Yesternow

February 6, 2009 · 3 comments

Miles came home with his report card today. He’s continuing to make excellent progress,  a trend that started last year.

What changed a year ago was our realization that Miles needed help in dealing with anxiety. He’s a very smart boy (yes, all parents say that, but I have empirical data), but he would get frustrated if he didn’t understand something new immediately. He’d get worked up, saying “I can’t do this!” over and over, until a teacher would have to intervene. If the situation escalated further, he would attempt to bite and hit the person trying to calm him down. Clearly, something needed to be done.

About two years ago we were at a birthday party for Joe, one of Miles’ old preschool buddies. Joe had been a disruptive, agitated kid, but when we saw him that day he ws calm and friendly – almost a different person. When we remarked on that to his mom, she told us the Joe had said to her “Mom, I can’t control myself.” Shortly after that, Joe started taking Ritalin, which resulted in his complete turnaround in school and at home.

Joe’s mom also pointed out the other kids at the party who were on Ritalin – everyone except one boy and Miles. It seemed to me that some parents had to be taking the easy way out, or caving in to school-suggested medication. The other boy not on Ritalin was on Risperidone and suffering from one of the side effects – serious weight gain.

All of this was fresh in my mind when we took Miles in for a psychological evaluation in the summer of 2007. We were informed that if we could “take the edge” off Miles’ anxiety about new topics, he might be able to work past it and do his schoolwork. I expressed my aversion to using a hammer like Ritalin when something more subtle might work, so that fall we started him on the lowest possible dose of citalopram, an antianxiety medication. We started to see results within a month: teachers were able to redirect him without him getting upset,  he seemed to have a longer fuse.

I watched him like a hawk for those first few weeks, looking for any manifestations of the drug’s side effects. We gave him his dose at bedtime to avoid any daytime drowsiness, but saw no other problems, a status confirmed by our pediatrician.

After a few months, however, Miles’ teachers reported that he had a hard time focusing on his work; his attention was always drifting. It seemed that by attenuating the anxiety we had unmasked an attention issue. Another consutation resulted in another pharmaceutical solution, this time for the lowest dose of atomoxetine, one of the ADD medications. That dose was administered in the morning to avoid any increase in his activity interfering with his sleep.

And, wouldn’t you know it, he’s fine. He’s a happy kid who looks forward to going to school (but still schemes to avoid homework). Once he asked me why he had to take two different medicines. I explained that both drugs would help him stay calm and pay attention so he could make good choices both at school and at home. I was careful to explain that the medicine didn’t make him “better,” but that it helped him become “unstuck.” We both like that explanation.

Here’s Miles demonstrating for us how he behaved before and after he started on his meds:

BeforeAfter

I’m looking forward to a few more years of good report cards. I know things might change with adolescence, but it will just be another challenge to meet.

3 comments

Bryan February 12, 2009 at 7:00 pm

“he would get frustrated if he didn’t understand something new immediately. He’d get worked up, saying “I can’t do this!” over and over”

I know that feeling. Had it most of the time I was in engineering school.

“Joe’s mom also pointed out the other kids at the party who were on Ritalin – everyone except one boy and Miles.”

Yeesh. There’s no way every kid really needs to be medicated. I mean, it’s normal for kids to sometimes have attention problems, to act out a little, etc. I mean, they’re kids. Their brains are still growing, they literally don’t have all the control mechanisms in place. Are the drugs really for the kids’ benefit, or the parents? I mean, it sounds like you’re taking a very cautious approach with Miles, which means you can see what is really helping him and what isn’t, but I certainly get the impression that a lot of parents aren’t really that careful, and take advice in the wrong places (hence, the anti-vaccinationists, etc.).

David February 12, 2009 at 8:13 pm

A significant number of the kids I saw had single parents, making it hard to discount the convenience factor. On the other hand, if your child asks for help, and is self-aware enough to know he has a behavioral problem, then by all means you should have him evaluated.

Fortunately for us, Miles is evaluated regularly by the same team that made his original diagnosis, and his pediatrician has been involved from the beginning, so there is a large body of behavioral information to use as a baseline preceding any pharmaceutical intervention.

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