RE: Re: Too incredible to be believed

[Guest guest]

and Aliceann,

Would you be so kind as to explain what kindling effect is.

Thanks,

Re: Re: Too incredible to be believed

Aliceann,

I have a five year old son who is diagnosed with Pediatric Bipolar

Disorder and takes Resperidal. I can't tell you how much it pains me to

Give him this medicine every day. The worse side effect is that it

Makes him groggy.

While I am sure there is a lot of misguided prescribing going on, there

Are, too, legitimate, loving/caring reasons for medicating children.

Kirk

[Guest guest]

Aliceann:

I like your reference to the use of appropriate medications to avoid kindling certain neurologic syndromes. You could use the same thinking, however, in regard to attentional disorders. It has been my experience, as a psychiatrist, that "stimulants" when appropriately prescribed, help avoid the kindling of genuine ADD/ADHD conditions. With these kids, the increased blood flow to the frontal lobes and the improved efficiency of neurophysiologic functioning in those areas actually has a calming effect because of improved executive and affectregulation/expression/interpretation--thus avoiding the kindling effect of non-treatment! Which says nothing about or against the therapeutic benefits of NF for these conditions, of course.

Denver

Reply-To: braintrainer To: <braintrainer >Subject: Re: Re: Too incredible to be believedDate: Wed, 7 Feb 2007 13:14:17 -0700 (Mountain Standard Time)

Kirk, I do not take issue with stepwise, informed options such as for yourson. I take serious issue with the wholesale buy-in of symptom clustersbeing railroaded toward serious mental illness diagnoses and "patient"identification by schools and the public. I work with a 6 year old withseizure history and PDD probable Aspergers who it took me 3 years to getthe neurologist to re-look at subclinical temporal/rage type seizureactivity in spite of compelling behavioral evidence to the contrary, justbecause he was "already on tegretol so that's not likely" It was not onlylikely but accurate as it turned out and his seizure medication was adjusted..why did he have to suffer from a practitioner's arrogant assumptions inspite of parents' and therapist's accurate behavioral descriptions?Hypersensitive kids especially are vulnerable to the diagnostic firepitbecause of the exact symptom pictures you describe. Your son as youexperience is living with mood dysregulation, and the Risperdal may bepreventing not only kindling but neuro-organic damage that could be hard toeradicate. I do not argue the wisdom of that.I just wonder in general when the heck are we going to back off of theheadlong rush toward "Bipolar" and "ADD" and simply define mooddysregulation and add specifiers to the type. We would still have viableoptions for treatment plus awareness that hypesensitive children have aninteresting gap between sensory and cognitive brilliance (in a technicalsense) and modulating/integrating inexperience and fewer developed pathwaysbecause of lack of living experience and developmental stage. Sometimes, ifsleep can be improved and sensory exposure protected and muffled a bit,simply allowing development to catch up will achieve emotional resiliencethat medications cannot. I like risperdal well enough in pediatric use for intolerable emotionalintensity and inconsolable distress. I'm not too keen on its propensity forhormonal effects as I don't think galactorrhea is a desirable thing tohappen outside of nursing mothers. The soporific effect does notnecessarily mean the distress is less, although hopefully it is. It doesallow for improved appearance of sleep, although sleep stage patterns maybelie what appears to be the case.Please understand, my rant here is not for the wise and loving folks likeyourself who observe, triage, allow for all possible options then choosemedications appropriate for the condition. I am talking about schoolsbringing parents to court and pushing for removal of children from parentalcare because they will not lockstep put their children on medications. Wewon't even get into the effect of the stimulants as priming the pump andkindling for methamphetamine addiction within late latency and early teenyears. When the educational system emerges from its 30-40 years of intentionalignorance perhaps it will be possible to return to education with classsizes not more than 8-12 students, study groups rather than grades,experiential learning including community apprenticeships and integrationwith academics, and making use of multi-age larger group settings forsocialization and larger group activities. Heaven forbid, that sounds anawful lot like Special Ed doesn't it? If we provide such positive learningfor children in special education settings, perhaps it is time to learn fromtheir wisdom rather than to set them aside as the aberrant ones?Best regards,Aliceann-- Re: Re: Too incredible to be believed Aliceann, I have a five year old son who is diagnosed with Pediatric Bipolar Disorder and takes Resperidal. I can't tell you how much it pains me to Give him this medicine every day. The worse side effect is that it Makes him groggy. While I am sure there is a lot of misguided prescribing going on, there Are, too, legitimate, loving/caring reasons for medicating children. Kirk

