Ask A Specialist
Dr. Kay Browne, M.D., FAAP
(Fellow American Academy of Pediatrics)
Behavioral Pediatrician
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Question: Dear Doctor, I am Director of Special Education for our local high school district. I know that you have written about teens and onset of mental illness before at this web site. Recently I have been hearing about “TAY” programs for late teens and early adulthood youth with mental illness. I know that some of our counties here in California are starting such programs and would like to know what they provide and if we should think about having such a program in our district. Curious |
Question: Hello, I know that the incidence of depression in teens is quite high and that the percentage getting treatment is low. I have also found that, in my work, parents know little about depression and signs that their children may be having difficulty. I look forward to your response. Judy |
Question: Please help we have a 9 year old son who has had anxiety and anger problems since around the age of 2, we have been to see someone twice now to have him tested for autistic disorders, the first time he was very young too young for a diagnosis and although they did say he was extremely anxious they didn’t think it was autism. At school, he is very different he is very quiet, shy and well-behaved, so getting school to understand what he is like at home is very difficult because at home he is comfortable enough to show how he feels, so if anything upsets him at school he brings it home. The latest doctor we have seen with him agreed his levels of anxiety were not normal for a 9-year-old boy and felt at first that his anger was a result of his anxiety. She had been really helpful and understanding .The last time we went a fortnight ago she was explaining punishing him too much would not help, as he maybe did not understand his own feelings. She was also going to write to his school as I was concerned they didn’t understand that we needed to quite often go into school because he gets too upset to go in and say things himself i.e. over his schoolwork which is already a little behind. She has done quite a few tests and although he has shown he is below his average age group in something’s he isn’t in others, which pushes them towards thinking he is anxious rather than having any kind of autistic disorder, but we have gone back to see her today as we are really concerned he is getting angry at everything and everyone to the point he is punching walls, and her attitude seems to have changed and she seems to have contradicted herself. Her answers today were yes he is a bit anxious but there is nothing she can do for him, we are feeding his anxiety by trying to talk to him about how he feels, he has to learn life does not always go how he expects, and he is controlling our house and us. We really don’t know where this change of opinion came from unless she has spoken to his school, who obviously don’t see him as a problem because he sits quietly away from everyone but we feel really disappointed and let down by her reaction. We just wanted to know if anyone could advise where we go from here as she was our last hope for help before he reaches senior school and now we are back to the same question we were when he was 2 years old what is wrong with our son because although no parent is provided with a text book, yes we make mistakes we wouldn’t consider ourselves bad parents neither would we say we spoil our kids we are just average parents that are worried about our son and his future. Laurie and Dez |
Question: I am an experienced special day class teacher. My class covers first through third grades. I have had children with seizures in my classes before but this fall there is a new student with a significant “mixed” seizure disorder in my class. I want to make sure that I have gotten the information I need in order to do my best with this student. Can you help? Worried teacher |
Question: I am in the process of implementing my recommendations for my PDD son who will be entering the high school this fall. He has within the last few months been getting in trouble at school for not being able to control his anger. He has had detention for being overheard swearing with talking to his classmates and also talking back to teachers when reprimanded. Most of his behavior is due to being on growth hormones in conjunction with puberty. A lot of testosterone. He is getting detentions for this behavior that he finds difficult to control and partially medical per his neurologist. My question is that I want a safe place for my son to cool down so as to not get in trouble with outbursts. How do I word this into an IEP to get my point across. It is affecting his self esteem and I think if he had a place to just cool down when he feels overwhelmed it would help. Thanks so much for your help. |
