It's Nobody's Fault Read Online Free PDF Page A

and the brief overview of a child’s developmental milestones are not meant to be alarming to parents, but I do hope that if you see that your child is not developing normally or that he’s exhibiting unusual behavior, you will be encouraged to do something about it. (Chapters 7 through 19 thoroughly examine the most common brain disorders in children and adolescents.) For example, if a child of two seems exceptionally uncomfortable with people, you should say, “You know what? My kid is supposed to be over this by now. Maybe I should talk to the pediatrician about it. Perhaps I’ll get him to recommend a child psychiatrist.” There’s nothing to be lost by getting some professional advice. The only thing better than prompt treatment of a disorder is the reassurance that nothing is wrong.
DISTRESS AND DYSFUNCTION
    Schoolteachers have the three Rs: reading, writing, and ’rithmetic. Child and adolescent psychiatrists have the two Ds: distress and dysfunction. In deciding whether or not a child needs treatment for a disorder, we look for one or both of the Ds. If a child’s symptoms are not causing him or his parents distress or dysfunction, we watch and wait. Perhaps it’s not a disorder but the child’s style or an element of his personality. If and when the symptoms of a disorder increase and
do
cause distress or dysfunction, we establish a course of treatment, usually a combination of behavioral therapy and medication.
    Child and adolescent psychiatrists are in the business of treating children who are sick, not medicating children who aren’t sick so that they can become more popular, perform better at a music recital, or turn a B + average into an A average. Since most children’s brain disorders are treated with medication and since all medications have some side effects, no physician is eager to put a child on medicine unless he really needs it.The first line of attack should be and is psychosocial intervention. Medication isn’t called for unless there is a diagnosable disorder.
    Any physician must weigh the seriousness of a disease against the effects of the cure. Before he is treated with medication, a child has to be sick
enough.
If a boy bites his fingernails and the medicine to get him to stop doing it causes liver failure, we live with the chewed-up nails. After all, there’s no dysfunction involved, and the distress is only on the part of the parents. On the other hand, a girl who’s banging her head so hard and so often that she detaches her retinas needs a trial of medication to get her behavior under control, even with the risk of side effects.
    Distress is not always obvious to spot in children. Some admit it, but many others deny that they’re in pain. Distress may manifest itself in any number of ways, many of them in conflict with the others: agitation, depression, social isolation, boisterousness, silence, sleeplessness, giddiness, sadness, and lots of others. Identifying dysfunction is a little more clear-cut. A child is dysfunctional if he doesn’t achieve and maintain developmental milestones; if he can’t or won’t go to school and pay attention; if he doesn’t have friends; or if he does not have a satisfying, loving relationship with his parents.
TAKING CHARGE
    “It’s been really hard,” said a father of a little boy with attention deficit hyperactivity disorder. “I was looking forward so much to being a dad, and when my son finally came along, I was incredibly happy and excited. I wanted to do millions of things with him—all the great stuff my dad did with me. I couldn’t wait to play catch and go camping and that kind of thing. Then I found out I was living with a holy terror who was an absolute pain in the neck to spend time with. I hate to admit it, but I was pretty disappointed.”
    The father’s statement is extremely blunt, true, but he’s only expressing what many parents with problem children feel. When a baby is on the way, parents are expectant in more ways