I recently received a call from a mother that made me both want to cry and scream out in frustration.
Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family to address both his behavior problems and the effects of his early trauma, then did not follow through. Whether it was lack of access to care, a wish not to deal with the problem, logistical difficulties, or some combination of these I do not know.
Then when he was in first grade, psychological testing revealed a likely diagnosis of ADHD and it was recommended that the parents consult with their pediatrician to consider a medication trial. His mother called me to set up an appointment. That was when I wrote the blog post.
I also returned his mother’s phone call, but she again did not follow through, and I did not hear from her again until last week, nearly three months later. She left me a message saying that things were much worse and she wanted to see me right away to put her son on ADHD medication.
When I finally was able to speak with her today, she shared with me a story of a child clearly out of control. Her son had run away from teachers several times. He often crawled under his desk and curled up on the floor during class. He was disruptive and at times totally unapproachable. His mother again repeated her wish to see me right away so that I could prescribe medication for his ADHD because “they want to put him in a class for emotionally disturbed children.”
My inclination was to stare at the phone in disbelief. How is it that this mother, a reasonable person, could expect that a pediatrician could effectively treat this problem simply by prescribing a pill? Clearly she was supported in this idea by the school. In fact our culture as a whole tends to disregard the impact of early trauma on development and relies heavily on medication to treat children once they reach an age when they are a problem in the school setting.
I explained to her that I was leaving the practice in a few weeks but that in any case, I felt that given the severity of the problem her son needed to have a comprehensive psychiatric evaluation, and, as I had recommended 3 years earlier, the whole family would need intensive help to manage this very challenging situation.
With Medicaid as the child’s insurance, their only option was the local mental health clinic. I knew that the wait for a visit with a psychiatrist could be as long as three months, and a wait for a therapist could be almost as long. I worried for the boy’s safety. I told her about the crisis team, and explained that if at any time she felt the situation was unsafe, she call that number and they would be seen right away.
This exchange left me with a feeling of despair. It is imperative that our culture as a whole recognize the value of early parent-child relationships in promoting healthy emotional development and the importance of early intervention when things go wrong. With powerful medications to fall back on when children reach an age that they are a trouble to society, as was the case with this little boy, there may be little incentive to provide or obtain meaningful help.
Claudia M. Gold is a pediatrician who blogs at Child in Mind.
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