Question: Hello, My daughter is currently a junior in high school. She has been an excellent student until last year when her grades began dropping and she seemed to withdraw from contact with her friends and even from extracurricular activities. The guidance counselor at school called me after talking with my daughter and suggested that my daughter was depressed and would benefit from counseling. Apparently, the stressors of sophomore and junior years in high school are heavy for those students planning to go ahead to college. My daughter has been seeing a psychologist for about 6 months and antidepressant medication has been recommended. I have been researching these medications on the web and talking with professional friends. It worries me that there has been an increased risk of suicide reported with the more commonly used antidepressants. My daughter is willing to take medication and has a good relationship with her psychologist, but I am feeling that I need to know more about the risks associated with such treatment. Can you help us? Thank you, |
Question: I teach SH students at a middle school. One of my students has cerebral palsy and globally functioning academically between K and 2nd grade. APE is about 6 years and delayed in speech (13 year old student). However his WISC indicated average to low average intelligence. He has not made academic progress for several years and continues to function at 2nd grade now for the last 4-5 years. He is certified OI and Speech and Language. It doesn’t add up. What to do? Sharon Eilts |
Question: Dear Dr. Browne, My co-worker has a 7-year-old son who has already been retained once in kindergarten, and now the school says he has not learned enough to proceed to first grade next year. The school psychologist has advised my friend that she should take her son to a doctor to have him evaluated for possible petit-mal seizures. The classroom teacher has also suggested that the boy may have ADHD, or even be autistic. Does the school have any further responsibility for evaluating the cause of the boy's problems? My friend wants to do the right thing for her son, but she is also worried about how much she will have to pay for all the suggested testing. What would you tell the mother to do? Sincerely, A concerned friend |
Question: Hi! I am the father of a 7-year-old boy. He has always been very inattentive and active. His teacher suggested that I ask his pediatrician about possible Attention Deficit Disorder. We went, my son had a physical exam and we filled out a variety of forms with questions and our doctor is now recommending that our son take medication to help him concentrate. Our doctor also talked with the teacher. I am worried about using these. I have read on the Internet that we are using too many medications in children and this can lead to problems later on. We have some family history of mental illness, which also worries me. How do you tell what medications are good and which are bad? How do you know what the right dose is? I do trust our pediatrician but this whole topic seems to be very controversial. Could you help us? Confused in California |
Question: I am a young single mom. My baby is 2 ½ and so far has been wonderful. I go to college and leave him at day care when I am attending classes. My family lives a long way away though we frequently talk on the phone and by email. I take my son to the health clinic for his shots and physical exams. I have been realizing recently that I do not know enough about normal child development and behavior. I want to be the best mother that I can be and wonder if you, as a developmental and behavioral pediatrician can recommend a good book that I, as a parent, can use as a reference for normal child development and behavior. Dr. Spock’s book was recommended to me but the information seems to be outdated, at least in the copy that I have. I would very much appreciate any resource that you could give me. Young mom |
Question: Dear Dr.Browne In the beginning of the school year, a middle school student, medically excused from participating in physical education when an onset of pain occurred. Instead, the child was allowed to walk when pain was reported, but would experience teasing from peers. The teacher, also prevented the child from attending recess when pain was reported. The child discontinued informing the teacher of pain. The child received a failing grade due to inadequate participatory efforts in certain sports that caused the child's increased pain. The child was then prevented from participation in physical education for a short period of time. The teacher informed the child that every day the child did not particpate in physical education, in the long run, the child's grade would be affected. The child reported this to his doctors. Doctors have received similar reports by other children and their families regarding these concerns. Upon new findings, the child is now restricted from pariticipating in physical education for the remainder of the school year and is prescribed therapy specific to weight loss, strengthening, weight reduction, at a local gym. The child is now assigned sports-related research papers, by the teacher, in the duration of the physical education class The child is now experiencing increased stress as these extra written assigments are felt a punishment for not being able to physically participate in this class. The parents are not agreeable to these written assignments, either. My question is, first, should children be given written assinments in the duration of their physical education class, though they are medically orevented from participating in physical education, can you suggest alternatives? Secondly, if a child's symptomatologies impeded upon their participatory effort in physical education affecting their grade, would it be in nhe child's best interest to change the grade or is this a possibility? Thank you for help and time. Erica Sonnier |