[Guest guest]

Hi ,

I agree that there are instances where appropriate and appropriately

monitored stimulant medications are a very good preventive against the

kindling effect of embedded ADD and the loss of self-worth and positive

relationships specifically due not only to frontal lobe/executive

functioning improvement but also the entire RAS/TAS pathway wake-up. That

said, my concern is not for psychiatrists such as yourself who can and do

discern the children with ADD/ADHD but for the wholesale prescribing of

these due to school pressure for what are seen as the ADD condition which, 9

times out of 10, is actually related to intense anxiety, coping with family

violence and abuse or coping with peer abuse and threats. The teasing out

of symptoms and context is an art form as I am sure you know. Unfortunately

we live in a society currently of " lumpers " not " splitters " which permeates

lay perspectives on everything, especially children's mental health.

I love assessment and diagnostics and find nothing more fun (oh please let

my patients not think I play at work) than following the taxonomic threads

and cultural contexts of mental health and health conditions. Unfortunately

the path with children and adults these days remains in the bucket of " give

me drugs and lots more if those don't work " The drug addiction kindling

worries me a lot, as the kids will seek out meth and coke before they are

teens in order to feel good as often as possible in a world where

concentration is of little value. In addition, too many teens are playing

with Ritalin, Adderall and all similar meds for the highs and to sell them.

If this is commonplace here in frontier Montana....well then it is a norm in

other parts of the country.

Neurofeedback and biofeedback are of great value in my clinical practice as

are appropriate medications to relieve symptom intensity and promote role

functioning restoration. However, being somewhat ancient, I also have the

advantage of having applied the same techniques with LD students in private

schools by having them draw alphabet letters in a riding ring on their

horses, and figuring out right and left while steering 1000 pounds of

soporific equine. That too woke up the sensory-integration, executive and

proprioceptive aspects of the brain and body. So it is always possible to

achieve change, and if the medications may be misapplied or misused, then

anything else if preferable in my experience.

Thanks,

Aliceann

-- Re: Re: Too incredible to be believed

Aliceann:

I like your reference to the use of appropriate medications to avoid

kindling certain neurologic syndromes. You could use the same thinking,

however, in regard to attentional disorders. It has been my experience, as a

psychiatrist, that " stimulants " when appropriately prescribed, help avoid

the kindling of genuine ADD/ADHD conditions. With these kids, the increased

blood flow to the frontal lobes and the improved efficiency of

neurophysiologic functioning in those areas actually has a calming effect

because of improved executive and

affectregulation/expression/interpretation--thus avoiding the kindling

effect of non-treatment! Which says nothing about or against the therapeutic

benefits of NF for these conditions, of course.

Denver

[Guest guest]

Very nicely put, Aliceann.

I think the problem many therapists, especially us psychiatrists, run into is responding to pressure from teachers who have a disruptive child in their class and want something done about it yesterday. In recent years, they have, somehow, increasingly been given the "power" and, presumably, the training to diagnose and prescribe treatment modalities. I've run into this many times, "My child won't be allowed back in the class until he's on (you name the medication) for (Bipolar Disorder or ADHD or whatever)." Teachers pressure the parents, and parents pressure the psychiatrist; and, to the extent we give into this kind of thing, we re-inforce the presumptions that underlie these incredible statements. If I say, "Let's try to figure this out first and see if we can find a way to avoid medications, most parents will take their child to the doctor who will give them what they want. When all is said and done, we end up abdicating to the professional with the least amount of training and expertise instead of the most! Sad, isn't it?

30 years ago a patient would walk into my office and say, "You're not gonna make me take any medication for this, are you?" Today, it's, "You're gonna be able to give me some medicine for this, aren't you?" Heaven forbid it might take some time; worse yet, work on their part!

