Clinically Speaking is a blog that will allow anyone to learn about Social Work, case presentations in psychotherapy, and the relationship of pop culture in psychology. Come one...come all!!!

Thursday, May 31, 2012

Case Study: Ricky R.

Today's case study will be about 8 year old boy who has a Dx of ADHD and how he is currently being treated.

Disclaimer: Certain information has been changed to protect the identity of this patient and is in accordance with the rules and regulations of HIPPA. To learn more about HIPPA, please click the link HIPPA.

Ricky is an 8 year old white Jewish male who resides in his parents home with two younger siblings 6 year old boy and 2 year old girl. He attends school in his community. He enjoys sports, history, and is in the school choir. Additionally, Ricky does have Dx of a learning disability which compounds the issue of him having ADHD. I have been seeing him for the past 2 years. He was brought in by his parents because he was unable to control his behaviors in school and at home. Ricky has been on medication from the psychiatrist to help him treat his ADHD. While working with Ricky, we would utilize play therapy,  learn coping skills to reduce ADHD, and behavior modification techniques to help him focus more on tasks that needed to be completed. During sessions he would have a finite amount of time to finish a task with a reward at the end of session. His parents and myself meet monthly to track his progress at home and school. At the end of last school year Ricky was assessed by the Jewish day school he was attending, which showed that he was not up to grade level on any of his subjects. Ricky's behavior continued to deteriorate socially and academically in school , but had improved at home with his parents. He was disrupting the other children which in turn Ricky started to be ostracized from his classmates.  In a meeting with Ricky's parents I had suggested that it might be a good idea for them to explore moving him from Jewish day school which has a double curriculum(learning bible, Jewish heritage, and Hebrew) to a public school and be in a special education classroom, may improve socially with peer like him, a shorter day and single curriculum. Initially, Ricky's parents had a lot of trepidation in switching him, but after explaining that at this point in his life he needs to feel that he is confident that he can succeed in school and have good peer interactions rather than him spiraling down academically just so he can be with Jewish kids and having the extra curriculum. I continued to explain that very often when you can eliminate one negative element from a child it has a positive effect on other areas of his life. 

That was 10 months ago...

Fast forward to his current functioning. Ricky will be completing his first year public school, not only has he caught up to grade level, he was mainstreamed for 2 classes in January. As reported by his parents he will be taken out of the special education class for the fall and put into a mainstream class. Parents reported that he is doing great socially, and he has not had any out of range problems (meaning no significant problems for A)a child and B) a child with ADHD)with his attention at home or in school. Parents reported that when an incident does occur they have been able to redirect him and he has been able to calm himself down and focus on using his coping skills.

In this case, it had more to do with the child and his needs academically and socially rather than the coping skills for his ADHD emotionally. While learning those skills were and are important for him, it was being able to recognize that although patients can be taught coping skills and other techniques, sometimes a change of scenery or in this case school had a trickle effect on his emotional and social needs.

Happy Thursday!

Thursday, May 24, 2012

ADHD Treatment and Prevention

Today we will continue our topic of ADHD. Now that we have a clear understanding of what it is, we can go ahead and look at some new treatment options that help those with ADHD.

The mainstream way to treat children and adolescence with ADHD is with medication and therapy. Therapy can consist of play therapy, or art therapy, and depending on the cognitive level of the child or adolescent Cognitive Behavioral therapy can be very good asset in helping to train coping skills. Finally, which I have seen and used that is effective would be Behavior Modification, in order to promote good behavior at home and school. While therapy alone won't necessarily work medications such as, Vyvance, Concerta, Intuniv, Strattera, Adderall, and everyone's favorite pop-med reference, Ritalin will be prescribed. Those medications are divided into two groups, stimulants and non-stimulants. There are various reasons why one would be prescribed a stimulant over a non-stimulant, like certain side effects, medical complication, and/or that they can't be taken with other medications.

In the recent years there are have been two particular ways that can improve a person's ADHD symptons dramatically. Exercise and Diet. While those both sound standard in changing anything that is wrong physically with your body, these two have a profound affect on the person with ADHD.

1) Exercise- Associate professor at Dartmouth, David Bucci conducted a study to measure the way exercise can improve memory and a gene has been indicated which seems to mediate the degree to which exercise has a beneficial effect. As reported by "Bucci began his pursuit of the link between exercise and memory with attention deficit hyperactivity disorder (ADHD), one of the most common childhood psychological disorders. Bucci is concerned that the treatment of choice seems to be medication. The notion of pumping children full of psycho-stimulants at an early age is troublesome," Bucci cautions. "We frankly don't know the long-term effects of administering drugs at an early age -- drugs that affect the brain -- so looking for alternative therapies is clearly important. Anecdotal evidence from colleagues at the University of Vermont started Bucci down the track of ADHD. Based on observations of ADHD children in Vermont summer camps, athletes or team sports players were found to respond better to behavioral interventions than more sedentary children. While systematic empirical data is lacking, this association of exercise with a reduction of characteristic ADHD behaviors was persuasive enough for Bucci." The article goes on to talk about being able to determine the genotype and modify which exercise would be best for treating ADHD for each child.  Click for the entire article How Exercise Affect The Brain: Age and Genetics Play A Role.
1A) Along the same lines as Exercise, this is an interesting video about the use of Karate for those children with ADHD.

2) Diet- Kim Fliescher, professor of pediatric nutrition from the University of Copenhagen who conducted research about diet and ADHD. She reported that, while there is more research that needs to be done,"...There is a lot to suggest that by changing their diet, it is possible to improve the condition for some ADHD children...Several of the studies show, for example, that fatty acids from fatty fish moderate the symptoms. Other studies detect no effect. Elimination diets are also promising."  This would really do wonders for children even more so for parents, but could also kill a huge part of the pharmaceutical industry. Even if we would be able to some how minimize and prevent ADHD by 10% that would still be enormous in so many ways, behaviorally, physically, and in school performance. For the full article click the link Children with ADHD May Benefit From Dietary Change.

Any way you slice it, medications and even therapy isnt always the answer. Nothing works 100% all the time!
Happy Thursday!

Monday, May 21, 2012

ADHD week!

Sorry for the long wait for a new post. This week will be all about ADHD, from treatment and prevention to a case study. Today as we always do is make sure that everyone has a clear understanding of what it is and who it effects in the world. A few statistics before we dive in like Pete Rose. An estimated 9.5 % of children between the ages of 3-17 are diagnosed with ADHD and 4% of adults. Click here to review some other really interesting long term and short term statistics of ADHD, ADHD Figures and Statistics...Without further ado in the words of Bud Light...Here We Go!

Attention Deficit Hyperactive Disorder:
Could be either A or B.
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
1.   Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2.     Often has trouble keeping attention on tasks or play activities.
3.     Often does not seem to listen when spoken to directly.
4.     Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5.     Often has trouble organizing activities.
6.     Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7.     Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8.     Is often easily distracted.
      9.   Is often forgetful in daily activities
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
1.     Often fidgets with hands or feet or squirms in seat.
2.     Often gets up from seat when remaining in seat is expected.
3.     Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4.     Often has trouble playing or enjoying leisure activities quietly.
5.     Is often "on the go" or often acts as if "driven by a motor".
      6.  Often talks excessively. 
1.     Often blurts out answers before questions have been finished.
2.     Often has trouble waiting one's turn.
      3.  Often interrupts or intrudes on others (e.g., butts into conversations or games)

There are other subtypes but for our basic understanding this is the important aspects that are important for us to know and learn about it during the week. 

Stay tuned for the rest of ADHD week!
Good day for a Monday!