Question: This question was forward from Shari due to the medical implications. Shari Our 7 year old son was diagnosed with PDD-NOS at the age of 3 1/2. We were making positive strides in our home program combined with his public schooling IEP. Unfortunately our son's attention is progressively getting worse and his energy level continues to increase (ADHD). That being said, we are struggling to make gains with both programs. We have done two trials of Celexa and two trials of Risperdal without any success with the hopes that treating his anxiety would improve his attention. In fact while trying the Risperdal it appeared that he was having a diabetic type of reaction -- increased thirst and urination. What is the normal treatment protocol for treating ADHD in children on the spectrum? Our son has such a great personality but really lacks the ability to focus. We are so fearful of losing his sparkly personality with medication yet we know that if we don't address the poor attention he will continue to fall behind and the gap will get much wider. Can you please give us some direction and hope? We love this little guy so very much and want to help him move along the spectrum without losing his free spirit. Thanks and I look forward to a reply ~ Mom with tears... |
Question: My grandson was diagnoses with ADHD when he was five. His mother started him on Ritalin at that time. By eight he was contemplating ways to get rid of himself, fearing no one loved him. I brought him out here worked with him seven days a week trying to get him to see how much we all love him, care about him and want him to show people that he is a smart and loveable child. I kept him on the Ritalin , up until it was too unbearable for him (school pressures from fellow students calling him dummy and a number of unpleasant names) to go in the afternoon to take his pill. I request the doctor change him to Concerta which only required 1 pill in the morning. I also had him talk with the school psychologist, but he lost trust in her. The contract was, whatever they discussed was not to be shared with anyone and she was to help him resolve issues without disclosing his name. This did not happen and he stopped talking to her and asked not to go, because of what she'd done. The Concerta worked up until Junior High , then his appetite was completely gone and he had trouble sleeping. I had to threaten him eat daily. So, I stopped the Concerta and his appetite returned and he was able to sleep. I can only say he did fairly well in school. From the 8th grade until now, his behavior is starting to drastically change. This year his older sister was diagnosed with cancer, this hit the whole family pretty bad. He was the only natural sibling for transplant, but unfortunately was not a perfect match. From that point, he seemed to give up trying in school and he barely graduated Junior High. Now he's a freshman, telling lies, clowning in class, not focusing during lectures and the list goes on. Should I start him back on Concerta or seek another medication along with some weekly counseling? Can I get teen counseling for him in Fremont? Is it very expensive? What about this ADDERALL XR? Any information would be appreciated. Thank you, Donna Neal |
Question: I am currently working with a student diagnosed with White Matter Disease. Very little information is available on this condition, and I cannot find any information about what educational strategies may be effective to help a child with this condition. First, in layman's terms can you give an explanation of White Matter Disease. What is it and how does it affect a child. Second, can you provide any guidance to help the educational staff to know what accomodations and modifications may be helpful. For example, what learning challenges might this disease create, how should information be presented, and what demands should be avoided? Thank you for your help |
Question: Hi, I am the mother of a 16-year-old girl who has had significant difficulties with depression over the last year. We have a family history of depressive symptoms. Her symptoms started when her boyfriend moved away and he did not keep in contact with her. She has become progressively more withdrawn and her grades have dropped. Her therapist thinks that we should consider treating her with antidepressants but I am worried because of all of the new saying that the antidepressants can cause suicidal thoughts and suicide itself. Am I wrong to have these concerns? Worried mother of depressed teen. |
Question: Dear Shari, My 5-yr. old son is a firstborn, perfectly healthy, always happy, no developmental or physical problems until about 2 1/2 years ago. My son was diagnosed with ADHD over a year ago and has since been on a medication called Focalin. He started at 2.5 mg twice a day and is now up to 7.5 mg twice a day. Since the very beginning, I have been dead-set against medicating my son; I'd much rather deal with the difficult behavior than give him medication. I still feel that way, I carry a great deal of guilt and shame and I can't keep away from all the research and articles about ADHD and the medications; I am obsessed with all the information and the more I read up on it, the more I want to stop his med's. His Psychologist is a wonderful, intelligent and caring woman. She thoroughly evaluated and tested him over several