Thursday, March 25, 2010

When the treatment didn’t work.

By R. Scott Benson, M.D.

Once I realized how depressed his mother was I understood why the treatment for her son’s behavior problems had not worked. And there was nothing new about this scenario.

A study of the treatments for ADHD found that for most children the treatments were very effective – improvements in academic performance, peer and family relationship, and self-image. But in the group of children who did not get better, when the treatment didn’t work, there were high rates of depression in mothers.

The impact of depression on parents and parenting was the focus of a study from the National Research Council and the Institute of Medicine. Their report, Depression in Parents, Parenting, and Children, is available on-line. 7.5 million parents are affected with depression each year but fewer than a third receive any treatment. In addition to the stigma of seeking treatment there are practical barriers to care that need to be addressed. The children who are affected are treated in separate health care settings by professionals who are not prepared to look at the whole family. Many families face financial barriers to care since many health plans are not designed for the coordinated care these families need.

The family in my practice was struggling with their second grader and his behavior problems at school. The parents done all of the right things. They had been working with his teachers since kindergarten. They had tried a variety of behavior plans at home. There was no improvement, and his grades were falling in spite of good ability. Their pediatrician confirmed his attention problems and reluctantly they agreed to a trial of medicine.

There was not much improvement even with a higher dose. And there were unpleasant side effects with a second medicine. So she recommended a psychiatric evaluation.

The behaviors were typical of ADHD. But his mother gave a clue to the problem as she teared up, talking about the stress she was under with his problems and guilty feelings about not having enough time for her husband and other children. At a separate interview she described typical symptoms of depression. She had been in treatment during college but stopped treatment when she was first pregnant. I was able to make a referral to a colleague and as her mood improved her interaction with her children improved. And the smiley faces began appearing in the daily planner.

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