Question: My son is a smart kid. His teacher got me really mad, though, when she said he is an underachiever. She says he spaces out in the classroom. He would get much better grades, but he doesn’t do his homework and he won’t study. Every year, his report card has comments about how his “organizational skills” need improving. I don’t know what to tell him because I was the same way. But I’d like him to do better. I think it is because he is bored in school. The teacher isn’t giving him interesting or hard enough work. When he is really interested in something, or likes the teacher, he does fine.

Anne Fenton, MD: Many children with good intelligence have the kinds of difficulty in school that you describe. They are smart, but have trouble focusing or concentrating. They often have trouble organizing their materials as well as their thoughts, especially when it comes to writing assignments. They need to be reminded over and over to do chores or tasks, they can be forgetful, and inconsistent in their academic performance. These problems become more obvious every year, peaking in middle school and high school, when academic requirements are more complex. These features are consistent with what is called attention deficit disorder. Many parents don’t think of this diagnosis, because their children, like your son, seem to be able to focus for hours on subjects or projects of interest. Parents figure that if the children can do that in one area, they should be able to do it in every area. However, like all of us, children with ADD can accomplish more and focus better on subjects they like. The contrast between “hyperfocus” and distractability on other topics is simply exaggerated. I would suggest you have your child evaluated for ADD. If that is his problem, it is a condition which is very treatable and widely treated.

Question: My child is really “high maintenance”. He has horrible tantrums and can be very aggressive. He is very intelligent, and does well in school, but at home he is a monster. Everyone tells us that it is our fault. They think we should discipline him better, but when we try to, he doesn’t respond. He doesn’t care if we punish him or take things away. And he lets us know.

We are at our wits’ end. It is especially hard because no one believes there is something wrong with him. They just think there is something wrong with us. His classroom teachers, our relatives, even his pediatrician look at us like we are the problem. We are afraid to take him to see someone who will tell us the same thing.

Anne Fenton, MD: There are children with significant symptoms which only show up at home, but not outside of the home, until much later on. We think that the structure of the school day or the public eye offers some buffer to help the child control the behaviors outside of the home, only to have a meltdown at home. It is parents of such children who have the hardest time getting help, just as you describe. Unfortunately, by the time others see the symptoms, it is too late for the early intervention so important for the child’s normal development.

Child psychiatrists are familiar with stories like yours. We understand that you know your child, and that you have already tried all the standard parenting approaches, read the self help books, and looked for answers wherever you could. A child psychiatrist will take your concerns seriously, and offer the help your child needs.

Question: I have always had certain thoughts in my head that I can’t get rid of. They drive me crazy, but I can’t get rid of them unless I say certain things over and over until they go away. It’s really embarrassing. I can’t tell anyone. I don’t think anyone else has this problem. Have you ever heard of this? Is there anything I can do about it?

Anne Fenton, MD: You may be surprised to learn that your problem is actually quite a common one. If I understand you correctly, you are experiencing symptoms to the condition that is called obsessive compulsive disorder. Most people think of this as compulsive handwashing. Some people use the term loosely to describe a person who is very neat or orderly. Actually, it refers to any repetitive activity or thought that seems to have no basis in reality, but is extremely annoying or worse, and only seems to fade or stop when the person does some repetitive action or thought to “make it go away”. Many times, people are embarrassed by the symptom because it defies logic. One hallmark of the condition is that the individual knows it makes no sense, but also can’t stop it.

There are behavioral therapies for the condition, as well as medications that can work very well to suppress the symptoms, so that they won’t interfere with daily living. Research suggests that a combination of combining the techniques is optimal for treatment.

Question: I have a male primary care who is treating my depression. My husband, who sees a psychiatrist, thinks I should see one, too, since they know more about all the conditions and medications and all that. Is he right, or am I ok to keep seeing my primary care? I think I’m doing fine, but I guess my husband thinks I could do better.

Anne Fenton, MD: My guess is that you wonder if your husband may be right. If that is the case, there is no harm in consulting a mental health professional. I am sure your primary care would have no problem referring you to someone for a second opinion. Our job in the medical profession is to help people in the best way possible. We know this often includes referring our patients to people whose opinion and expertise may prove to be more helpful to our patients.

Question: For the first time in his life, my husband, who has always made really good money, and has had high power positions, is out of a job. He sits at home at the computer all day and doesn’t get anywhere. He has really changed. He’s mad all the time. I wouldn’t be so worried if this hadn’t been going on for so long. It’s been two years now. How can I get him to go see someone?

Anne Fenton, MD: This is unfortunately becoming more of a problem with the decline of the economy. You might try the straightforward approach. Let your husband know that you are worried about him. You understand how stressful and frustrating it must be to have difficulty providing for his family and to be at home all the time. In fact, for someone who has always been active, and whose identity is largely tied into his profession, this kind of change can trigger a depression. There may be other factors at play as well, such as his thinking you see him as a failure, which may result in his trying to avoid you. If you let him know you are aware of these things, he may be more receptive to seeing someone.