hours, she talked with him, they told each other stories, they drew pictures together, she performed various activities, puzzles and stretches with him and I honestly feel she diagnosed him accordingly. But, I have noticed as many cons as there have been pros and every situation that comes up, I can't help but ask myself if this would have been as prevalent if he weren't on his med's. For example, before the medication, my son had a great healthy appetite and now sometimes I have to force feed him. His eating habits have been one of the most discouraging side effects and I worry that his medication may be affecting his height & his weight. Also, he has been having awful nightmares that wake him from his sleep screaming and crying uncontrollably until you physically shake him and wake him from his sleep. He also has been wetting the bed quite often. He is fully potty trained and has been for years now, but at night; he still has a problem. The pros with the med's is that he is able to concentrate and focus and follow through in class and it shows in his schoolwork, such neatness and clarity. He can sit still and listen to directions, he is calm and not impulsive, he understands and really thinks things through. He is extremely sensitive and emotional, he has been through soo much in his first few years of life. I am strongly considering taking him off his meds and keeping him at home with me. I love him soo much and I feel like I'm hurting him. I want, I feel like I need to take him to the best specialist out there and get another opinion; see if I'm doing the right thing for him. I would greatly welcome and appreciate any feedback you may have for me. Needing some reassurance, Laura Palada |
Question: I am a special education district director. I have been noticing that more and more teenagers are being diagnosed with depression, particularly those in special education. I have also noticed that some of our students are depressed but they are not getting any mental health treatment. We even had a junior commit suicide this January. He had not received any treatment either. Is this something that is being addressed in other communities? Worried |
Question: Considering all implications, treatment and conditions involved, which is worse, suffering from a neurosis or a psychosis? |
Question: Third of 3 part series Why has the prescribing, type of medication and liberal use of medication including multiple medications at the same time become so widespread? |
Question: Second of 3 part series Why have the diagnosis and range of childhood psychiatric disorders changed so very much over the last several decades? |
Question: Dear Doctor, I have been a special educator for 30 years. I have a 2 nd and 3 rd grade special day class that includes children with disorders of language. Many of the children, through the years, have moderately severe behavioral disorders. I have noticed over the last 20 years that more and more children have psychiatric diagnoses, including such as Bipolar Disorder, ADHD or Asperger’s Syndrome. I have several children in my current classroom who are on two or three different medications and still having behavioral difficulties. Sometimes I wonder if the medications are causing more problems instead of improving behaviors. I have one child in my class now that has gained 20 lbs and is eating all the time. Is this only happening in our area? What has caused this shift to using many medications? It seemed, 20 years ago, that the only medications really being used were stimulant medications for Attention Deficit Disorder. What do you think? |
Question: Dear Doctor, I have a 3-year-old son that I am very worried about. He has been having more trouble paying attention at the level of his preschool friends. He sleeps poorly at night and snores. His breathing seems irregular. He often seems tired during the day. He does not seem to be growing as much as he should recently. I have talked with his pediatrician and she suggested that he might have ADD. I am reluctant to have him take medication. My sister in law is a preschool teacher, she told me that one of the children that she cares for had similar problems, and they did a "sleep apnea study" to see if he was breathing poorly during the night. She said that the test was abnormal and that he had his tonsils and adenoids out and his behavior and growth improved significantly. Could this be what is wrong with my son? If so, what should I do about it? Thank you for considering this. Concerned mom |
Question: Dear Doctor, My 18 year old son has developed paranoid thinking and seems to be hearing voices that the rest of us cannot. He is staying up all night and sleeping during the day. He leaves the house in the middle of the night and we don’t know where he is going or what he is doing. He had just started his first year of college but came home and didn’t bring all of his belongings. We took him to a psychiatrist who said that he is psychotic and may have Schizophrenia or depression. Apparently my son is not sick enough to hospitalize. He is currently refusing to take any type of medication but he will see the Psychiatrist. I've been doing some reading on anti-psychotic drugs and have run across something that concerns me. I've read that over 70% of patients that take anti-pychotic drugs develop Tardive Dyskinisia. It is a grim disorder. Can you give me any information you know on this topic, please? Concerned |
