Archive for the ‘stress’ Category

Hand Movements May Give Clues to ADHD Severity – MedNews

Tuesday, March 8th, 2011 recently posted an article about ADHD that – wait – you don’t get news from How else are you going to find out about new drug approvals by the FDA, breaking information about recalls & lots of other useful stuff? Where else are you going to get articles like the one about which I’m commenting?

OK. So they posted this article about studies involving hand movements and ADHD which had some interesting points. One study found that children with ADHD weren’t able to perform the finger-tapping exercise without extraneous movements that weren’t as apparent in “typical children.” Another demonstrated that magnetic pulses caused movements in ADHD children to a greater degree than “typical children.” They said something about myelination of the left/right brain connective nerve tissue, the brain’s “braking mechanism” on movements, and a demonstration of why ADDers have a problem with keyboards and fine hand movement tasks.  The article also said that there wasn’t a clear “clinical” application for the outcomes of this study or these tests.

Whoa! That’s a lot of stuff there, compadre! First of all, does anyone other than me have a problem with comparing ADDers to “typical” children? Typical? What are they saying? Who are they stigmatizing? How about calling those “typical children” as having “Attention Surplus Disorder” (thank you Thom Hartman.) Typical indeed. Read Harte’s anthropological & historical view of ADD in “Think Fast: The ADD Experience,” T. Hartman & J. Bowman, 1996, Underwood Books,(link to Amazon page for the book,) a book of excerpts from the Compuserve (remember that) ADD forums. Typical! Poppycock!

Next: What do you think of a parent that allows his/her child to be subjected to “magnetic pulses” as a form of testing without knowing the outcome? Even with knowing the short-term outcome.  I realize that it’s hard to test pediatric effects and dosages but, really…. “God said, ‘Abraham, kill me a son.'” (“Highway 61,” B. Dylan, as if you didn’t know) but Abraham was spared from having to do that by the substitution of a ram at the last minute (insert computer and RAM joke here.) How do you feel about parents submitting children to experiments in the name of science? Me, I believe in things between consenting adults being permissible (within limits) but how does a parent consent for his/her child to be subjected to “trans-cranial magnetic pulses” – zapping the kids brain with magnetic charges – to observe if his/her arm jerks in response.

Finally, and this is the big one for me, and the whole point of this post: No clinical application? Are you ferreal? How about the simple “clinical” value of a piece of psychoeducation? Being able to tell a frustrated parent that the fidgeting child doesn’t have anything wrong with him, that it’s just the way his brain works and let’s find things that will help him learn instead of beating him down for not being able to sit still. How about being able to tell the child who doesn’t have the same fine motor skill as some of his buddies that, believe it or not, that will develop with time but, in the mean while, what can you do that they can’t because that’s what makes you special. How about using the information to educate teachers so they can learn that the kid who gets up from his seat to watch the squirrels running in the ivy on the side of the school building is also learning something, probably already finished the assignment, and is preventing himself from being bored (and getting in trouble for fidgeting.)

How about forgetting this ADHD vs “Typical.” Treat a child like he’s defective and you get a problem child. Treat a child like he’s a member of the family and you get a member of the family who can use his gifts.  ADDers aren’t defective. Just different. If  you think they frustrate you, you have no idea how frustrated the ADDer is – but that’s for another post.

Therapists Behaving Badly

Wednesday, November 24th, 2010

This one’s gonna be touchy. I’m not all that clear about putting this post up there. It could be nothin’ but net, could be a brick. I’m sure this is going to make some people unhappy on both sides of the couch but, I gotta say something & so, as Wellington said to his mistress when she threatened to make his letters to her public, “Publish and be damned,” though I probably already am. It’s a professional liability.

This is written in part for patients, in part for therapists, and in part to get it off my chest ’cause its been there for a while & it’s startin’ to feel like a 10-ton safe. Here goes and if it bends you out of shape, so be it.

I was in the elevator going up to my office a few weeks, maybe a month and-a-half ago with 3 other people. Two were therapists, one was, I think, a patient. One therapist asked the other about his next patient & the comment came back something along the line of “He’s a real borderline.” The other said something like “yikes,” and then followed with a comment about being told by some mentor that you shouldn’t have more than one on your caseload. The one who made the comment in the first place said something about that being right.  If you’re reading this and you recognize yourselves, I’m not picking on you. I’ve picked you as an example. If you’re offended you can take it up with me. Leave me a comment. Please. If you have an opinion about what I’m saying here, please, leave me a comment.

