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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by asilydur on November 16, 2001, at 3:02:49
Hi-My son was diagnosed ADHD by a child psychiatrist
8 years ago when he was 4 1/2. He was extremely hyperactive and responded very well to ritalin.
After beginning medication his life started turning
around, he started making friends and doing well in
preschool. At some point we switched to dexadrine spansules and added paxil to help with rebound problems.
He was a straight A student all through elementary school and was accepted last year to a very good magnet
school in our city for gifted and talented students.
I had been wondering during 4th and 5th grade if his meds were working as well but his grades weren't suffering so I didn't do anything about it. He
started 6th grade at this new school and after being
off the dex all summer, it was apparant that the medications were much less effective and he has
been struggling all year. We increased the medication
to 15 mg dexadrine in the morning (from 10) and that
didn't do much so we added a 10mg spansule at lunch,
it seems to be helping a little more in the afternoon
but he is still having alot of trouble in the morning.
I am wondering if he needs to get off the paxil.
I have also been treated for ADD by this Dr. and my
experience with antidepressant/stimulant combos is that
they can work for awhile and then after awhile there are
strange side affects or you just start feeling bad.
When it gets to that point i've found that I feel better
when I get off the antidepressant. I'm at the point now
where I don't even need the AD for rebound anymore.
Anyway, my son is struggling, his counselors and teachers seem to like him and are willing to do whatever
they can to help him through this period. We all feel
its a combination problem of adjusting to middle school
and needing a medication change. My son's counselor said we would need to get a letter from his Dr. requesting an IEP and that they could do some things
to help him. Our doctor flat out refused to write a letter to the school saying our son has ADHD and requesting the iep. He says he doesn't what any information in our son's file at school "that we can't control". I really can't imagine what he is worried about. In my experience, teachers and councelors keep that info private. This Dr. has also told us not to tell his teachers he has adhd. We couldn't have had the great working partnership we've had with all of his teachers had we not been honest with them and I've never regretted telling his teachers. It seems to me that
the decision about what goes in our son's file should
be our's, not the doctor's. I feel more than a little betrayed that we've spent 8 years with this doctor and now he won't give us the support we need? He would rather see our son fail at this school rather than have a letter in his file? Can anyone give me an idea as
to how common a response this would be from a psychiatrist? I also have concerns about this
doctors knowledge of medications. I've read alot
of discussions on the two "babble" boards about the
roles of psychiatrists vs the roles of psychologists.
Our doctor can and does prescribe medication but he
seems more interested in therapy. And when something
goes wrong with a medication, he is more likely to dismiss it, or attribute it to some stress in my(or my
son's) life than deal with the fact that it is a biochemical problem. I do think I can tell the difference between an purely emotional problem and a
brain chemistry problem. When, after being on prozac
and dexedrine for a couple of years I started having
hand tremors, he dismissed it, didn't seem concerned.
I became more and more uncomfortable and finally took
myself off the prozac. Later we would try different
antidepressants that would work well for awhile then
I would start feeling bad. I would be feeling a discomfort that was not emotional (It was more like
feeling ill) the Dr. would attribute it to some stress in my life. I would eventually wean myself off the antidepresant and feel better after doing so. Now I am
not on any antidepressant and haven't been for months.
The stimulants don't seem to be working as well. My
doctors response was that maybe I shouldn't be doing
as much. I have to help support my family and I am not
doing nearly as much as I was when my kids were younger.
Giving up is not an option. He doesn't seem to get the
fact that our family is suffering financially because
of my lessened ability to produce income. Now my son
is having trouble with medications and while the doctor
is making some effort to adjust his meds, he was unconcerned when I reported an episode my son had that
clearly seemed to be a result of medications being out
of balance. He was acting very strangely and I was
was very worried. Again, it was the stress of the situation according to the doctor. My son is showing
some obsessive/compulsive tendancies and is having
problems with compulsively spitting, nail biting, etc.
The doctor doesn't seem concerned. When I talk about
his school problems he suggests that maybe the teachers aren't doing their jobs. I know enough about the school and how my friends are doing at the school, that I don't have any reason to think the teachers aren't teaching.
I am sorry this is so long but I just don't know what to do and I am very worried and frustrated. We need a doctor that knows these medications inside and out and I don't know how to go about finding one. Its not like they mention their strengths and attitudes in the yellow pages. I'm almost wondering if we need a neurologist. But do all neurologist treat ADHD? I've heard that the psychiatry dept at our state medical school is very old fashioned which might explain our doctors attitude but it also makes me think it might be difficult to find a more progressive doctor. Our doctor seems so out of it that when I asked him about Concerta several months ago
he told me it wasn't out yet, and I was seeing ads for
it in magazines and parents on an add parent forum were
writing about their experiences with it.
Thanks for listening and I would appreciate any feedback
and/or suggestions.
Posted by wendy b. on November 16, 2001, at 15:20:02
In reply to Dr. won't write IEP letter, other problems..., posted by asilydur on November 16, 2001, at 3:02:49
Dear Asilydur,
I'm sorry you have these troubles... The short answer is to find a new doctor, preferably one with a special knowledge of kids and ADD. Your current psychiatrist is not listening to your observations, and he's dismissing your suggestions. You yourself have had to go through many med trials and then discontinue them because they don't work for you for very long. A doctor with an AD/HD specialism sounds like it would be great for you to go to, as well, so that you can get something that works well for you.
I really feel for your son. I recently wrote an article for my local newspaper about how parents can help their children with AD/HD. The first way to help is: get him to a specialist. They are familiar with all the medications and the proper way to answer a parent's request for an IEP referral, which is: "Certainly I'll write a letter for you, we do it all the time." NOT the way your doc answered! This makes me soooo mad..