Question: Dear Dru, I have a 6 year old son, and last summer he was in a bicycle accident which caused him to fall and have to get stitches. however the doctors didnt feel that he would need a catscan or x-rays at the time just stitces. now currently in the past 5 month i have noticed a drastic change in his behavior, I have been to the doctors who say that if he is ADD he would of showed signs earlier and the teachers say he is very impulsive and wont follow directions and is distracted very easily, so on that note i have taken him to a pediatric neuorlogist and we have ran many test all coming normal except for my sons EEG it was Abnormal and my son has been put on topomax for seizures , Could you explain what kind of seizures im faced with and how serious is this. Thank you for your time , Lisa |
Question: I have a three and a half year old boy. He has a twin sister and a brother who is one year older. My concern is that he chews everything, I mean everything! He did have mild anemia which was quickly corrected over a year ago and we keep tabs on his hgb. We cannot keep, books, puzzles, paper, foam toys, wooden toys, plastic without him destroying it. He wrecks his siblings belongings also. This means there are less educational materials around the house for the other children. He is to start junior kindergarten in the fall and I am afraid they'll ask him to leave. We are at our wits end. Otherwise, he is a normal, very active pre-schooler. We have been giving him time outs which of course do not work. I am not sure that he is always conscious of what he is doing. |
Question: My daughter is 11 years old and has been on various adhd medications for the past five years. She currently is taking 72mg of Concerta and suffers from ADHD, inattentive type. We have been told that some children build a tolerance to this type of medication and it no longer works, it is her doctor's concern that she is one of those kids. She is a bright, intelligent child, and does well in school as long as her attention span is stable. What options do we have if she builds a tolerance to this medication? Thanks, Anne |
Question: I have a child in my class who is said to have Fetal Alcohol Syndrome. He is living in a foster home. I have some medically related questions about his condition.
Thanks |
Question: I have a fourth grade student that is academically doing find. He is a wonderful pianist and is very happy if he is doing something of his own choice. He has had a shunt in place since Kindgarden. His level of alertness is quite low in production of amount of work. Since he is capable of completing the work the teacher is modifying the amount of work he has to produce. However, I observe this to only decrease further the amount that he will complete in the allotted time. He is in RSP to support and his ability to complete work is not effected by incentives, rewards, choice time, visual timer, auditory timer, verbal redirection. he does do better if a task is new, novel and he is interested. he even will even forget he is playing a game of his choice and need to be called back to task. He is currently on no medications. And we send him to the office if he gets a headache. he sees his Neurosurgen for a yearly check. Julie his mom reports that both JR's brother and father have ADHD/ADD. She also reports more difficulty getting him to complete homework- no matter the amount. She is willing to try other options. Thoughts and ideas please? Regards and thanks for your time. |
Question: I have recently received a new student diagnosed with Temporal Lobe Epilepsy, who experiences both Grand Mal seizures and constant "silent" seizures. After his latest Grand Mal seizure, he lost many skills, Including his ability to dress himself. He has a very high IQ, and very supportive parents. He has relearned how to dress himself, but is experiencing great difficulty learning to read. He often experiences full memory loss in conjunction with his seizures, and it seems as if this memory loss is affecting his ability to retain both words and skills. |
Question: My 20- month- old son is in a special preschool and they have diagnosed him as having mild developmental delays in all areas but most particularly in speech and fine motor areas. His older cousin has similar delays and extreme behavioral problems. Our pediatrician has referred us to our local Regional Center. We would really like to know why he is delayed and what we can expect for him in the future. Can you help us? |
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Question: Hi, My 27-year-old son has ADHD. It has literally ruined his life and made it very difficult for his father who passed away in January at age 68. I am 63. I have this burning desire to really understand what the cause of this is. I hope I can find the answer before I pass from this world. My son was very ill at seven months of age and had diarrhea and was also vomiting. We took him to the hospital and he had to stay for a few days to be rehydrated. I just can’t help but wonder if there is a link between this dehydration and ADHD. Do you know of any ADHD kids who may have dehydrated as a young child? Also, it seems like many people diagnose ADHD very differently. We have been to many experts and they have expressed different opinions about my son’s diagnosis. It seems that ADHD is the correct diagnosis but how do I know for sure? Thank you for your help. |
