General Practitioners

• Electrocardiogram
  Stimulant med­i­ca­tions, as compared to other psychoactive med­i­ca­tions, are not only very effective but they work quickly and, relatively speaking, have a good side effect profile. One does not have to monitor blood levels like one does with many other medications, and when prescribed to a healthy child, no lab test or procedure need be done although some physicians and parents choose to do baseline EKGs.

Neurologists

• Autism
  Those members of the American Psychiatric Association (APA) who advanced the pro­posal wrote in the rationale for the changes: “Differentiation of autism spectrum from typical devel­op­ment and from nonspectrum disorders is done reliably and with validity, while dis­tinc­tions among disorders have been found to be inconsistent over time, variable across sites and often associated with severity, lan­guage level or intelligence rather than features of the disorder”. When the APA first published the pro­posals, one could reply on line to them and I wrote that I wondered on what basis one could say that one can differentiate reliably and with validity spectrum from nonspectrum disorders. In my experience in diagnosing AD there are many border­line cases as there are many relatively clear, close to textbook, cases. For the unclear cases it is left up to the diagnostician to decide whether one meets the threshold of AD and there is no tool that one can depend on to determine with absolute certainty that one has AD. If AD is eliminated, what will hap­pen to the ongoing research of subjects diagnosed with AD that seeks more objective psychological and biological signs that differentiate autistic spectrum from typical devel­op­ment and from nonspectrum disorders? I also argue that in my opinion one can not say that there are no char­ac­ter­istic features that differentiates one that clearly meets criteria for AD from others within the autistic spectrum.

Psychiatrists

• Attention Deficit Hyperactivity Disorder (ADHD)
  I have often encountered in my practice children who have severe problems controlling their tempers and who pose diagnostic dilem­mas. Usually their lack of self-control began as toddlers, or in the preschool years. After taking a careful history, interviewing the children and perhaps talking to school teachers, it is unclear if the prob­lem with self-control results from ADHD in terms of impulsivity; if it is the result primarily of emotional (affective) dysregulation, or if the lack of self-control reflects a lack of empathy in an overly egocentric child. In the latter case, the diagnosis may be in the area of the Pervasive Developmental Disorders (PDD).
• Depression
• Psychiatry
  The introduction of Temper Dysregulation Disorder With Dysphoria (TDD) is mainly a reaction to the consensus within child and ado­les­cent psychiatry that many children who have significant problems con­trolling their tempers are misdiagnosed with Bipolar Disorder. I previously addressed this in a topic in this website. Children who over­react to slight provocations with frequent outbursts of physical aggression and/or verbal rages are those that might be diagnosed with TDD as long as they meet the other criteria of the disorder. The children that meet this criteria, from my experience, make up a sizable group that are assessed and treated by child psychiatrists and other professionals. I welcome the diagnosis with the hope that it will lead to better treatment. An impression has been that in over diagnosing Bipolar Disorder, children were being administered medication that was inappropriate. The new diagnosis will have, in the very least, the result of better research into the understanding, psychotherapy and medicating, when indicated, of these children.
• Anxiety