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  #1  
Old 11-06-09, 04:36 PM
MGDAD MGDAD is offline
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Im a bit Worked up today.

My daughter has not been doing very well lately. Anxiety so high that she has not been able to do much homework. Im finally so sick of her current doctor and have found another place to take her. They are expensive, but at this point I dont care.

Their intake consists of about 50 pages of questionaires the screen for everything, asbergers, adhd, adhd for girls, depression, bipolar, etc. Complete blood work to test for a host of things. Then two hours with the director who is a psychologist, then two hours with their board certified child psychiatrist trained at Harvard and Massechusets General.

Answered a million questions for me which caused me to conclude that my last doctor is a completely unqualified for his line of work.

Among other things he told me this. They call it the ABCs of treatment. A is mood, B is anxiety, C is Focus. He says you always treat in order, because when you treat the mood, sometimes the anxiety goes away. Or if there is no mood problem, but there is anxiety, then yor treat the anxiety and sometimes the Focus increases. In short, focus (stimulants) are the last thing you treat, since stimulants can increase anxiety and trigger mood problems. This makes total sense to me, and matches a lot of what I have read elsewhere. Is he oversimplifying?
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Old 11-06-09, 06:41 PM
canukie canukie is offline
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Re: Im a bit Worked up today.

I'm no expert but I do know that people respond differently. I would ask them to provide the evidence of why they follow the ABC protocol, or is it just their belief that it works, (for most people...and which ones?)
My child's mood improved with stimulants which also improved focus. Better behaviour meant not getting in trouble as much and therefore less anxiety. I found a good website that talks about the right "window" of dosage....corepsychblog.com. I found it helpful in identifying when the med dosage is too high. And then again, we've had our ups and downs with different meds. Currently the issue is tics.

I'm interested in knowing what the blood work was for. (I know that vitamin D blood levels are often low in Canada--we don't get enough sun exposure at the right time of day, and never from fall to spring-- and it correlates with mood.)

Also, Russell Barkley recommends that the diagnosis be based on the history...in our case the screening questionaires may have been somewhat helpful, they did not pick up the adhd. We spent 4 hours with an adhd specilist to give a complete history, and already had complete psychological testing done prior which did not provide enough evidence for an adhd diagnosis.

Last edited by canukie; 11-06-09 at 06:45 PM.. Reason: supplementary info
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Old 11-06-09, 07:33 PM
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Re: Im a bit Worked up today.

I know it must be frustrating for you,but I like hearing from people that take such an active part in their kid's health.

I think you have a lucky daughter to have a parent like you.

I agree with Canukie. I don't think they (the new clinic) should be offended at all by those types of questions.

That ABC method certainly seems oversimplified to my untrained mind.

I can appreciate the desire to go with stims last,but for me personally...no mood treatment could possibly help as much as getting my anxiety under control.

SSRI's are one way to help with both mood and anxiety,but not if anxiety is overbearing,like it was for me.
Also,I just started a stim yesterday,and it is actually reducing my anxiety,and I don't feel euphoric like I've read how some initial doses can behave.

I hope you form a trusting bond with your doc,and you need to confront any doubts you have with him,for that to happen.

Please be sure to keep us posted on your girl's progress!

How did you find your new doc,and would it be too indiscreet to say who it is?

Oh...and the website that Canukie mentioned is run by someone who occasionally frequents this forum,named DocParker.Might be Doc Parker.
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Old 11-07-09, 12:49 PM
Vickie Vickie is offline
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Re: Im a bit Worked up today.

MGDAD,
I hope this new group will be a good fit for you and your daughter. A different approach might work out in your daughter's favor. Hang in there.
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Old 11-07-09, 11:43 PM
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Re: Im a bit Worked up today.

You know, it makes sense to me. Dr wanted to start my son out on Strattera because it's non-stimulant and can help anxiety since he had so much. We were hesitant because of the severity of the anxiety and it's impact on his ability to go to and function at summer camp so he agreed to treat the anxiety first and Strattera takes a while to see effects. We did a month on lexapro before starting the strattera and it seems to have worked will for us. Unfortunately, I can't speak to whether the lower anxiety had a positive impact on focus because we weren't in school then. But it does make sense to me that when you feel better, you can focus better.

I hope this new doctor is able to help your daughter.
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Old 11-08-09, 09:36 AM
Dizfriz Dizfriz is offline
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Re: Im a bit Worked up today.

Quote:
Originally Posted by MGDAD View Post

Their intake consists of about 50 pages of questionaires the screen for everything, asbergers, adhd, adhd for girls, depression, bipolar, etc. Complete blood work to test for a host of things. Then two hours with the director who is a psychologist, then two hours with their board certified child psychiatrist trained at Harvard and Massechusets General.

Answered a million questions for me which caused me to conclude that my last doctor is a completely unqualified for his line of work.
This is a very good approach. It is a clinic based method and works quite well but can be expensive if insurance will not cover it. This is what you will most often see in university or teaching hospital based settings.

In many private practice settings, these functions are split up between different independent clinicians. Many psychiatrists will refer out for an assessment before treating, some will save this for the trickier cases. Keep in mind that some very good child psychiatrists do not use this but instead prefer the clinical interview as the primary method of working and the lack of the extensive diagnostic process does not by itself indicate a lack of competence on the part of the physician. It sounds like you found other things that make you to question competence however.

If there is ever any doubt of the professional competency of the clinician then changing should be strongly considered

Quote:
Among other things he told me this. They call it the ABCs of treatment. A is mood, B is anxiety, C is Focus. He says you always treat in order, because when you treat the mood, sometimes the anxiety goes away. Or if there is no mood problem, but there is anxiety, then yor treat the anxiety and sometimes the Focus increases. In short, focus (stimulants) are the last thing you treat, since stimulants can increase anxiety and trigger mood problems. This makes total sense to me, and matches a lot of what I have read elsewhere. Is he oversimplifying?
The ABC method is a logical and reasonable one and appears to be often used even if the name is not given. That is why you see posts of Inattentive type adults discussing being treated for depression before ADHD is considered.

I might object to some degree to the term "always" however. One thing I have learned the hard way that one size does not fit all. I prefer thinking of each child as unique but that is just my approach.

Other than that, I can see no objections to that method. To be effective you have to have a protocol from which to work with the freedom to vary at need. In the diagnostic process, mood, anxiety and other issues that can mimic ADHD must be ruled out before a diagnosis of ADHD can be made. Mood, anxiety, focus is a good order to tackle these issues.

Canukie asked about the blood work. A good physical exam is often recommended just to rule out symptoms being caused by medical causes.

These are just my thoughts, nothing more.

MGDAD, you are on the right approach. You are a good example of parents determined to find help for their child being the best diagnostic and therapeutic tool.

Good luck and keep on plugging.

Dizfriz
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Old 11-09-09, 02:04 PM
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Re: Im a bit Worked up today.

As an update to my daughter. I had gotten her current doctor to agree to reducing the Vyvanse dose by half, to see if she improves. After two days of half the dose she was much better. Much less anxiety. So we quit giving her the vyvanse for the next two days and she is a completely different girl. It was really shocking to see the huge change.
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Old 11-09-09, 06:22 PM
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Re: Im a bit Worked up today.

I'm glad she's doing better. Can you elaborate on the differences you see in your daughter?
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