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The treatment of children with ADHD, autism, depression, pediatric bipolar, and anxiety disorders at Cady Wellness Institute
 The twenty-first century is both the "best of times" and the "worst of times" for the treatment of children with significant neuropsychiatric disorders.
On the one hand, at no time in history have clinicians had the breadth of knowledge, sophisticated medications, and amazing neuroimaging devices that can peer inside the living minds of our children. On the other hand, at no previous time have children been bombarded with the levels of toxins in the environment, mercury in their (past) immunizations, concentration-destroying media involvement, and economically stressed families in a tumultuous period in the national and global economy.
The evaluation of children, and the appropriate interventions - possibly including medication, a comprehensive neuro-psychiatric/bio-medical approach, or both - is considerably more complicated than in adults. Children, with their precious developing minds, are not as capable as adults at describing exactly what is wrong with them. They are just beginning to understand their feelings. Figuring out what the relationship between how they are feeling or acting, and what may be wrong with them, is beyond their processing or communicating abilities.
Sometimes they feel "bad" or "mean" or "down" for no particular reason. If they are on the autistic spectrum, they may not even appear to manifest feelings, and will retire into a solitary world of their own bleak isolation, trapped inside the confines of their minds. If they are pervasively hyperactive, they may realize that they are "wound up" more than other children (and are constantly in trouble) but will be powerless to change it. If they are sliding into depression and harboring dark thoughts of suicide, they may be simultaneously alarmed by it but incapable of reasoning through what is happening to them. If they have processing disorders, they may appear "stupid" or "dull", even though their intelligence may be extremely high, simply because they "can't get the data in and out" through their eyes, ears, or in their verbal expression. And if they have significant attention deficit disorder of the predominantly or exclusively inattentive type, they may be lost in a fog of their own, dreaming away their lives, with most of the excitement and color of their existence passing them by because they can't focus on it.
As children age, there is a fascinating evolution of issues and symptoms. What we have seen at Cady Wellness Institute follows approximately these ages and issues:
2 - 3 years of age: usually it is PERVASIVE, dramatic, and pathologically obvious hyperactivity that brings frazzled parents and their children in for evaluation. We have frequently heard, "My kid is flunking day care," by which the parent means the child is about to be ejected from day care due to assaulting other children, inability to keep still or be silent, and so forth. Disorders of hyperactivity this severe are exceptionally rare, but they do occur, and we have had excellent results in treating them - and without turning innocent little children into drugged, mind-controlled "zombies."
2 - 4 years of age: this is where severe autism and the autistic spectrum disorders begin manifesting. What is frequently seen is an uncomplicated birth and development, normal bonding, normal development, and then the child just begins slipping away, lost in a world of his or her own. The little girl or boy seems to lose emotional attachment with parents and siblings, retreat into a strange and remote place where sitting quietly and spinning the wheels on toy cars, or leaning out of a motor boat to "watch the propeller go around" seems to be the most fascinating and compelling thing possible. It is critical for children to be evaluated and vigorously treated at this time, according to a mounting and intellectually overwhelming body of evidence compiled by bio-medical experts in the treatment of autism, because it is through this period of time that the brain is going through some of the most critical emotional and intellectual processing and development. The general orientation of most experts in the field of treating autism and autistic spectrum disorders is that early intervention is imperative, because you can "never get it all back" if treatment is delayed.
Separation anxiety disorders or increasing evidence of ADHD - usually the hyperactive form - can be seen.
5 years of age: preschool. Auditory processing problems, attention deficit disorder with inattentiveness, or hyperactivity, or both, can be seen. Autism symptoms will be obvious. If disorders are subtle, the child can overcompensate for them and nothing will be seen clinically.
6 years of age: first grade. Frequently children with significant ADD (hyperactive or inattentive) will begin falling behind. More problems with separation anxiety may be seen. Autism symptoms more obvious. Kids with subtle symptoms can continue to slide by under the radar.
7 - 8 years of age (2nd and 3rd grades) - problems with ADD/ADHD may be more severe. If there are problems with a pervasive developmental disorder, Asperger's, or autism - it will be even more obvious, and peers of the child will begin to catch on. Typically, in first grade, kids get a "pass" from their little buddies, because everyone is pretty oblivious. As the second and third grade classes continue, kids begin to be known as "weird" or "strange", and unfortunate labeling by their peers begins.
9 - 10 years of age (4rth and 5th grades) - academic work gets harder. If there are reading disorders or verbal or auditory processing delays, the buildings blocks of a child's education are not set correctly. Children begin to consider themselves "stupid" or "dumb" and begin to accept the labels that other children place on them. More mood disorders - depression and anxiety - can result. Kids with Asperger's disorder or who are developmentally delayed or clumsy start to get ridiculed by their peers. Interest in sports may start to evolve - and the child will be the last one "picked" for the teams.
11 - 13 years of age (grades 6, 7, and 8) - entry into middle school presents new challenges for children with ADHD or processing difficulties. Changing classrooms, getting books out of lockers (and being able to find things in there!), and getting to the next class on time can be insurmountable tasks for kids that can't process information rapidly, or who have very poor senses of direction, no sense of time, or who are perpetually confused because they are just "not getting it." More severe problems with anxiety and depression can result. Experimentation with alcohol, marijuana, and even other illicit drugs can begin if the child falls victim to a bad peer group. Children with ADD/ADHD or processing problems are falling hopelessly behind. Suicide attempts in this age range have been made.