Nice talking with you,

Reply-To: braintrainer To: <braintrainer >Subject: Re: Re: Too incredible to be believedDate: Thu, 8 Feb 2007 23:20:50 -0700 (Mountain Standard Time)

Hi ,I agree that there are instances where appropriate and appropriatelymonitored stimulant medications are a very good preventive against thekindling effect of embedded ADD and the loss of self-worth and positiverelationships specifically due not only to frontal lobe/executivefunctioning improvement but also the entire RAS/TAS pathway wake-up. Thatsaid, my concern is not for psychiatrists such as yourself who can and dodiscern the children with ADD/ADHD but for the wholesale prescribing ofthese due to school pressure for what are seen as the ADD condition which, 9times out of 10, is actually related to intense anxiety, coping with familyviolence and abuse or coping with peer abuse and threats. The teasing outof symptoms and context is an art form as I am sure you know. Unfortunatelywe live in a society currently of "lumpers" not "splitters" which permeateslay perspectives on everything, especially children's mental health.I love assessment and diagnostics and find nothing more fun (oh please letmy patients not think I play at work) than following the taxonomic threadsand cultural contexts of mental health and health conditions. Unfortunatelythe path with children and adults these days remains in the bucket of "giveme drugs and lots more if those don't work" The drug addiction kindlingworries me a lot, as the kids will seek out meth and coke before they areteens in order to feel good as often as possible in a world whereconcentration is of little value. In addition, too many teens are playingwith Ritalin, Adderall and all similar meds for the highs and to sell them. If this is commonplace here in frontier Montana....well then it is a norm inother parts of the country.Neurofeedback and biofeedback are of great value in my clinical practice asare appropriate medications to relieve symptom intensity and promote rolefunctioning restoration. However, being somewhat ancient, I also have theadvantage of having applied the same techniques with LD students in privateschools by having them draw alphabet letters in a riding ring on theirhorses, and figuring out right and left while steering 1000 pounds ofsoporific equine. That too woke up the sensory-integration, executive andproprioceptive aspects of the brain and body. So it is always possible toachieve change, and if the medications may be misapplied or misused, thenanything else if preferable in my experience.Thanks,Aliceann-- Re: Re: Too incredible to be believed Aliceann: I like your reference to the use of appropriate medications to avoidkindling certain neurologic syndromes. You could use the same thinking,however, in regard to attentional disorders. It has been my experience, as apsychiatrist, that "stimulants" when appropriately prescribed, help avoidthe kindling of genuine ADD/ADHD conditions. With these kids, the increasedblood flow to the frontal lobes and the improved efficiency ofneurophysiologic functioning in those areas actually has a calming effectbecause of improved executive andaffectregulation/expression/interpretation--thus avoiding the kindlingeffect of non-treatment! Which says nothing about or against the therapeuticbenefits of NF for these conditions, of course. Denver

[Guest guest]

-- RE: Re: Too incredible to be believed

Wow! Did I ever kindle a response! That was fun to read. You should write a

book: You write so beautifully, with grace and intensity--quite a

combination. Thank you,

Thank you for the compliment . Writing is a love of mine. In some

nearby year I hope to transition from the demands of progress notes,

assessments and court reports to full time college teaching and a return to

a book I started some years ago entitled Crazy is as Crazy Does.

This discussion has been great fun, and, I hope for the tattered parents who

do face too much pressure from teachers and occasionally from medical

prescribers, has provided some introduction to the inner world of how some

of us continue to struggle with the same dilemmas and to listen to our

patients and their families.

Best regards all,

Aliceann

[Guest guest]

Aliceann;

I, too, have, enjoyd the exchange, found it helpful, and hope some others did as well.

My very best to you,

Reply-To: braintrainer To: <braintrainer >Subject: RE: Re: Too incredible to be believedDate: Sat, 10 Feb 2007 23:36:52 -0700 (Mountain Standard Time)

-- RE: Re: Too incredible to be believed Wow! Did I ever kindle a response! That was fun to read. You should write abook: You write so beautifully, with grace and intensity--quite acombination. Thank you, Thank you for the compliment . Writing is a love of mine. In somenearby year I hope to transition from the demands of progress notes,assessments and court reports to full time college teaching and a return toa book I started some years ago entitled Crazy is as Crazy Does.This discussion has been great fun, and, I hope for the tattered parents whodo face too much pressure from teachers and occasionally from medicalprescribers, has provided some introduction to the inner world of how someof us continue to struggle with the same dilemmas and to listen to ourpatients and their families. Best regards all,Aliceann