The “real” me: with medication or without?

onefour

I’ve been doing research for my latest book and was interested to find studies are showing that students who take medication for AD/HD are conflicted about their identity. These students seem to be absorbing larger social impressions/myths that imply that some kinds of medicine are less valid than others.

While starting medication from a young age can allow a student to suddenly focus in class, students are also being impacted from a young age by the social myth that goes something like this, “Normal means being who you are without taking medication [unless you need medicine for life and death], so when you take medication for AD/HD you aren’t behaving like your normal self; you only are your normal self if you aren’t taking medication.”

childm

Obviously there are a few problems with the myth that says we aren’t our normal self when we take medicine, or that medicine impacts our identity and makes us someone else; that the behavior we exhibit when taking medication is not our ‘real self.’

In order to make it clearer why I think this is problematic, let me compare this version of what it means to be ‘normal’ or authentic, with what it would mean to be Type One diabetic and to not take insulin. We understand that people who need insulin and do not take it are more likely to have serious health impairments and that they will potentially die. So as a society we do not label someone who takes insulin as more or less their true self – we say they need to take insulin to maintain their health. As a society we suspend judgement about the person’s ‘authentic’ identity and tend to think that someone who is diabetic is their regular self while taking their insulin.

Yet, when someone takes medicine because of a health issue that affects their mental state, we seem – as a society – to be quicker to make judgements about the person: about how normal they are, about who they ‘really’ are; as if a person can be separated out and  should have to choose between being authentic, or being healthy. We don’t seem to be as quick to accept that a person can be their authentic self while taking their medication to remain healthy, or to function to their potential when the medicine impacts mental states. This seems most true for AD/HD medication but applies to a lesser extent to medications given for unrelated mental health issues (depression, anxiety, etc.)

girlmd

We’re giving young people in our society a very troubling message, and studies are showing that young people are absorbing this message. As a society we’re saying that there are medicines we see as being legitimate, and medicines which we see as enabling poor study habits, unruly behavior, and medicines which enable people who should be able to just ‘pull themselves together’ to get by without the effort other people put into life.

As parents, caregivers, and educators, we need to promote the idea that a medication that assists a child in being healthy, productive, and happy is not a crutch. Nor is the child less him or herself when taking their medicine. Just as our behavior will change if we don’t sleep for several days in a row, or our behavior changes if we consume a lot of sugar at once, our behavior can change under many circumstances. We remain ourselves, even when our behavior changes. Medicine may impact our behavior however, the medicine does not make us less real or genuine. We remain our true selves when we use medicine to assist our quality of life. We are not less genuine, less normal, or less our ‘real selves’ when we are using medication.

Of course, some people will always choose to not use medication and I certainly believe that individuals have the right to make choices. An insulin dependent diabetic who chooses to stop using insulin will have dramatic consequences. Young people who choose to stop using medication as they become adults entering college will also find they face some dramatic consequences; when any person stops using a medication that their body is accustomed to, both their health and their study habits will be significantly impacted. One’s body will react to any sudden change in chemical balance.

medstu

Whatever medication a young person is accustomed to, if they are planning to stop using the medication on even a trial basis in college, I would suggest they begin this trial stoppage before college begins. At least allow one’s body the summer in between leaving high school and beginning college as an opportunity to begin the adjustment – I would also recommend staying in contact with a health care provider during this transition as any sudden change in body chemistry can threaten a person’s health.

Parents need to understand that they cannot force a student in college to remain on medication. Again, I would suggest families allow their students the summer months to practice what it is like to function without medication, so that students have some idea of what to be prepared for in college. I also recommend that anyone stopping their medication because they feel their identity/personality is impacted by the medication, work with a counselor. Identity is complex and fluid. We all tend to reach a point in our lives when we question who we are and what makes us our genuine selves. Students who have been medicated from a young age are increasingly finding this an internal debate that needs to be worked through and families can assist a young adult by making sure he or she has the necessary counseling support to assist talking through their concerns.

To recap: medicine is a valuable advancement that allows individuals to live a quality of life that is not possible without medication. Not everyone, however, will always choose to use medication, particularly if they are concerned that the medicine they take impacts their identity – their sense of self and personality. In cases where a person is questioning their identity due to the impact medication has on them (or on their behavior) then families can be supportive of counseling which helps a person work through the issues they are encountering. As a society, we can support the idea that a doctor and patient are best able to judge the medication a person legitimately needs and as individuals/groups we can spend less time and energy second guessing medical judgements about medication. The average person is not qualified to determine if someone really needs to take medication – leave that judgment to people who are qualified; when you hear someone else second guessing a person’s need for medication, then remind them that the doctor’s opinion is more valid than their personal bias.

namenotstory

Whatever our personal bias about medicating children, particularly children living with AD/HD – we need to stop voicing these opinions in front of children. We, as part of our larger social groups, are having a negative impact on how these children view themselves. We, as individuals, can be the source of improving the social climate these children grow up in.