The whole time this exchange was proceding I was uncomfortable because I wanted to say something to this pair. The other guy in the elevator (remember him, the patient looking guy?) was looking decidedly uncomfortable and unhappy.  I wanted to tell this pair to pipe down, that there’s other people on the elevator. Mind you, they didn’t say anything that might identify the patient (other than that he’s a he.) The behavior broke no privacy or confidentiality rules, HIPAA was certainly not violated. So, what’s my beef?

That’s easy. It makes patients uneasy when they hear this. They already think we talk about them when they’re not present. They have wonderful imaginations and are very sure we talk about them. There’s no need to prove them right. It doesn’t make them happy and gives them a not great opinion of us because, they think, it tells them what we think of them.

We’re not even going to talk about the categorizing of a patient with an unflattering label. We all know what borderline means, and that includes patients. It means difficult, explosive, unmanageable, right? Too bad it didn’t mean that when it was first proposed, but that’s what it’s come to mean. But I digress….

My point here is this: I was fortunate. My first internship was, in part, at the James A. Peters Veterans Medical Center in the Bronx where there were signs on the two side walls of each elevator reminding the staff to not discuss patients in the elevators because staff, patients and patients’ families all share the same elevators. Good signs to post because people forget.

What I’m saying to therapists – pipe down! If you must talk about patients, and I’ll be generous and say that you’re “consulting” with a colleague, do it in your office or your colleagues office and do it with the door closed. Not in the hall. Not in the elevator. Not in the toilet. Let’s show them the respect they deserve.They come to us in pain and we’re not here to add to it by hearing us talk about patients (in the pejorative) in public. We’re not carnies and our patients aren’t Rubes. If you can’t pipe down, and you’re in a public place with me, expect that I’ll ask you to hold it for when you’re alone. I invite any other clinician to do the same when they hear another of us doing this.

By the same token I’m saying to patients that it’s OK to tell the therapists who are having this conversation in front of you that they should zip it. Tell them not to have this discussion in front of the kids. Tell them that you feel disrespected. Tell them that they’re treating you like you’re not there. They may get huffy. Let ’em.

ADD & Taxes Pt. II: The Folly of Working Hard: Completeness is the enemy of sense

Wednesday, July 14th, 2010

My last post was a bit of a disappointment to me. My “voice” was missing (what, you couldn’t hear me because it’s written, not spoken? Shirley, you jest.) I was missing a simple ingredient. Simple. That’s what I was missing.

See, I was trying to do too much in one shot. There’s only so much stuff I can cram in a 5-pound sack & I was looking at about 2o pounds. Then tried to tie it closed with a string. In the middle. The result? An overflowing, non-flowing pile of stuff that wasn’t satisfying to me, I don’t know about you.

The “simple” answer to the issue of ADD/ADHD and taxes is that there’s no “simple” answer that I can give. I can make suggestions but that’s already me imposing my thoughts. The simplest answer I know is to try things, no matter how logical, illogical, whimsical or insane they may seem until you find the method that works. If it works for you and Uncle Sugar it’s a bingo.

As for the other “simple” answer: I forgot the simple rule: Don’t work hard. Work smart. I was working too hard to try to get all my thoughts into one post. Phaugh! What a headache. It was a bad idea even if I could have done it. It was too much to organize (especially doing it inside that crowded melon between my hat & my neck.) Hard work never helped. Look at John Henry. He “…was a steel-drivin’ man (lord lord”) and, yeah, he beat that steam drill, but he died and his wife had to finish the job for him. He wasn’t even bustin’ up the mountain, he was just drilling pilot holes for the blasters (if you’ve never heard them, you gotta give them a listen. They’ll knock yer socks off) so they could bust up the mountain. The guy with the steam drill? He got to go home & have his soup. John Henry “…laid down his hammer an’ he died (lord lord.”) Where’s the percentage in that? He got a folk song written about him, but so did the guy with the steam drill. Don’t think so? Listen to the song again. It’s all about John Henry vs the Steam Drill.

What’s my point?  Zeit nicht meshugeh! There’s no “right” way to do your taxes (or anything else) as long as your in compliance with the codes, but working harder isn’t necessarily better. Working smarter, thinking about what you’re doing before you do it is often better. If someone accuses you of being lazy, go ahead and agree. Tell him (or her) that sure, you’re being lazy, but not unproductive. Remind him (or her) about John Henry. “He laid down his hammer and he died (lord lord.”) Does that sound good to you? Not me, cousins. I’ll use the steam drill any day rather than swing that sledge and go home, have my soup and, if necessary, come back tomorrow and finish up. The opposite of hard work isn’t “hardly workin.'” It’s workin’ smart.

Next up: Credit cards & psychotherapy fees.