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Dr. Navitsky
Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1037
Experience:  US Pediatrician licensed in California living abroad.
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My son is a twin aged 6.He was born at 29 weeks and had

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My son is a twin aged 6.He was born at 29 weeks and had severe twin to twin tranfusion,He has been very difficult to bring uo and is extremely impulsive and hypa active.I have had him assesed but can not get a clear diognosis,although i know he has this.In school his behavour is better and that is why i cant get the answers i need.Please could you give some advice?
Dr. Yogindra Vasavada :


Dr. Yogindra Vasavada :

By age of six most behavioral problem cases are considered for drug therapy. But since his behavior is good at school, you may defer this decision for later.

Dr. Yogindra Vasavada :

Most likely cause is brain center development anomaly. There can not be clear fix solution but you have to devise reward and punishment strategy which is consistent and agreed upon by all elders.

Customer: replied 4 years ago.

Please can you explain the centre development abomaly?is this to do with his birth?

I have used this type of reward and punishment stratedy with him for a few years now,although this helps a little,he is still so impulsive and im woried he is going to hurt himself or someone else.He is doing such dangerous things and i have to watch him at all times.

Customer: replied 4 years ago.
Relist: Answer quality.
Hi there I can try to help you first I am going to enter this to see if I can catch you online still and will send you some more in just a moment thanks!
Customer: replied 4 years ago.

hi im still online

I see that I have reached you. So for your son's case it sounds like you feel that he fits a diagnosis of ADHD. You have had him evaluated by whom? What were their thoughts? A prime characteristic of ADHD is being impulsive to the point of doing dangerous behaviors (running into the street for example), and sometimes I may move to try a medication when something like this is going on even if a child may not "fit" the diagnosis criteria totally. But if the behaviors are less (but present) at school vs if they are totally gone at school this may make me feel different. If the impulsiveness is gone at school then it would make me feel that things may be more a reflection of just behavior not necessarily a disorder but how he fits with you as a parent and thus may not require medication. Stimulant medicines for children with ADHD are amazingly effective and although I highly agree that we are medicating too many kids these days (most of them don't really have ADHD), I also strongly feel that there are children who need this kind of medicine to be "normal" and have a normal childhood experience. Actually when impulsivity is so great that it places them in danger I get worried about what could happen to them and this far outweighs my fear of using a psychotropic (mind altering) medication. More to follow.
your son being 29 weeker and then having severe twin to twin transfusion had obviously a long illness as a neonate that required significant medical therapy and support. Just being born at 29 weeks places him at a higher degree of risk for issues with learning and behavior later on (now!) but in addition to that he had an experience that kind of altered his first few months of life and medicalized them. I am glad that he was able to pull through for you guys! However many kids who have been very ill even as babies can also be at a greater risk for behavioral problems later on either stemming from their illness, or the bonding they had as a "sick" baby/kid etc...thus for a child like this I would have my radar on high to make sure that he got all the support he needed at school in order to learn to the best of his abilities. Did he get any early intervention services such as for speech or PT or OT? What does school say about his behavior to you? In the US at school age the school itself is responsible for doing psychological/learning assessments is this true in the UK as well?
Being highly impulsive can also be symptomatic of something like bipolar disorder as well later on although this is kind of controversial to diagnose in a child this young it is fairly accepted that it does exist. Just being premature and having had a severe illness wouldn't increase his risk of mental illness later on but if there is any mental illness in your families then this would. Basically I would make sure he has been evaluated by a pediatric developmental specialist and I would share your concerns about not being able to take your eyes off of him for even a second. If you feel that there could be any type of mental illness then a child psychiatrist is also a good place to seek an evaluation. If medication were to be suggested either one could help you with this. There are rating scales that we use in pediatrics that are validated and well accepted to "test" a child for ADHD the 2 most used include the Conners scale and the Vanderbilt's scale. I like the Vanderbilt personally as it also has questions that involve mental illness. At age 6 as a pediatrician I am able to diagnose and treat this without the help of a specialist in the US, but around 6 and under I really like to exercise caution in using medication and often will send a child out for either a psychological evaluation or a developmental/behavioral one.
Please feel free to reply to me with any thoughts you have as I see you are now offline. If you could share what type of evaluation you have had this would help me give you more specific advice. I will be looking out for a response and hope you are having a good evening!
Customer: replied 4 years ago.