 

Who made your child’s diagnosis, how was it arrived at, and does it matter?

papers

Recently I’ve had people send me several news stories about the over-medication, or inaccurate medication of young people.

(Examples: “Drowned in a Stream of Prescriptions” – this story is about an ‘adult’ child and therefore different from the younger children I’m speaking of in what follows in this post. http://www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamine-addiction.html?emc=eta1&_r=0

“Attention Disorder or not, pills to help in school” – a story of pills being used to make up for over-crowding and other school and social issues.

http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?pagewanted=all)

Collect family silhouettes

These stories prompted me to think — does the average busy parent, (possibly with more than one disabled child to care for), even have an opportunity to stop and think about the qualifications a doctor needs to accurately diagnosis a disorder like AD/HD? Even if a doctor is qualified to make the diagnosis, did the doctor take the time and go through the necessary steps to accurately diagnose a child? Or did a doctor take shortcuts that led to a quick best guess? Is a doctor ‘just trying’ medication to see if it helps; in this case ‘help’ being shorthand for getting a child to focus more at school.

Unlike antibiotics, which arguably aren’t going to leave a person any worse off if prescribed when not needed, anti-depressants, and the stimulate medication usually prescribed for AD/HD, can both lead to dangerous outcomes if given to a child who doesn’t have a medical need that warrants these drugs.

medical-checklist-hyman

What I am suggesting today is that when parents are given a diagnosis of depression, or AD/HD – or any other disability that a doctor feels requires medication – that parents ask what diagnostic tests have been given that helped the doctor arrive at this diagnosis. Particularly with AD/HD it isn’t enough for even a qualified doctor to just talk to the family or give a quick questionnaire about a child’s symptoms. Along with a full medical history, a doctor should give a child a range of diagnostic tests before arriving at an AD/HD diagnosis. The actual tests may vary slightly between health care providers, but there should be some ‘proof’ that supports the clinical diagnosis.

Depression and other affective disorders are more complicated to diagnose, in that there is not a set of standardized tests that can necessarily be applied to reach an accurate diagnosis. This is why it is important to seek out professionals who are qualified to make the diagnosis: a psychiatrist or neuro-psychologist who works with young people is the sort of professional I would seek out to work with a child. The qualified doctor should take a complete medical history of a child including the child’s family medical history, ascertaining if there is any family history of affective disorders.

pediatric_waiting_room

The doctor should also have follow up meetings with a child, particularly if medication is prescribed, to accurately judge how a child is responding to the medication. Finally, depression and bi-polar disorder both respond best when medication is accompanied by talk therapy – if a doctor is prescribing medication and not requiring follow up talk therapy you need to find a different professional to treat your child.

A qualified doctor making a legitimate diagnosis of a mood disorder, AD/HD or similar disorder and finding a useful medication to prescribe to a child can be a life safer. Parents as always, however, have to be their child’s advocates. Do not allow someone to medicate your child without having first done ample medical tests to ascertain that the medication being prescribed is treating a disorder your child actually has. The right medication is only ‘right’ if it treats an illness or disorder that one lives with.

cdr

 

 

 

Parents supporting students at college: Part Two – Housing and Independence

rainbo

Where will a student live when they go to college?

If they stay in their local area, then they may be able to stay at home. Depending on a student’s disability and how they are managing their transition, medication, and independence, a year at home that further supports the transition to independence might be a good idea.

Sometimes though, dorm life is a good idea for supporting independence, even if the student is close enough to live at home. Moving to a dorm allows a student to be responsible for getting themself up and to class on time, taking their own medication without reminders, being responsible for their own laundry etc. Even if a student remains living at home during their first year at college, families should be encouraging the kind of independence that includes these same specific skills.

studnet

This may mean parents clenching teeth when a student is sleeping through class however, students need to learn the consequences of missing class including failing grades.

Families are not helping students in the long run if the only thing that ever gets a student out of bed is a parent. Students have to learn to be responsible for such things themselves if the final goal is for the student to live independently. Ideally, a student will have practiced getting up, doing laundry, taking medication while still in high school but life isn’t always ideal.

housing

When it is time for students to apply for housing at a university, some parents choose to take on the responsibility of filling out the housing application for their student. I would suggest that it is better to work with the student then to fill out the application for the student. Again, this is a step towards independence and if the student isn’t ready to fill out the application by him or herself, then they probably aren’t ready to live away from home either.