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Question: I have a 4-year-old son who has been diagnosed PDD-NOS and possibly ADD by a neurologist. This has also been considered and is being considered by a Kaiser neuropsychologist. However, the diagnosis has been ruled out by the Diagnostic Center (last week). What are your criteria for ruling this out? I believe that my son has many of the PDD NOS autistic spectrum components. He is a twin and his sister, though language impaired and gross/fine motor delayed as well, share none of the social problems, behavior problems, or problems processing information that he has. I feel that he is so close, maybe borderline or on the spectrum, because of the different things he does. Would you happen to know if the state requirements and medical descriptions do not confer? Thank you, Heather |
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This month's Medical Question is shared with our Behavioral Specialist Question: Dear Dru, I am working on a behavior plan for a 13-year-old male who has been diagnosed with Septo-Optic Dysplasia (SOD). In addition to his many medical issues, this young man also has a number of behavioral concerns in the area of social skills and impulse control. The problem behaviors center around bizarre comments made by the young man, verbally and physically aggressive behaviors towards specific peers, and what appears to be self-stim behaviors (head rolling, playing with hairs on arm, rolling knuckles together, also picking nose and /or scabs on arm.) This young man has also been diagnosed as ADHD. He is currently taking Ritalin and a number of other medications (hormone replacements). How much of the behavioral issues might be due to drug interaction or improper dosage of drugs? His mother is in the process of scheduling an appointment with a psychiatrist to determine the medicine issues. Some of the information I have found online also refers to a connection between SOD and autism. Is this something to pursue? Once again, I would appreciate any help or guidance you could provide to help me help the parents and teachers, as well as the young man I have found some limited information on-line regarding his condition, but I would greatly appreciate any information you could provide, or resources you could point me to regarding Septo-Optic Dysplasia. I would appreciate any sources that could address behaviors and strategies for addressing these behaviors. Thank you, |
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Question: We have a 4th grade special ed. student who continues to soil his pants at school. Do you have a toileting program we could use for him? We have been working with this child since 1st. grade and it seems as though we start over each year. Thanks. |
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Question: Dear Expert, Could it be that the social issues (lack of understanding of other peoples feeling) & their need to control issues associated with Aspergers syndrome are being made worse by the ADHD medicine? Or could we be giving these kids too much medicine trying to curb the inattention & distractibility due to Aspergers in addition to the same due to ADHD (because there are biologically different reasons for the inattention)? I can't find out any definite information on this problem. Who would know about this? Can you help me understand? -Worried |
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Question: I have a 6 yr old child who at the age of 3 yrs was diagnosed
with ADHD and has been on 5 different medications (now on concirta 36mg)
and is still bouncing of the walls both in school and at home...It has
been bought to my attention that my son may be suffering from anxiety
more than ADHD...I have tried to research every thing I can on the subject
but still can't come to any conclusion on the issue...I should tell you
that my husband and I suffer from mental health issues...also I had a
very hard time caring my son for the nine months of pregnancy...He was
born at over 10lbs and he had to be put on a respirator at birth...(I
have type 1 diabetes)I guess what I'm asking is how do I tell if this
is ADHD or anxiety? |
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Question: I have a son who is 6 years old and was just diagnosed with ADHD. He has been having troubles in school for 2 years (paying attention, inability to sit still, impulsivity, etc) His doctor has suggested putting him on Adderall and I would like to know what kind of effect this will have on his personality. I am concerned that it will change my son and, of course, my extended family members are very much against using drug to "cure" this problem, but I am the one who has to continually hear from his teachers and see my son hurt over thinking that he is a "bad kid" because he got in trouble again in class. I know that my son is a good hearted kid, but just he is too impulsive at times. I want to do what is best for my son, but I don't know of anyone else who has had a child with ADHD. I have 4 children and he is my youngest and the only one I have this problem with so this is all new to me. I would appreciate any suggestions or comments you might have on this. |
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Dear Specialist, |
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