14 - 17 years of age (grades 9, 10, 11, and 12) - with entry into high school, everything begins to count for real. Now there is real pressure to "get the grades" in order to continue in higher education, or just to learn the lessons and "get the diploma." Kids with developmental disorders or special needs are by this time "identified" and they may be getting either perfectly appropriate treatment or be shuffled off into less demanding work for the two fold objective of not slowing down the other kids who are "getting it," as well as to avoid rubbing their noses in the fact that they, themselves are not. Degrees of remediation and educational intervention and assistance by the school system may range from superb and encompassing to mediocre or downright pathetic. By this time, if a child was "hyper" growing up, the hyperactivity begins to dwindle. Concentration difficulties do not, however, dwindle by themselves, and it is usually 10 - 15 years into the future when, as a young adult, concentration and focus has improved to the maximum extent that it will.
Children with significant Asperger's or PDD are headed for marginalization and social isolation the rest of their lives, and usually have not experienced success through this period of their lives. Autistic kids are diverted into a path they will most likely stay in the rest of their lives. Depressed kids, or kids that have begun to manifest pediatric bipolar disorder may have already tried to kill themselves more than once. Experimentation, abuse, and outright dependence on alcohol, marijuana, cocaine, or methamphetamine is possible.
In rare cases, the "first break" episode of paranoia and psychosis can occur in young people who are hit with the disorder of schizophrenia. I have seen these episodes occur as early as the junior or senior year of high school, frequently with a sense of isolation and being "picked on" by classmates and peers.
18 years and up. Congratulations. Your child has made it into adulthood. However, problems that began in childhood and continued in the teenage years are likely to remain. Your child has hopefully had an intervention and assistance during this time. If not, problems are likely to persist throughout life.
The absolutely critical thing in evaluating children - from tots to latency age children, to pimply faced adolescents, to maturing and delightful young people - is that a comprehensive evaluation, of broad scope and sufficient detail to encompass ALL of the aspects of a young person's history, should be performed. This includes a DETAILED history of the presenting problem at hand, a complete review of the child's and family's medical history, a complete review of the child's past psychiatric history, if any, as well as the family psychiatric history. Usually, that is as far down as the diagnostic "drilling" goes. At CWI, however, we want to know about toxic exposures, environmental toxicities, dietary habits, and evidence of food sensitivity reactions as well as inadequate protein consumption (which depressed the normal amount of neurotransmitters) as well as essential fatty acid consumption (which relates to nerve cell membrane fluidity and the severity of depression, bipolar disorder, and ADHD).
Another commonly overlooked problem is HEAD INJURIES - which do not require loss of consciousness. They may have occurred in motor vehicle accidents, falls down stairs, in bathtubs, out of tree houses, or off of jungle gyms. The manner in which these subtle brain injuries can affect a child is incredible and profound. It is commonly overlooked, and, in the experience of Dr. Daniel Amen, M.D. (and confirmed by Dr. Cady in his clinical practice), the child (and parents) typically have to be asked about FIVE TIMES in order to make sure that no brain trauma is overlooked.
We obtain this complete biopsychosocial database using a form of intake known as a collaborative evaluation: the child (and parents) usually see either Linda Simmons, LCSW, or Marcella Piper-Terry, MS for an exhaustively complete background interview before they are seen by Dr. Cady. If there is evidence of profound psychoneuroendocrine disruption, the child and parents may also be interviewed by Dr. Whitney Gabhart, a naturopathic physician who works as an educational consultant to Dr. Cady and the Cady Wellness Institute.
After the determination is made about our findings and diagnoses, we collaboratively discuss with the parent and the child the various therapeutic interventions (based on accepted diagnostic protocols in the psychiatric profession, as well as the accepted protocols in the bio-medical intervention model of autism, iindicated) we believe are appropriate. In general, our preference is talk therapy first, then treating underlying medical and physiologic abnormalities, and medicine as a last resort. Our patients - by the time they arrive at Cady Wellness Institute - tend to be so complicated and so frankly ill, however, that we usually end up using a synergistic combination of all three, with psychotherapy frequently having to wait until a child can be stabilized.
We emphasize optimizing the family system, appropriate use of time outs, the use of both negative AND positive consequences, and an attempt to set up the child so that he or she can succeed more frequently than not, rather than fail. If we believe that a child is noncompliant, stubborn, oppositional, and unlikely to benefit from treatment, we will bluntly tell the child and his/her parents that we do not appear to be making progress and that they are wasting their time (and money).
This rarely happens, however, as we have found the following: it is truly amazing that when a child or teenager is approached in a neutral, non-judgmental way, the facts are candidly and unemotionally reviewed, and the child or teen is told that a lot of what they've lived through is not their fault because they had a brain system problem that we can fix, three wonderful things happen. First, the child relaxes and stops fighting. They experience a great sense of relief that it not them who have been "screwing up" or "are stupid." Second, the child begin cooperating with the treatment program. Third, the family system improves almost immediately. Parents and their kids are no longer at each others' throats.
As we consider our work with our youngest patients, we are once again reminded of the tender words of the Lebanese poet and painter, Kahlil Gibran in his lyric verse, "On Children":
Your children are not your children.
They are the sons and daughters of Life’s longing for itself.
They came through you but not from you.
And though they are with you yet they belong not to you.
You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams.
You may strive to be like them, but seek not to make them like you,
For life goes not backward nor tarries with yesterday.
You are the bows from which your children as living arrows are sent forth.
All the clinicians at Cady Wellness Institute treasure the opportunity to work with you and your child in preparing "their souls [to] dwell in the house of tomorrow."
© 2008 by Louis B. Cady, M.D. No part of this web page or essay may be reproduced or distributed in any way without written permission of the author. If you desire to quote from it or reprint it, kindly direct a phone call to the staff at Cady Wellness Institute to request permission to quote or reproduce it - permission which will not be unreasonably withheld for churches, community organizations, schools, and educational institutions.
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