Some families tell me their student is too busy to fill out the application. A student’s life is not going to be less busy once they are a full time college student and learning to manage multiple demands on their time is something families can help students with by helping them make the time to fill out their housing application. Think about it this way – students have to learn to prioritize the most important events over lesser events – having a place to live is a priority over most other activities, including sporting events and extra curricular social events.

cmpshsing

While in college a student may choose to live off-campus at some point. Parents may provide emotional support and advice during this process, they may even accompany their student on visits to potential apartments. Remember however, that this is another step in gaining independence; the final decision is the student’s decision as are the final consequences. If the student chooses a building that has a great social life and as a result their grades start to suffer, the student has to learn how to re-balance their social/academic life and parents will not be able to oversee this process.

The other main thing families can remember is that with university dormitories, students are still in a supported environment – the housing staff is specifically trained to work with young people making the transition to independent living. Rather than stepping in to “fix” problems with the housing staff, families can encourage their student’s independence by discussing issues the student may run into, (perhaps a problem with a roommate) but then encourage the student to follow through on the steps that are necessary to resolve their issue without the parents becoming directly involved.

building

For example, if a student has a roommate issue, they can discuss this with the housing staff person responsible for their living unit (floor, hall, building) – there are levels of such staff, whose purpose is to help students resolve conflicts: Resident Advisers, Community Advisers, Professional Staff etc. When families would like more information about such staff and related processes they can now find this information on web sties; go to the university’s web site, find the link for Housing, and then read over the related housing web pages to find out what processes your student does have available to them. You can then advise the student about the process, without having to step in and implement the process yourself.

On or off-campus, a student who is in college needs to start putting into practice the independent living skills that are part of becoming a self-sufficient adult. Families need to remind themselves that it is generally better for students to live through a few bumpy moments at college, sorting out their problems without parents jumping in to ‘fix’ things, if students are going to be well prepared to adjust to the next step of their life – living independently as a working professional.

ngthcmp

Parents supporting students at the college level: Part One – Transition and Classes

shadows

Raising a disabled child is challenging. Just ask my parents (they don’t complain but they could tell you a lot about the challenges.) How children are raised has changed a lot since I was growing up but one thing hasn’t really changed – when parents have a child who faces a unique set of challenges, the level of support the parents provide in advocating for and providing auxiliary support for their child has a huge impact on how much of the child’s potential the child will realize. Parents who work outside of the classroom with their child have children who tend to do better in the classroom.

Given this, I understand it is particularly difficult for parents who are used to assisting their children achieve success when the now young adult moves to college. How much support should parents continue to provide? Parents recognize that the geographical move alone hasn’t changed who their son or daughter is, so how does a family reconcile what the student may still need with what the parents can provide from a distance?

1-CollegeBoard-brochure

Transitioning to college is challenging for every student – don’t let the recruiting brouchers for colleges, with their pictures of happy students, deceive you. Everyone faces challenges when they first transition to college life; disabled students are going to encounter unique problems as well as some of the same changes their non-disabled peers face such as  new food, new smells, new rooms, new people, new schedules, new ways of doing things….

For some students – disabled or not – a move which places them at a significant distance from home is not a good first move. More students should be making a several step transition to the college they plan to eventually graduate from. At least one year, and often two, can be spent at either a community college or a regional university that is not the university the student intends to take their final degree from. What students sometimes loose sight of is that no matter where they start their college education, their diploma will still have the name of the school they eventually graduate from, not the names of the schools they studied at along the way.

rere

Parents, your role may be in helping students recognize when they are not yet ready to jump straight to a school that is a significant distance from home. Similarly, if your student is only comfortable in a smaller school, going directly to a very large school may not be a healthy transition for him/her – each student has an individual limit to the number of new stresses they can successfully deal with at any one time. Parents, you may be the best equipped to advise your student about their personal tipping point for too much stress.

Parents can also be helpful in making sure their students know where to access the major life essentials in a new environment. Does the student know how to catch a bus/train/subway in their new town? Are they aware of where the closest grocery store and laundry mat are?  Have they found the dining hall and laundry in their dorm housing? Does their school have a health clinic or do they know where the nearest doctor’s office is? And where and how will they be getting any needed prescriptions refilled?

waiting

At the college level perhaps the most significant change in the parent-child relationship that is taking place comes to the parent’s involvement in their student’s study/homework/grades and teacher interactions. It is no longer appropriate – or legal – for parents to receive information directly from the professors of their sons/daughters classes. Legally, once a person becomes a full time college student, they are considered an adult and their right to privacy regarding their grades and school progress is protected.

