Friday, 30 May 2008

The mental health lucky dip

Posted by Dr. Thunder:

I'm struggling a bit lately. I help run this "Child and adolescent behaviour clinic" once a week at my new hospital. As I've said before on previous posts, I've no real training in this kind of thing. Adults with mental health problems get seen by psychiatrsists (well, they're supposed to), but kids here get seen by the paediatrician for pretty much every ailment under the sun (medical, surgical, psychiatric). It's fine. I'll get used to it. But at the moment, I'm a little out of my depth.

I saw a kid today. A 7 year old girl with Attention Deficit Hyperactivity Disorder. She's got it BAD, to the point where she is pretty dysfunctional. Her brother has mild autism. Both her parents are disbled, and on disability allowances.

So, the little autistic boy goes to a special school, and is in a tiny class, with an individual carer. Quite right, too. The health authority seems to regard autism as an "important" illness. He does well at school, and functions relatively well in her day to day life,within pretty strict parameters.

His sister with ADHD obviosly hasn't got an important enough mental health problem. She has to go to the local state school, which is a very good school. But there's 26 other kids in her class. There's no individual teaching assistant. There is no one-to-one time.

To my mind, the child with ADHD has a better chance of managing to get what we in the mainstream would call "a good education" than her autistic brother. The autistic child is likely to require care for the rest of his life. That is not the case with his sister.

So, Nicola (with the ADHD) is doing badly at school. Her lovely parents are very worried. They came to me with an agenda today. They informed me that if Nicola was diagnosed as being on the autistic spectrum, she would get the financing for a classroom assistant.

Nicola's parents can't afford an form of extra tuition.

They looked at me, hopefully. They wanted me to diagnose Nicola with autism. I couldn't do it. It's not ethical. But it's tempting. I told the parents this. They're sensible people. They understood. But it didn't stop me feeling like crap for the rest of the day,a s I sent Nicola away with an increased dose of Ritalin.

I shall see her again in 2 months, when her school reports have deteriorated further. I have asked ther social worker to look into their situation, but she didn't hold out much hope.

I see Nicola becoming a pretty unproductive member of society when she leaves school, due to what is likely to a huge educational deficiency. We'll complain about how much benefits the state will have to pay her for many many years. Sadly, the savings would be enormous if we could just give her the money she needs to get some help at school.

Roll on next week's clinic!


  1. Attention Deficit Hyperactivity Disorder... mmm!

    It strikes me that this poor child may well be suffering from a 'deficit of attention' if her autistic brother is taking up most of the parent's time? Is there any scope in finding some help for the whole family unit?

    I think your decision was a wise one despite the outcome.

    Good to see you back on the beat!

    Not sure if this will reach you as I encountered a problem accessing your comment facility tonight. Seems okay now though.

  2. And the cycle of socioeconomic deprivation continues. One of the downsides of being a paediatrician I imagine.

  3. My mother left secondary school teaching to work one-on-one with children in primary who need it for various different reasons. What she has achieved with some of her children with ADD and ADHD is extraordinary. She is no expert but she really feels the one-on-one aspect is vital for this particular problem. What a shame this girl cannot get even an hour a week that could help her so much.

    As an aside, I've used Ritalin with pretty fantastic results in an elderly gentleman whose GCS stubbornly bounced between 8 and 11 after a stroke that affected his reticular activating system. He is now eating a soft diet with no PEG feed requirements, mobilising with assitance and hoping Holland win Euro 2008!