<![CDATA[Michael J. Lustick, M.D. - Children & Treatment]]>Sun, 28 Nov 2021 20:06:00 -0800Weebly<![CDATA[Formulation]]>Fri, 20 Mar 2020 14:54:51 GMThttp://mlustickmd.com/children--treatment/formulation
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]]><![CDATA[The Treatment Relationship]]>Thu, 04 Dec 2014 23:15:49 GMThttp://mlustickmd.com/children--treatment/the-treatment-relationshipRecent reports that children under the age of 3 have received stimulant medication for ADHD has understandably led to an outcry about the potential harm to the developing brains of those children.  More strident voices have used the finding to take up arms against the use of stimulant use for any child and even the more radical belief that any psychiatric medication use with children and adolescents is inherently evil.  
The practice of medicine starts with disease and suffering of patients and families seeking help.  The scientific findings of medicine and psychiatry  provide an ever expanding knowledge database that must be artfully applied to each individual patient.  The individual is not to be treated as a statistic nor part of a cohort.  The individual has the right and the physician has the responsibility to develop a specific illness narrative that defines the nature of the illness or disability within a developmental framework that is respectful to biologic, familial, and sociocultural realities.   Working with patients and families who struggle day to day and week to week to get by means that as a physician I need to cultivate awareness of the implications of each person’s vulnerability within the context he or she lives.  Families with marginal resources, in communities lacking supports and services create physician / patient dynamics that push the limits of medical knowledge for the sake of trying something to offer hope in the face of despair.  

I do not defend the widespread use of stimulant medication for children of any age and I am particularly concerned about the use of such medications in children under the age of 5.  In my 30 years of practice I have initiated stimulant use for a handful of children less than age 5, and never for a child less than 4.  However, the careful use of psychiatric medications with children and adolescents has brought relief and joy to many of the patients and families I have had the privilege of treating.  I have witnessed the over and under use of medications with children and adolescents and I have worked with parents who have been against the use of medications and others who have come in wanting their child on a specific medication.  It is my responsibility to sort through the layers of opinions and try to cultivate a respectful collaboration so that parents and youth can participate meaningfully in treatment decisions.  I worry less about the statistics of medication over or under use and more about the loss of the professional intimacy between healthcare providers and those they try and serve.   When any treatment is done to someone and not with someone, physicians and all healthcare professionals lose the bedrock of their noble profession.  It is time for all of us to avoid our strident political agendas and remain committed to the right of each person seeking health care to receive treatment that is grounded in the authentic caring of a professional trying to do his or her best to reduce disease and suffering.
]]><![CDATA[Eye Contact Problems in Children]]>Thu, 04 Dec 2014 22:44:54 GMThttp://mlustickmd.com/children--treatment/eye-contact-problems-in-childrenThe natural inclination to make eye contact with another person is sometimes disrupted in children and adolescents.  The observant clinician can use the nature of the eye contact disruption as a help in clarifying the underlying diagnosis that is likely responsible for the referral.  There are 4 possible reasons for disruptions in eye contact.


The first and least common is due to paranoia that is usually associated with a psychotic condition.  In this instance the avoidance of eye contact is active and it represents an attempt to prevent the clinician from seeing the distrust, fear, and anger that lurks behind the eyes of the person as his or her mind tries to protect itself from agitating interpersonal contact.   Eye contact that is made will likely feel like a brief intense stare and the person will then quickly look away or become increasingly agitated and need to withdraw either physically or emotionally.   The history of such a person who is referred will typically include substantial problems with peers and parents and there are likely to be vegetative disturbances.  A history of hallucinations, nightmares, poor hygiene and declining school performance are quite possible.

The second reason for disruption in eye contact is with Autistic Spectrum Disorder.  In that condition, the person does not make smooth natural eye contact during the course of the interaction because there is a basic lack of the natural inclination to make eye contact.  The person is not necessarily avoiding contact, but is rather living in a state in which eye contact does not occur as a natural extension of human interaction.  In fact the most basic disruption in ASD is the naturalness of the human interaction, so it is not surprising that one of the basic means of fostering increased human relatedness would be disrupted.  The person can be briefly oriented to making eye contact, but the contact will feel somewhat contrived and will easily revert to its disconnected status.  

The third reason for disruption of eye contact is quite common and is the active avoidance by the oppositional child who carries an angry attitude and  uses eye contact avoidance as a way of displaying their limited willingness to participate in the interview process.  The eye contact is yet  another manifestation of the child’s angry oppositionality.

The fourth reason for disruption is probably the most common and represents exaggerated interpersonal anxiety.  This is the overly anxious, inhibited, shy child with a soft voice who can barely look up and seems like he or she is trying to shrink and hide.  

Eye contact between humans is a basic and natural means of engaging in interpersonal connections. The astute professional can use disruptions in eye contact as part of the diagnostic data base that helps determine the nature of the underlying disturbance.






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