Finally found a pediatric p-doc *and*

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Registered: 03-26-2003
Finally found a pediatric p-doc *and*
4
Mon, 05-05-2003 - 12:59pm
they even accept our health ins within that practice. We even managed to get an appt for *tonight* (a miracle, yes??), due to a cancellation. The "catch" is that we have to start off seeing a "licensed therapist" there even though ds has seen a psychologist in the past. They may also require us to continue with the therapist even after they "graduate" ds to the p-doc. Do most of your kids see both a therapist and someone who handles their med management? (Our PED is not comfortable taking the meds to a point beyond where we are right now -- Strattera -- or with combining different meds.)

I know that therapy can be a valuable tool, but we are really seeking a confirmed dx and med management as a first priority right now. Of course, we will jump through any and all hoops necessary -- with an open mind, even! I am now stressing about starting therapy again, though (that "celebration" emoticon I used for this post is only partially accurate!!!!!) Oh, and the therapists within this practice are licensed Masters-level people; previously, we had seen a psychologist for therapy. Should that be making me nervous, too?? Please send us some positive thoughts for tonight if you have any to spare, and also some for getting us an appt with the p-doc ASAP! Thanks, all! ~ ruth

Avatar for kathy_in_ga
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Registered: 03-26-2003
Mon, 05-05-2003 - 3:01pm
Hi Ruth. I would think the pdoc would be first, but what ever, as log as you got in that's the key! A therapist can only work on behaviors & such, can't prescribe meds. They may have you jump through the behavior mods hoop first. I would also let the therapist know what you are wanting from them, a DX and med management. Good luck & Let us know what happends!
iVillage Member
Registered: 04-15-2003
Mon, 05-05-2003 - 10:29pm
Hi Ruth,

I hope the appt went well today, and that you got some help. I also hope the setup works OK. Beware, tho, even a lot of pdocs don't believe in early onset bipolar, let alone therapists, but it sounds like you're knowledgeable enough to avoid getting led up the behavior mod garden paths. As so many of us have found, behavior mod doesn't work on an unstable child, and when the child is stable, it's often not necessary, or its focus is very different. How soon do you get in to see the pdoc himself, and when can you actually start meds?

Not to say that your ds is bipolar, but since mine is suspected eobp, I'll pass on what I know from that angle. Many bipolar kids do see therapists (tdocs) in addition to pdocs, but it's a specialized kind of therapy. Rather than trying to "fix" the problems with behavior mod -- some liken that to trying to "fix" epilepsy with behavior mod -- it focuses on learning to live with the disorder, family therapy, med compliance, associated issues like social skills, stress management, etc. Unfortunately, it's not that easy to find therapy like that. In particular, there's a kind of therapy called Cognitive Behavioral Therapy that's been shown to be quite effective in reducing the relapse rate in bipolar disorder, but it's really more suited to adults, I believe, b/c it requires self-awareness. On the other hand, many bp families flatly refuse to see therapists, having experienced too many professionals whose ignorance of early onset bp causes more harm than good. In the end, it all comes down to the therapist and his or her experience with the disorder in children.


BTW, how's the Strattera doing?

Melissa

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Registered: 03-26-2003
Tue, 05-06-2003 - 2:52pm
I guess the initial appt with the therapist went well. How much can one reasonably expect to accomplish/discern in an hour when part of it is spent filling out paperwork and checking off little boxes, right? ;o) (This is our third time filling out this type of intake stuff, and it's getting on my nerves! ... though at least while dh and I were filling it out, the therapist was talking to ds in her office, so it wasn't "wasted" time.) DS seemed to like the therapist and was willing to open up with her. In their short one-on-one time together, he apparently just sort of sat there and rambled (like mom like kid??;o) -- she knew all about his upcoming class trip, our cats/recently-dead fish/hermit crabs, the fact that his humanities teacher's dad just passed away, and the fact that he loves reading and soccer and swimming ... and that is in addition to the behavioral stuff they discussed (that I don't know the entire gist of, which is *really* hard for me!!!) We all talked a bit about his anger and how he needs to try to learn to manage it better. I don't really think that much "concrete" came out of this initial visit (she had ds sign a "contract" promising not to pinch me or kick dh -- knowing ds he'll figure out the loophole that he can still kick *me* and pinch *dh*.), but I'm hoping that our visits grow increasingly more productive.

Anyhow, she said that it's obvious that we have tried a lot of different behavioral approaches with ds (who she said she really enjoyed talking to a lot, and who she said is also obviously very bright), and she recommended us to the p-doc (yippee!)... who is, of course, very booked up. HOWEVER, the practice already called today and scheduled something for mid-June, which is waaaaaay before dh and I thought we'd get in. (It happens to be for the same day that is also ds' last day of school, so I do feel a little bit bad about that for him, having to go to the doctor right from school. But I think that is a 1/2 day for him, so that wouldn't be too terrible to take him right from school to the appt -- would it??) In the interim, we are seeing the therapist again at least a couple more times. (This group is VERY big on integrating behavioral and med approaches.)

I am just very antsy to get a confirmed dx of exactly what is going on with ds besides the ADD (as I've said, my bet is on early-onset bipolar disorder, though I suspect that ODD is also a possibility) and -- of course -- to start doing some work with determining the appropriate the meds. Melissa, to answer your very good question/concern (and we thought about it too!): This practice purports to specialize in treating ADD/HD and pediatric bipolar disorder, and they also see a LOT of ODD, so I may have actually stumbled upon a good place for us to be. We will NOT let them try to give us a lot of "kumbaya" behavioral mod stuff in lieu of working with meds ... I promise! The therapist even put in her written plan for ds something about helping him learn to better *manage* his anger/frustration - so at least we know that they *are* going to work with what he IS, and not try to totally wipe his behavioral slate "clean" if you know what I mean. It took dh and I a LONG time to come to terms with putting ds on meds, but we honestly believe that, for now at least, it's the right path for him. However, I'm sure that all three of us can use more than a little therapy at this point! :o)

Oh, and our PED called today just to check up on where we are with things, and see if we've been able to get an appt anywhere, so it was nice to be able to tell him that things have progressed in that vein. It was also really nice of him to call, period.

Thanks for the encouraging words and feedback Kathy and Melissa -- much appreciated!! I'll keep you posted! ~ ruth

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Registered: 04-15-2003
Tue, 05-06-2003 - 6:36pm
Hi Ruth,

Sounds very promising that they acknowledge eobp and have some experience with it! Re ODD, there's a lot of controversy about this as a stand-alone dx, because nearly all bipolar and many ADHD kids exhibit this as what many believe to be just another symptom of their disorder. I read one pdoc's article that said ADHD + ODD is more likely to be eobp; I don't buy that completely, but I think eobp should at least be ruled out in an ADHD/ODD kid. In fact, both ODD and anger often disappear with stability; their occurrence or absence is actually a measure of stability. This has been our experience as well. Niels (5yo) is dx'd ADHD/ODD/mood disorder, but he is now stable on Trileptal. The oppositionality just evaporated into thin air, and anger is no more than normal now. IF David really is eobp, don't expect him to hold to the contract; it will be beyond his ability to control. But when he reaches stability, in all likelihood the contract will be unnecessary.

One other tip -- keep calling the pdocs office to see if there are cancellations. Often you can get in much, much quicker.

Good luck!!! Better days are coming.

Melissa