Comments on: Leon Hoffman on “Avoiding the ‘alphabet soup’ maze: Parents with difficult children” http://internationalpsychoanalysis.net/2007/02/05/leon-hoffman-on-avoiding-the-alphabet-soup-maze-parents-with-difficult-children/ A psychoanalytic slant on the world...with support from the American Psychoanalytic Foundation Tue, 22 May 2012 22:02:40 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: lombardomd http://internationalpsychoanalysis.net/2007/02/05/leon-hoffman-on-avoiding-the-alphabet-soup-maze-parents-with-difficult-children/comment-page-1/#comment-8 lombardomd Wed, 14 Feb 2007 23:42:58 +0000 http://internationalpsychoanalysis.net/?p=37#comment-8 I agree with the main argument of Dr. Hoffman's paper. I would add: 1) An evaluation should always include a family history to assess medical and psychiatric genetic factors that may be contributing. 2) A psychiatric diagnosis such as bipolar disorder always affects developmnt, so the task is to help the child and parents see how the biology has affected the person, and specifically certain developemntal tasks. The "alphabet soup" is brewed from the complex interactions of biology and development. 3) Particularly in bipolar disorder, but in most psychiatric diagnoses, we have to do with a spectrum of intensities and symptoms. Diagnosis is not catergorical but a complex synthesis. 3) There is no such thing as a "strong medicine"; there are appropriate and inappropriate medications, and a medication that is appropriate for one child may not be appropriate for another child with the same symptoms. In psychiatry we have syndromes not diagnoses. The undelying molecular biology is not yet known. 4) In many cases effective psychotherapy cannot be conducted without appropriate biological relief. But, as Dr. Hoffman argues, without appropriate assessment and psychotherapy diagnosis becomes a hammer and every child a nail. My recent book, UNDERSTANDING THE MIND OF YOUR BIPOLAR CHILD, puts biology together with developmental and parenting tasks and looks at them through each stage of development. It strongly supports Dr. Hoffman's argument in a style written for parents and other professionals. Gregory T. Lombardo MD, PhD I agree with the main argument of Dr. Hoffman’s paper. I would add:
1) An evaluation should always include a family history to assess medical and psychiatric genetic factors that may be contributing.
2) A psychiatric diagnosis such as bipolar disorder always affects developmnt, so the task is to help the child and parents see how the biology has affected the person, and specifically certain developemntal tasks. The “alphabet soup” is brewed from the complex interactions of biology and development.
3) Particularly in bipolar disorder, but in most psychiatric diagnoses, we have to do with a spectrum of intensities and symptoms. Diagnosis is not catergorical but a complex synthesis.
3) There is no such thing as a “strong medicine”; there are appropriate and inappropriate medications, and a medication that is appropriate for one child may not be appropriate for another child with the same symptoms. In psychiatry we have syndromes not diagnoses. The undelying molecular biology is not yet known.
4) In many cases effective psychotherapy cannot be conducted without appropriate biological relief. But, as Dr. Hoffman argues, without appropriate assessment and psychotherapy diagnosis becomes a hammer and every child a nail.

My recent book, UNDERSTANDING THE MIND OF YOUR BIPOLAR CHILD, puts biology together with developmental and parenting tasks and looks at them through each stage of development. It strongly supports Dr. Hoffman’s argument in a style written for parents and other professionals.

Gregory T. Lombardo MD, PhD

]]> By: arolde http://internationalpsychoanalysis.net/2007/02/05/leon-hoffman-on-avoiding-the-alphabet-soup-maze-parents-with-difficult-children/comment-page-1/#comment-7 arolde Wed, 07 Feb 2007 03:34:35 +0000 http://internationalpsychoanalysis.net/?p=37#comment-7 Dr. Hoffman's comments serve as an immesurable aid to parents across the nation who struggle with the question of how to help their children in distress. I can only concur, as a child psychiatrist who regularly consults to a residential treatment program for children 7-18, with his statement "However, without an adequate comprehensive evaluation and without comprehensive ongoing care, families and children may enter into the “alphabet soup” maze where one diagnostic label after another is followed by a trial of one medication after another." In my experience parents and children are subjected to many evaluations by many different "providers", many of whom have not had any communication with one another. The child's problems are often intensified by the fact that they cannot form an attachment to a treater who would do just what Dr Hoffman suggests and stay with the family on an ongoing basis to provide reasonable care. Many of the children I see at the residential school, end up there as a result of the multiple fractured care that they have received. This results in an escalation of their symptoms and often in the loss of or breakup of the families. Alexandra K. Rolde, M.D. Dr. Hoffman’s comments serve as an immesurable aid to parents across the nation who struggle with the question of how to help their children in distress. I can only concur, as a child psychiatrist who regularly consults to a residential treatment program for children 7-18, with his statement “However, without an adequate
comprehensive evaluation and without comprehensive ongoing care, families and children may enter into the “alphabet soup” maze where one diagnostic label after another is followed by a trial of one medication after another.” In my experience parents and children are subjected to many evaluations by many different “providers”, many of whom have not had any communication with one another. The child’s problems are often intensified by the fact that they cannot form an attachment to a treater who would do just what Dr Hoffman suggests and stay with the family on an ongoing basis to provide reasonable care. Many of the children I see at the residential school, end up there as a result of the multiple fractured care that they have received. This results in an escalation of their symptoms and often in the loss of or breakup of the families.

Alexandra K. Rolde, M.D.

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