tag:blogger.com,1999:blog-8184208181444239184.post4798359838579250341..comments2024-03-14T13:25:42.698-04:00Comments on Child in Mind: Ritalin for all: the fallacy of simple answersClaudia M. Gold, MDhttp://www.blogger.com/profile/13081419560269676730noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-8184208181444239184.post-90393379840045616492012-09-16T22:01:37.163-04:002012-09-16T22:01:37.163-04:00May I suggest that if you do in fact hope to follo...May I suggest that if you do in fact hope to follow the guidance implicitly found in the phrase "embrace complexity" that you - as a professional care provider - can multi-track your response to parents such as those you describe.<br /><br />Put another way, multi-factorial problems require multifaceted responses. In the case of the family described herein, disaggregating the familial, marital, developmental and behavioral issues that you recount, you can undertake (or urge the parents to approve) cognitive testing of the child should he/she endorse the diagnostic criteria for ADHD in your office. Once the results are in-hand, a course of treatment can be more accurately and reliably implemented - should the data indicate ADHD or another disorder.<br /><br />As you know, the testing conducted sans medication. In this way, you and the parents will be working from a common understanding and an objective set of results. Of course, some parents and even some clinicians harbor pre-existing doubts about the efficacy of cognitive testing and may therefore torpedo even the most genuine efforts on behalf of the child in concord with the data.<br /><br />I would also suggest that the controlled use of stimulant medication is among the most well understood psychopharmacological tool that clinicians can use in service of their patients. The body of knowledge upon which you and any other clinician can draw on is over 100 years deep.<br /><br />That said, it seems only sensible to approach the problem of issue disaggregation, diagnosis and differentiation on mutually reinforcing, parallel tracks.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-60309002917085814812012-09-04T16:16:04.294-04:002012-09-04T16:16:04.294-04:00The bin sounds like a good idea. However, we would...The bin sounds like a good idea. However, we would still have children who have what I am calling biological vulnerabilities such as sensitivity to sensory input or difficulty with state regulation. In another culture where kids are less bombarded with sensory input, or Kindergarten was less structured, these might not be a problem. However, in our society, I think it is important to validate parents' experience of children, as well as the child's experience, and support them in thier efforts to mamage these vulnerabilities. If we could do this without a diagnostic label it would be ideal.Claudia M. Gold, MDhttps://www.blogger.com/profile/13081419560269676730noreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-31411905115631162222012-09-04T07:19:58.536-04:002012-09-04T07:19:58.536-04:00Claudia and David, the germ theorists were right, ...Claudia and David, the germ theorists were right, but they were not proved right until Koch proved them right. Claudia, you will appreciate that a likely counter-example are the attention-deficits. Do we continue to hold out hope that biological correlates will be found? Or will we wait for the diagnosis to fall into the bin next to hysteria, homosexuality and masturbational insanity?Big Lebowski Storehttps://www.blogger.com/profile/09131330425557709407noreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-52556827862103966952012-08-31T21:27:32.529-04:002012-08-31T21:27:32.529-04:00Unless we're talking about souls here, which i...Unless we're talking about souls here, which is outside the realm of science, ALL human behavior and all brain activity is "biological." It's not reductionistic to say that. <br /><br />The question is what behavior patterns are or are not due to a physical brain abnormality, or are instead the reactions of a healthy brain to a problematic environment. <br /><br />Hard to absolutely "prove" one way or another given our current understanding of neuroarchitecture, but I don't think that level of proof is required to discuss the evidence for and against and make a reasonable guess. No one knew what germs were when the plague wiped out half of Europe, but they sure knew it wasn't the workings of a healthy body. Seems they were right.David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-54034209458883425522012-08-31T08:23:58.678-04:002012-08-31T08:23:58.678-04:00And your point is well taken as well, Claudia. I ...And your point is well taken as well, Claudia. I want to underscore that calling a trait "biological" ought to remain in quotation marks until such time as we can identify what biology we are referring to. Otherwise, we commit another fallacy: the fallacy of biological reductionism. To repeat, the fallacy is a fallacy because we assume a biological entity without actually producing one.Big Lebowski Storehttps://www.blogger.com/profile/09131330425557709407noreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-10415891312670114132012-08-31T06:18:54.933-04:002012-08-31T06:18:54.933-04:00Hi Rob
Thanks for your comment. I understand what...Hi Rob<br /><br />Thanks for your comment. I understand what you are saying about cultural bias regarding "normal" activity level. What I mean by biological vulnerabilities is traits that appear to reside in the child from birth. This would include such things as a baby who is not cuddly or who has intense reactions to sounds, or has difficulty transitioning from awake to asleep. Nurses often identify these babies in the newborn nursery as standing out from the other babies. When a child develops motor skills in advance of cognitive development, this can be seen as a biological vulnerabiity analogous to language delay when a child's capacity to communicate lags behing his cognitive development.Claudia M. Gold, MDhttps://www.blogger.com/profile/13081419560269676730noreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-81353818233812500542012-08-30T16:51:16.697-04:002012-08-30T16:51:16.697-04:00"Current research at the intersection of gene..."Current research at the intersection of genetics, neuroscience and developmental psychology reveals a complex ongoing interaction between biology and environment."<br /><br />More wishful thinking on your part, than the evidence would suggest. Claudia, as much as we'd LIKE to understand the biology of behavior, the fact is we haven't the foggiest idea what "biological vulnerability" means.<br /><br />You prove this point with the running 9-month old. Calling his behavior abnormal reveals nothing about his brain, and everything about our culture biasesBig Lebowski Storehttps://www.blogger.com/profile/09131330425557709407noreply@blogger.com