January 31, 2011

Mark Foster, DO
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Bob–

Today, I saw an intelligent and sarcastic teenage boy for renewal of his Adderall. He presented with his well-meaning but frustrated father, who is a retired military man and a disciplinarian. I was trying to draw the boy into the discussion, but the father kept interrupting and correcting him. Tension was thick in the room, the boy rolling his eyes, sighing in exasperation as his father tried to control the conversation. Eventually, the boy lay back on the exam table and refused to speak.

I took a history from the father, discovered that the boy had been on medicines continuously since age seven, and had never been given summer or weekend holidays. Unable to reconnect with the boy, I explained to the father my concerns with chronic stimulant use, why we need to periodically question if they are still necessary, and if we should consider occasional drug holidays. Amazingly, through almost ten years of psychiatric care, counseling and alternatives had not been explored, and drug holidays or cessation of medication had never been suggested. The dad was taken aback that this would be possible, or wise. He said, “But I thought this was a disease, right? His behavior is getting out of control, and he’s about to fail out of school. If he’s not on meds, then what are we going to do to help him?” To which the son sat up, pointed his finger and retorted, “No, dad, the meds aren’t about helping me. They’re about helping you.”

It was a terse and heartbreaking summary of the use of psychotropics in children today.

Mark

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