Wednesday, March 26, 2008

Sports and Dads

As a kid I played organized sports, so part of the excitement of being a new father was anticipating watching my son play sports and even coaching him. This happened, but not as smoothly or effortlessly as I anticipated. The introduction of special needs and the child’s individual interests into the equation complicates life and requires modifications in expectations.

I pledged that I would not be one of those overbearing dads who forced sports onto his son. Neither would I be one of those dads who structured sports training programs for their sons that resembled Marine Corps boot camp. And I haven’t—I wanted to introduce my son to the positives of sport. My son has had obvious developmental delays and awkwardness since around the age of one to two. I wanted to introduce Andrew to sports at the appropriate age when his peers were being introduced to sports, as possible options for him to explore.

It took me awhile to understand the tremendous physical and mental effort it took for Andrew to participate in these activities, which did not come naturally. We first tried soccer—it didn’t work. My wife and I had met skiing, so we tried skiing lessons for several years. We stopped skiing after Andrew asked us, “Why do you put me through this?” Andrew tried karate, but didn’t like it. We tried baseball. Andrew liked baseball, but when it turned to kid pitch, he asked to stop playing. He still liked the design and flow of the game, however. We tried basketball and he liked it (Andrew is on the tall side). What made all these sports possible was a policy and practice within our community of residence: Every kid up to the age of 14 who wants to play, plays—and plays equally. Most of the coaches (but not all), most of the parents (but not all), and many of the kids (but not all) support this policy and encourage the kids who are not quite as skilled. Andrew was blessed with several good basketball coaches and I was able to serve as the assistant coach. It was a positive and enjoyable experience for both of us.

While baseball was a challenge for Andrew as a player, he has developed into a knowledgeable and interested fan. During the past few years we have bonded by attending baseball games together and keeping informed about the game. So, while my original hopes did not come through, other enjoyments and bonding experiences did occur. We rarely leave a baseball game early, for as a friend of mine reminds us, “You never know.” You try. You see what sparks an interest. You stay patient, flexible, and supportive. You build on the positives. At Andrew’s high school, he is required to participate in sports programs of his choice. While a great challenge, he also enjoys it. And he is healthier for it.

For many children with AD/HD, it seems that the mother is the key figure in their child’s life. On October 23, 2007, the AD/HD program at the University of Buffalo’s Center for Children and Families issued a press release, “Getting Fathers Involved in Children's ADHD Treatment Programs: Sports Element in COACHES Program Improves Dads' Participation, Relationships with Children.” For many fathers and sons, participation in sports at all levels can build a positive relationship.

During the past several months, CHADD has received letters of frustration from parents whose teen or young adult child was excluded from a non-school organized sports program because they were taking medication for the treatment of AD/HD. A former U.S. Olympic athlete contacted us regarding his dismissal for use of stimulant medications. These requests and recognition of the value of participating in sports encouraged the CHADD board of directors to adopt a statement of issues, considerations, and philosophy when thinking about children under medical treatment and their participation in organized sports programs.

Sport is a vehicle for building relationships and promoting good health. It may be an appropriate vehicle for some. CHADD advocates that anyone properly diagnosed with and treated for AD/HD is assured participation in their sport of choice.


Thursday, March 20, 2008

Self-Esteem, Bonding, Enjoyment

My son Andrew and I just completed six baseball spring training games in six days in Florida. We are fans of the Baltimore Orioles and the Boston Red Sox. This is our second time attending spring training. We enjoy it and grow closer given our shared interest.

I received a column published March 4 by child psychiatrist Dr. Michael Jellinek on "Kids and Self-Esteem," and I have been thinking about the topic ever since. Andrew is in eleventh grade and has learning differences and challenges. He passed the state mandatory math exam for graduation and he is very pleased. He missed the mandatory reading exam by a single point. He knows that next year he will pass the reading exam. He was honored for the highest grade in his math class. For a kid with few "accomplishments" during his academic career, each of these events has reinforced his self-esteem. Last year, Andrew came in second in a schoolwide spelling contest. This year he didn't study ahead of time and he went out of the spelling contest early. He has learned that effort is correlated to progress.

Andrew is a whiz at baseball statistics and team rosters. When at a game, many fans, overhearing the observations he makes to me, will ask Andrew questions about players and their situation. Andrew feels confident at the ballpark. He gets reinforcement from strangers about his knowledge. There is a familiarity about being at the ballpark, no matter the team or stadium. We both are knowledgeable fans and love attending. Andrew is a much louder and animated fan than me.

Dr. Robert Brooks has emphasized at CHADD conferences over the years the need for each of us to have and use our "islands of competence." As Andrew grows and matures, his islands of competence continue to expand. He is still very anxious, still socially awkward, still has learning challenges, still has major doubts. But as a father, it is so reassuring to see his growth, maturity, and increasing self-esteem. He's also seventeen. It is a feeling of great satisfaction.

May we always look for and build the strengths of our kids.


Friday, March 7, 2008

Medications and the Internet

Just this week, several news items related to medications and the internet have caught my eye.

The February issue of Behavioral Healthcare magazine emphasizes that "the casual scribbles that pass for handwriting and the extensive use of abbreviations, acronyms, and shorthand dose designations in many doctors' offices" are to blame for miscommunications with pharmacists. More than 12,000 prescription drugs are on the market and 3 billion prescriptions are authorized each year, with similar names, potential contraindications, and multiple formulation and dosage options. The magazine advances the use of e-prescribing to reduce errors, maintain a more accurate medication history, and allow patients and their families to have access to this information. Promotion of e-prescribing is available from the Center for Improving Medication Management. The American Academy of Family Physicians is a founding member of the Center. The Center demonstrates and enhances the advantages of e-prescribing.

While the magazine advances e-prescriptions, the magazine also reports that Drug Enforcement Administration regulations prohibit e-prescribing of "controlled" medications that includes stimulant medications for the treatment of AD/HD. DEA regulations require medical personnel to manually sign prescriptions for controlled medications. Nineteen U.S. senators are considering legislation to allow e-prescriptions.

Meanwhile, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a National Survey on Drug Use and Health (NSDUH) report on the misuse of prescription medications for non-medical uses. Among these are 2 percent of adolescents aged 12 to 17 (an estimated 510,000 persons) who have used stimulant medications at least once for non-medical purposes. The science-based literature discusses the importance of medication as part of a "multimodal" treatment process. Medications need to be prescribed by medically licensed professionals with the legal authority to prescribe using evidence-based guidelines with the informed consent of the consumer and/or family to treat a precise disorder. It is regrettable that there is such misuse. The report documents that the adolescent rate of misuse is twice as high as the rate of adults aged 26 and older. The survey asks people about their illegal use of drugs. The NSDUH report is currently posted on the CHADD National Resource Center on AD/HD Web site under "What's New."

Last Saturday, President Bush devoted his weekly radio address to his administration's proposed 2008 National Drug Control Strategy. The President expressed his concern for the "growing availability of highly addictive prescription drugs online," and focused on painkilling medications. The President called for legislation to prevent internet sales of medications; you can hear the address on the White House Web site; click on Radio under "News" in the "In Focus" column.

While research studies on medications as part of "multimodal" treatment continue, concerns about non-medical misuse continue and administrators are attempting to improve the accuracy and safety of prescribing. CHADD will continue to monitor these developments and share them when appropriate.