not sure if my last email reached you?he was assesed by a consultant phsyciatrist,he said that he thought Bryces probs were to to with the hard wiring of his brain,but showed symptons of ADHD also. In the last week he was caught stealing at school and climbing on the sinks to get out of the window.At home last week he ran straight accross a road,tried to climb up the chimney and says he can fly.His impulses are so quick and there seems to be no triggers for these.I have to pay to see a phsciatrist as i have been trying for 4 years to get him assessed but have been told no over and over.I have always known things are not quitebe as they should be.He also head bangs at night although i have managed to get to do this just on the matress now.Was on the floor at one point.I worry about some of the things he says.He talks about hurting people and his brother a lot.He certainly worries me

Hi I hadn't gotten word of the response and all of what you describe would worry me as well. Did the psychiatrist suggest medication for Bryce? He was a child psychiatrist that you saw correct? Not a psychologist (PhD not MD). I am assuming that you have tried to have him assessed via your GP referring out correct? Do you have any behavioral developmental pediatricians around they would be in a teaching hospital area most likely. The head banging is actually common and not really a specific sign of anything in particular kind of a self stimulating or calming behavior. At 6 I would also worry about what he is saying as it seems that he may be acting on what he thinks (hopefully he hasn't tried to fly!) but it does seem that he is lacking the common sense that normally stops us from acting on our impulses. Is there mental health illness in your families? The problem with medicating for ADHD when there is actually something more going on (like for example only! the start of a bipolar disorder) behavior could be pushed in one way or another by the medicine for example towards mania the high points in bipolar when they feel they can do anything like fly...which could be dangerous. I don't quite understand a physician telling you that there is something wrong with the "hard wiring" of his brain though at least not in 2013. Child psychology has advanced by leaps and bounds and many things can be given a bonafide diagnosis or at least a ballpark that can give us goals for treatment.

Customer: replied 4 years ago.

yes he is a child psychiatrist md mrcppsych msc actft.My local hospital refused to do the assesment and also the child devolpment team refused.i had to ask my gp to help me find a private doctor.He has sugested ritalin,which i have been unsure about he was tried on fluoxetine but he seemed to go even more hypa on that.The only mental illness thats been in the family is myself as i have suferred from depression for about 15 years,but not bi polar.i have quite stable for about 7 years before that it was quite severe.I would not like to risk ritalin if it could cause more probs for him?

Thanks for your response. So having depression in the family even if it wasn't severe increases his risk of having a mental health disorder later on period. I glad for you that your depression has been under control since your twins have come into your life! Also very sorry you have had problems advocating for assessment for him as you know something is going on and it is so hard as a parent to "make" the system know it as well. But if a bondafide child psych has evaluated him and suggested Ritalin it make much more sense to me than fluxetine does. Their job is to look out for other mental health disorders as well. Ritalin is not my drug of choice for ADHD treatment as I prefer a longer acting drug such as Concerta or Adderall XR that can be dosed one time a day and last all day vs 2 time dosing and peaks and valleys of Ritalin. However it may be a good idea to try it first as you can start at a low dose and gradually increase easier and you can stop quickly if need be. If it is going to work should be evident at doses of at least 10mg a day and it can be so crystal clear that when you forget to give it to him the school can call and ask if he took it or not. I am often amazed at how well it works and how proud kids can be of themselves being able to stay out of trouble and not be the "bad" kid anymore. Taking medicine is a huge step I understand as a parent but it seems that your son's behavior could be dangerous to him or to someone else and if medication could help this I would think it would be totally worth the side effects. I liken it to an asthma pump or a insulin for a diabetic. ADHD is a real disorder and thankfully it is treatable. I wish you the best. I am about to call it a night but will be back online in the am thanks!!

Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1037
Experience: US Pediatrician licensed in California living abroad.
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