Grades are not going to be updated daily.

Teachers are not going to respond to demands for information.

Students are not going to always have quickly updated grading information either. At the college level professors may provide very little grading feedback during the course of the semester. Combine this with the potential that a student may choose not to share grades they know a parent will not approve of and it is very possible that a family will not know until the end of a semester that their student has failed some or all of their classes. This is the adult reality of college.

parent

This is a further reason why some families are best served by taking a stepped transition from living at home to living away at school; community and regional schools may be less expensive than the final-destination university that a student intends to graduate from. If a student needs practice being independent then the stress of expensive classes with little room for failure may not be a good first transition step on the way to obtaining a professional degree.

In the next part of this series we will look at another area where students need to be working towards independence: their ability to make housing arrangements.Both on and off-campus housing have specific steps which parents can help with, and points at which parents will need to let their students manage on their own.

 

Science News: “Students with Autism Gravitate Toward STEM Major”

Image

I want to point people towards this article in  Science News.

It supports the observations that those of us working in STEM fields have been making over the past few years – students on the autism spectrum are making up an increasingly larger part of our freshman classes.

Written by Anna Kuchment:

Students with Autism Gravitate Toward STEM Majors

By Anna Kuchment | February 1, 2013

How to read a textbook and learn.

textbook

There is an impression among many students that the way to learn from a textbook is to sit down, read, and perhaps underline/highlights as they go.

Too much highlighting though, is not helpful

Students need to focus on key ideas, main points, and foundational information – then move on to more specific concepts, like how to apply that information to answering questions.

Today I’m suggesting ways to help identify and focus on the main ideas that should be the primary focus when reading a textbook.

What does the Heading Claim?

Pay attention to what the heading says – this is the first clue about what each specific section is supposed to be telling the reader.

Sub-headings – indicate where more detail is being given about the topic in the heading and paragraphs that come before the sub-heading. One way to tell if you’re understanding main ideas is to see if you can review the headings and sub-headings and give a synopsis of the information in that section of the book.

sidebar

Note that most books now use sidebars and boxed text to pull out information that is supposed to be relevant to a section.

These sidebars/boxed text are often a space where you will find examples that try and show the reader another way of understanding the main point.

Terms and Definitions

Textbooks will indicate specific terms and ideas that are important by using bold and italics to make key words/ideas stand out. When a student attends class the professor will also be using these key terms/ideas – listening to the professor and reviewing the text after class will help a student identify which words/ideas they should know in preparing for an exam.

KeyTermsExample

    The importance of attending lecture – Students sometimes think that going to class isn’t important if the professor is just going to say stuff that they can find in the textbook. There are at least two reasons this is usually a mistake:

  • Professors may explain things differently than the textbook, and a student may find this additional explanation very helpful
  • Professors may provide clues about what pieces of information they value (and are more likely to test on)  in the textbook by telling students which ideas to focus on – this helps a student know which parts to focus on when reading the text

Table of Contents and Index

Students sometimes ignore the table of contents/index. These are helpful places for the following reasons:

  • The table of contents lays out ideas in a way that shows how they are connected – the table is like a point-form outline of main ideastable
  • The index will show the reader other places where they can find more information about key-words/ideas – looking at other places where an idea is discussed can help some readers to understand these ideas

indes

Review First and Last Lines of Paragraphs

Some readers find it very helpful to review the first and last lines of a paragraph, to make sure they are understanding the main ideas within the paragraph. The first line usually introduces the main idea. The last line usually summarizes the idea. If you understand the first and last line of the paragraphs in a section, you are probably getting the main ideas from that section.

PictureMarkedPage

It can be useful to summarize a point in the margin of the book, or to mark places in the book where main ideas are stated.

Closing Ideas: Conclusions, Summaries, and Specific Quesitons

Most textbooks now clearly indicate where a summary of the main ideas of a section can be found, by clearly labeling this section “Conclusion” or “Summary.”

conclusion

If a reader doesn’t understand an idea/concept that is discussed in the concluding section, then that is the area of reading in the chapter to go back and re-focus on. If the main ideas in the conclusion seem clear, then move on to the Review Questions or Sample Problems that most textbooks also now include.

sample problems

If after using these techniques a student still has points she is not understanding, then she should either visit a learning center and discuss these points with a tutor, or go to the professor’s office hours and raise these specific questions with the professor. Question and Answers in class or laboratory time may be helpful, however, it is usually a good idea to follow up with specific questions in office hours if questions remain – a student should make sure his questions are resolved before he is tested on a subject; clarifying after the test will negatively impact one’s grade.

     prof student