No Money, No Care

One of my favorite families brought their 6 year old boy to see me for ADD the other day.  Dutifully, the parents had filled out the questionnaire about their son’s behavior, and they had successfully obtained a similar form from one of his teachers at school.  The scores were not good.  In fact, they had just come from the principle’s office, as the boy had been detained there for fighting that very day.

The parents of this boy do their level-best to take good care of him.  That said, there are many children in the house and they are mixed from previous marriages.  I admire both parents for overcoming numerous destructive behaviors earlier in their lives and focusing on building a healthy family.  The mother has chronic headaches, but refuses to take narcotic medications for them.  With kids scattered all over their small apartment – including a needy newborn – I very much respect her efforts to be a good mom, and she is one.

So, I trust that this boy is in good hands.  But he struggles in school.  He often explains his bad behavior by stating that “forces” tell him to punch kids, or tip over desks.  In reviewing his ADD assesment scores, his inattention was not the primary problem.  The bigger scores centered around behavior issues.  When evaluating children for ADD, we tend to give medication to kids who can’t pay attention, but not to the ones who have behavior issues.  Meds only seems to help the inattention kids.  What this very fun little boy needs, I think, is consistent and thorough counseling.  I am especially convinced of this because his problems are largely confined to school.  Even in his sometimes hectic and certainly cramped home, the boy behaves.

We recently had a new child psychologist open a practice in the area, and he gave a presentation to our clinic the other day.  He began his talk by noting that most children with psychological problems are in the low socio-economic groups.  Meaning, they don’t have any money.  He said nobody was able to explain the correlation sufficiently, but that’s just the way things are.  He went on to talk about many effective treatments and interventions he has for children with phobias, anxiety, depression and behavior issues.

He also provided some good information.  For example, the most common childhood psychopathology is not ADD or depression, as I would have guessed, but anxiety.  He said depression is often a comorbidity as a result of underlying anxiety.  He said anxiety afflicts 10-15% of children and is often unrecognized.  Of the anxiety disorders, he said that separation anxiety is the most common, and that the disorder manifests itself differently in different age groups.  Some kids fear something will happen to their loved ones once separated.  Some are afraid of the sheer distance – so the farther the parent will be from them, the more anxious they become.  Other kids become afraid of things like monsters, animals, insects (well, me too on that one) and the dark.

Maybe this is the problem with my patient.  I would love to have him evaluated by a specialist who does this every day.  Especially one with years of experience and a nice new office with lots of open time slots because the practice only just recently opened.  “Do you take insurance?”  I asked, hopefully.  His answer was and enthusiastic, “Oh yes, I take all kinds!”

“Good.  I’ve got a patient for you.  His parents have medicaid.”

The good doctor’s face winces, “OH!  Sorry, actually, I don’t take medicaid.”

So, we’re back to me, with little time and experience, to try to help this kid.  This is common in the medical world.  I don’t really blame the psychologist, either.  I sure hope I have a limited proportion of medicaid/care in my practice.  I’ll never get out of debt if I get paid as badly as they pay.  The frank truth is that until universities and banks become altruists, doctor’s should be either.  So, his refusal to take government insurance – in the process of lowering payouts to even worse that they are currently – is understandable.  But that still leaves me with a beautiful little boy that needs good psychological care.  In talking with him, he was kind, very sharp – at 6 years old he correctly used the words “opposite” and “thorough” in sentences – and actually rather sweet. 

But any kid that young getting suspended that much is not headed toward a successful life.  It’s hard to really believe you have something to offer the world when you’re constantly in trouble from the time you’re 6 years old.  Likely, he will end up making a living with a gun and knife, threatening the lives of doctors, bank execs and child psychologists as they walk to their fine cars outside their well-funded clinics.  This is medicine in America.

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