Six Doctors highlights an idea that there are more than 2 sides to every story.
Using six different points of view, these six doctors discuss important topics in mental health from A(DHD) to Z(oloft).
Introducing Dr. Arnold, who analyzes patterns or trends and tries to learn from the available data. Dr. Arnold is a cardiologist by training and concerns himself with concrete facts and numbers when making decisions. He looks for gaps in the information and either tries to fill them or account for them.
Introducing Dr. Barnett, who uses his intuition and gut reaction when trying to understand the emotional responses of people. Dr. Barnett is a pediatrician by training and attempts to take the temperature of each situation, while recognizing that he does not fully know the reasoning of others
Introducing Dr. Chiu, who cautiously and defensively highlights any weaknesses or known risks. Dr. Chiu is a pathologist by training and concerns himself with resilience. He thinks about future risks and prepares for tough times and difficulties
Introducing Dr. Duman, whose optimism helps you see all the value and benefits of a decision. Dr. Duman specializes in infectious diseases and thinks positively when everything looks gloomy and dark
Introducing Dr. Edelman, who creatively experiments outside-the-box for solutions to problems. Dr. Edelman is a psychiatrist by training and develops tools to help you create ideas while minimizing self-criticism
Introducing Dr. Ford, who expertly understands when and where to direct activity. Dr. Ford was trained in internal medicine and prepares contingency or back-up plans when ideas are running dry and frustration is overflowing
Bullying And Aggression
Aggression often prompts requests for intervention. It is defined as physical violence and can be an associated feature or symptom of an impulsive or affective condition as well as it can be predatory in nature (Kruesi et al, 2003).
Bullying and aggression or persistent antisocial behavior of children and adolescents that significantly impairs their ability to function socially, academically, or occupationally defines Conduct disorder, one of the most commonly diagnosed disorders in child psychiatry (Kaplan and Sadock, 1995).
Antisocial behaviors include Aggression toward people and animals; Destruction of Property; Deceit or Theft; Serious Violation of rules.
Studies with aggressive children and adults consistently show an association between decreased serotonin activity and impulsive aggression (including violent suicide attempts, van Praag, 1982)
6 Doctors Talking About Bullying And Aggression
Dr. Arnold’s first priority would be to obtain data from the child’s neuropsychiatric evaluation and educational assessments, specifically looking for a higher performance IQ than verbal IQ, since I understand that children and adults with antisocial behaviors typically have deficits in written and verbal language skills
Dr. Barnett understands that aggressive behaviors are strongly associated with abusive, chaotic and neglectful family environments, so my first priority would be to cautiously develop a rapport with the family as well as avoid disrespecting or criticizing them. Then I would explain to the parents and child the evaluation process as well as treatment options, which typically require parental involvement
Dr. Chiu’s first priority would be to explain to the parents and child that while aggression limited to the home setting or non-delinquent conduct disorder does not predict later antisocial behaviors, pervasive childhood aggressiveness and delinquent behavior does predict juvenile court involvement as well as long-term impairments in academic, occupational and interpersonal areas
Dr. Duman’s first priority would be to relieve some of the family’s stress and anxiety by telling them about some well-documented protective factors related to aggression and Conduct disorder. I would say, “Certain factors, such as female gender, high IQ and lack of related and co-occurring conditions (impulsivity, depression), seem to prevent poor outcomes even when there are risk factors present”
Dr. Edelman’s first priority would be to reassure the parents and child that there are many ways to help a child who is bullying, being bullied or both. I would tell them, “the psychodynamic approach addresses feelings of mistrust and rejection, family therapy attempts to improved child-parent interactions and medication therapy can target co-occurring ADHD symptoms or aggressive symptoms directly”
Dr. Ford’s first priority would be to look into all the family’s previous treatment attempts, that addressed bullying and aggression, to determine why treatments have failed. Then I would discuss the likelihood of the family engaging in alternative treatment options
Attention-deficit Hyperactivity Disorder (ADHD)
Attention-deficit Hyperactivity Disorder (ADHD) is the most common juvenile psychiatric disorder seen in the clinic setting.
Evidenced-based literature documents that stimulant medication works well in children for the core features of ADHD (hyperactivity, impulsivity and inattentiveness) as well as cognition, social function and aggression. More specifically, stimulant medication also helps kids with their social skills and emotional maturity.