Question: I would like to find a therapist or psychiatrist who understands the religious lifestyle and respects that. I would like to talk to someone about some issues.    But whenever I have tried in the past, I can tell that people think there is something wrong with me and tries to talk me out of being religious.  My friend sees a therapist who is a Christan, but I really want to talk to someone about medication, not just counseling.

Anne Fenton, MD: There are professionals who share your beliefs, and understand that spiritual health is at least as important for sound mental health as are social, emotional, and physical health. For a list of such like minded counselors and doctors in your area, consult your local religious organization. You are absolutely right that tampering with one’s religious beliefs can be as seriously detrimental to one’s health as religious sensitivity, awareness, and belief can be of incomparable therapeutic benefit.

Question: I’ve worked hard all my life to give my kids everything they could ever want, maybe because I grew up poor. I didn’t finish school, but I wanted my kids to go to college. Now my oldest son is a junior in high school. He is very smart, but he doesn’t really care about school, and even if I take things away like his game boy and his Wii, it doesn’t matter. I want him to have a good job some day, but at the rate he is going, it doesn’t look like he is going to.

Anne Fenton, MD: You are describing a problem of motivation. Unfortunately, many kids today have so many toy that they don’t care about any of them. Appreciation seems to be a thing of the past. It sounds to me like your son may not need a therapist as much as a father to help him appreciate the value of all those material things, not by giving him more and more, but by taking all of it away and starting from scratch. Think how you developed the kind of motivation that enabled you to afford all those things for your kids. It wasn’t by having more than you needed, but needing more than you had.

Question: My teenage boy has just been hospitalized and diagnosed with bipolar disorder. He was discharged to a partial hospital program. But he refused to go, and just wants to get back to school and “be like a normal kid”. He is giving me a hard time about taking his medication, even though it helps. His father doesn’t want him to take medication, either. What should I do?

Anne Fenton, MD: There are times when, due to the child’s opposition to treatment, and minimal cooperation or support from other family members, it can truly be impossible to enforce treatment. In such circumstances, a child my have to fail before he and others are willing to accept the reality of the condition and need for treatment.

Obviously, this is neither the ideal nor the preferred outcome. I therefore suggest that you try to enlist the support of anyone you know, friends, other family members, your pediatrician, your and your husband’s primary care physician, your spiritual counselor, and anyone else you can think of to speak with your husband about your child’s need for treatment. Once your husband understands and is “on board”, it will be easier for the two of you as parents to present a united front to your child. Many times, parental ambivalence is very transparent to the child. It confirms his or her worst fears and erodes trust in the treatment experience. On the other hand, when parents stand united on any matter, the child feels more secure and safe, and therefore more willing to turn his care over to the treaters his parents trust.

Question: How young is too young to have a child evaluated? I have a 4 year old.  He is very wild and hyper, and he has never slept through the night. Now he is starting to have terrible tantrums. Our family is paralyzed. We can’t take him anywhere, because he has a fit whenever he knows something is about to change.

Anne Fenton, MD: Without exaggeration, no one is too young or too old for an evaluation. Of course, the younger the child, the more his or her parents are integrally involved. Much of what we do, therefore, is parent guidance. However, we are also learning that many psychiatric disorders we formerly thought affected only adults actually are identifiable in early childhood. Such conditions as autism, bipolar disorder, and anxiety manifest in various ways in infancy which are predictive of certain symptom trends in later childhood and adolescence. Obviously, early detection and intervention can help a good deal to prevent complications later on. For example, mood dysregulation (inability of the child’s nervous system to regulate mood and respond with resilience to various stimuli) in early childhood seems to adversely affect learning in school later on. One mechanism may be due to the interference of mood in the child’s ability to focus in the classroom. An ounce of prevention is worth a pound of cure.

Question: My husband and I are going through a divorce. We have two kids. I’m really worried that they are going to act up, and I won’t know what to do. What should I expect. I want to be ready for the warning signs so I can get them help if they need it. But I don’t want to jump the gun and give them some idea that they have to have problems if they are able to get through it ok.

Anne Fenton, MD: Your question is a good one. The larger issue you pose is at what point should anyone seek treatment. I define symptoms as any behavioral changes which interfere with normal functioning. In the case of children, it is often difficult to tell when they are having real behavioral issues, and when they are simply going through a stage in normal development. If you are uncertain, feel free to consult a child psychiatrist. If you would rather spare your children an unnecessary evaluation, interview the psychiatrist first and ask your questions. The psychiatrist can help you identify possible issues, as well as make recommendations based on your account of the situation. The psychiatrist may advise you to hold off on an evaluation, or see the children directly. Most treaters are experienced enough to offer a comfortable and non-threatening environment to children and parents.