond to my question with the same response "My teacher (or Mom) says I move around too much".

Um, isn't that what children are supposed to do?

Case Study:
AJ an 8 yo boy presents with his mother and younger brother to get his ADHD medication changed. Both AJ and his mom state that his teachers are complaining about him not completing tasks, losing focus and his inability to remain still in his seat. AJ doesn't have an IEP (individualized education plan) and gets no classroom accomodations, such as small group sessions, additional testing time or tutoring. AJ's mother confesses that she doesn't have a problem with him at home. AJ participates in band on Saturday mornings. His band instructor says AJ is a great student and exhibits no behavioral problems.  AJ's is currently taking Vyvanse 20mg every morning. What do you do for AJ and his mom?


Response:
First of all, not every child that moves around in his seat and doesn't complete tasks has ADHD. If that's the case, my entire 1st grade class had it.  Sometimes, I know a lot of teachers won't admit this but sometimes children are bored and probably aren't being challenged to their full potential.

Nonetheless, appropriately diagnosed children with ADHD don't always need medications (some absolutely do) but rather an individualized plan that caters to their academic needs. My preceptor gave me and AJ's mom some really good information regarding ADHD.  Children with ADHD are very creative. They love the arts, they love being imaginative and portraying fictional characters and events. Health care providers must partner with teachers and parents to tap into their creativity and focus less on medicinal remedies. Relying on drugs to correct ADHD directly correlates with drug-seeking behaviors seen later in adulthood.

We are going against everything we spent 20 years teaching children on afterschool programs:
JUST SAY NO TO DRUGS!!