Research shows that children treated with stimulant medication have an increased ability to understand peer communications, self-perceptions, and situational cues (Whalen, 1989)
Six Doctors talking about ADHD:
Dr. Arnold’s first priority would be to obtain the data from questionnaires, given to both the parents and teachers, to help determine whether the core symptoms of ADHD are present in the child or not. If symptoms are present, I would then begin to investigate all the possible reasons for the child’s behaviors
Dr. Barnett’s first priority would be to anticipate and to address parents’ emotional reactions regarding the social perception that ‘all children are diagnosed with ADHD’. Then I would explain to the parents and child that I need to complete my evaluation before I can offer any professional opinions
Dr. Chiu’s first priority would be to inform the parents and child about the well-described risks related to having a diagnosis of ADHD. I would tell them that ADHD places a child at risk for social as well as academic impairments including truancy, substance misuse, antisocial behaviors and other impulse control issues
Dr. Duman’s first priority would be to share the positive facts about ADHD with the parents and their child. I would tell them, “children treated with stimulant medication are less likely to misuse illicit substances during adolescence and adulthood”; or I would highlight the stimulant medication’s side effect of weight loss in cases where the child is overweight
Dr. Edelman’s first priority is always to respectfully listen to the family’s concerns about their child and try to understand how the parents feel about their child’s impulsive and disruptive behaviors. Then, with the family’s cooperation and based on their flexibility and openness, I would help guide them through a list of creative treatment options that address ADHD symptoms
Dr. Ford’s first priority would be to find out what the family and school have done so far about their concerns related to the child’s ADHD symptoms. I would also want to know if the family was invested in any of the previous attempts or not. Then I would focus my recommendations on alternative treatments or things that haven’t been tried yet
Complementary and Alternative Medicine (CAM)
Complementary and Alternative Medicine (CAM) is often used in childhood conditions (Ernst, 1999). Alternative medicine is increasingly seen as complementing mainstream practices (Ray et al, 2004)
A dietary supplement is any product taken by mouth that may include vitamins, minerals, herbs, and amino acids as well as substances such as enzymes, organ tissues, metabolites, extracts, or concentrates and can be found in forms such as tablets, capsules, liquids or powders.
In the United States and since 1994, Nutritional Supplements are NOT subject to regulations by the Food and Drug Administration (FDA) in the same manner as Prescription Drugs. As a result of the lower standards required, there are concerns about the fidelity of botanical and nutritional products
6 Doctors Talking About CAM
Dr. Arnold’s first priority would be to familiarize himself with the active ingredient(s) of the product and determine what it’s used for as well as its quality standards within the market. Depending on the availability of the limited information, I may visit the Office of Dietary Supplements at the NIH or http://odp.od.nih.gov/databases/ibids.html
Dr. Barnett’s first priority would be to anticipate and to address the parents’ wish to avoid a Western Medicine approach for their child and utilize something ‘natural’, ‘organic’, and safe. I would make sure to thoroughly discuss all of the risks and benefits with the family and child, traditional and alternative, as well as present my individual recommendation(s)
Dr. Chiu’s first priority would be to illustrate the dangers of CAM whether regulatory system limitations or the under-reporting of adverse events following CAM use. I recall a Chinese herbal remedy for weight loss, used throughout Europe in the 1990’s, that was contaminated. I believe many consumers of the contaminated product developed kidney disease and others acquired cancer
Dr Duman’s first priority would be to emphasize the wide range of CAM treatments from acupuncture, yoga and reflexology to herbal medicine and homeopathy. I would tell the family and child, “There is a trend not only to educate physicians about alternative medicine but also to obtain safety information of botanical medicines in the near future, since Europe has an established tradition of herbal use for medicinal purposes among their pediatric and adult populations”
Dr. Edelman’s first priority would be to consider and to discuss with the parents and child the many issues related to the use of herbal treatments and dietary supplements. I would want to know the family’s concerns as well as reservations and if they are able to obtain reliable information about these products on their own
Dr. Ford’s first priority would be to find out if the family has been treating any of their concerns about their child with complementary or alternative medicines. It is well known that many people use alternative therapies without discussing it with or informing their doctors and I would be concerned about their use together with other traditional medications