The IEP, for anyone unfamiliar with the lingo, stands for Individualized Education Plan. The plan allows the school and the doctor to work together, with the parents, to help the child succeed in school. The schools need to be notified by the doctor, in order to get the process rolling. The teachers who deal with your son meet with the school counselor and draw up a *written* plan (the IEP). That way they can stick to a plan and everyone is aware and notified and proactive about his schooling. Also, they can then be in compliance with section 504 of the US Federal Code, which basically states that no child will be discriminated against in public schools because of a handicap or illness, or other impairment.
The other thing you can do, and it's done here in the school system where I work and where my daughter goes to school, is to request an assessment by the school district. They have staff employed to do the testing. And then you don't have to worry about the doctor's letter.
But still, your doctor sounds very old-fashioned about a number of things. Your son's file is confidential, yes, but there is nothing you want to hide from the teachers. Covering it up, the way your doctor wants you to do, would be detrimental to the process. You want to help your child succeed in school. He has to have every opportunity possible, every avenue must be open to him, so that he can succeed. The doctor sounds a little paranoid, and too concerned with control issues. You CAN control what goes into his file, that's what you've been doing all along in trying to get him the help he needs. Of course you feel betrayed - you are right to question whether after 8 years with him, he cannot see his way clear to writing a letter for you and your son. Very unprofessional.
It just now came to me too, that you can request that a copy of your son's file be mailed to whomever you wish. That is the law. If YOU want a copy, they have to make you one, if you request that they send one to the school, his office HAS to do it. So maybe that's another way around this guy.
I know the yellow pages don't advertise doctors' strengths and attitudes, but you can get a referral from your GP, or ask the GP whom to talk to about getting a referral. Also, and I've done this so I know, you go down the list of potential doctors in the yellow pages, and you just call each one. It's a game of phone tag, but eventually you can talk to them, or go for an initial consult, and see if they sound good to you. I truly don't believe you need to see a neurologist.
Write back if you'd like, I know I didn't touch on everything, but I wanted to give you some support in your feelings about the present doctor. Good luck, and welcome to psychobabble if you've never posted before (I don't remember seeing your name...)
Best,
Wendy
>
> Hi-My son was diagnosed ADHD by a child psychiatrist
> 8 years ago when he was 4 1/2. ...
Posted by Mair on November 16, 2001, at 21:04:29
In reply to Re: Dr. won't write IEP letter, other problems... » asilydur, posted by wendy b. on November 16, 2001, at 15:20:02
Wendy's right. Confidentiality is not a doctor's call but a patient's. It's one thing for this guy to strongly recommend against making info available to a school, but i don't see how he can withhold information that you otherwise authorize him to release. Perhaps you should present him with a signed medical release form together with a written request that he provide the school with the letter they've requested.
This guy must have had some awful experiences to be taking the stand that he is, but if his approach has validity it certainly doesn't sound like he's explaining it to you very well at all.
Mair
Posted by LyndaK on November 16, 2001, at 22:04:10
In reply to Re: Dr. won't write IEP letter, other problems..., posted by Mair on November 16, 2001, at 21:04:29
I totally agree with Wendy. I'm a therapist who works with disabled children and I attend IEP meetings on a regular basis. Your forthright approach of working with your son's teachers is to be commended, not discouraged. Although it's difficult to leave a doctor who is familiar with you/your son's history and who has been helpful to you in the past, it doesn't sound like he's being very helpful right now. You might want to start by being up-front with him, BUT I also agree with Wendy's suggestion to find a specialist who works with ADHD.
Best wishes to you as you search for the help that you and your son need.
Take Care,
Lynda
Posted by susan C on November 17, 2001, at 12:35:57
In reply to Re: Dr. won't write IEP letter, other problems..., posted by LyndaK on November 16, 2001, at 22:04:10
hi, my boy, now 18, was made a 'focus of concern' in a letter written by me to the principal when he was in first grade, he was obviously intelligent, but just could not get the alphabet or reading...the teachers recommended it. By the second grade (it did take a whle-though with in the time required by law) we had a meeting of the special ed teacher, the school psychologist, the teacher and parents. They discussed the results of all the tests and evaluations and prepared an IEP. This was updated regularly by the SE teacher. Though he was not like the 'ususal SE student' the process' goal was to preserve is self image until he catching up...which was about 4 or 5th grade. He did, and started doing very well (with coping skills for spelling). The public school did an excellent job. In middle school he decided he wanted to go to an independent selfdirected private school, and spent the next three years studying at home. He is now a Junior at the local University getting ready to leave for a year language study in Japan.
Tho, he isn't ADHD as your son is, the public school did an Excellent job of identifying and planing and doing exactly what they said they would do.
I too, encourage you to hunt for another doctor. Especially one who has a focus on your son's and your needs. I had to change pdocs, and found those that specialize know right away if they can help you or not, and can tell you who else to consider...
a real telling point with my previous pdoc is when i asked him if i should go get a second opinion and he po-poed it...i should never have asked...
go for it.
sixth seventh eighth grade is pure hell for some.mouse with a piece of chalk
susan C
Posted by Noa on November 18, 2001, at 12:24:31
In reply to Dr. won't write IEP letter, other problems..., posted by asilydur on November 16, 2001, at 3:02:49
I think it is fairly common for kids with ADHD to do well through elementary and then start to unravel in middle school because middle school makes so many more demands on them in terms of attention and organization, etc.
I also think you are right that the school will keep the special ed info in a confidential folder, separate from regular school records. You could ask them to write a letter to your doctor explaining their privacy procedures, etc.
You might want to consult with another doctor for a second opinion, first of all regarding the medications, but also to see if there is a doctor who is willing to work WITH the school.
JMHO.
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