By SARAH DOOLITTLE, Four Points News
Two Austin medical professionals — a pediatric neurologist and a psychiatrist — who specialize in treating children and adolescents, talk about cognitive or mental disorders, and they weigh in on whether to use medication or not.
Dr. Dilip Karnik is a Board certified pediatrician and child neurologist trained in Bombay, India, and New York. His practice, ‘Specially for Children, is an affiliate of Dell Children’s Medical Center of Central Texas. Soon he will open the Karnik Institute, a one-stop shop for the comprehensive diagnosis and treatment of learning disabilities.
Besides his practice, Dr. Karnik is the author of numerous books, articles, lectures and seminars specifically on the subject of Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities and autism.
These are cognitive disorders, a term that describes problems with higher functions of the brain: memory, executive functions, problems with organization and time management, attention issues and impulsivity.
“The numbers of children with ADHD has gone up. I mean, when I started practice we were looking at about three to five percent. Now we are looking, in (Texas) at around seven to eight percent,” he said. This he attributes to increased awareness and earlier recognition of symptoms, as well as changing guidelines in diagnostic manuals.
“We recognize it at early age. And the advantage of that is that children receive help much earlier. And that’s the key. Early intervention is a big key in making a diagnosis,” Karnik said.
He says it hasn’t always been this way. “Many years ago people doubted there was anything like ADHD. And still today, there are so many people who say, ‘Oh, there is nothing like ADHD. Just, you know, discipline them.’”
Instead, he encourages parents to trust their instincts. “My feeling is most of the parents will have an idea that if their child is having a significant problem then they know something is not going right… Because they know our child is different than somebody else’s child.”
Besides parents, teachers can be a valuable tool in recognizing if there is an issue. For example, a teacher may notice that a child is smart but not achieving at the expected level.
Karnik is emphatic that the “earlier you make diagnosis and get team — the whole village — to support that child is a good thing to do.”
If parents are concerned, he recommends they first discuss their observations with their family physician or pediatrician. A primary care physician can then recommend a specialist who can do more comprehensive testing and drill down the specifics of a diagnosis.
A child may have a combination of issues, not just ADHD but perhaps an additional learning disability or mood disorder.
“That child (specialist’s) job is to make sure that they go through evaluation and make a diagnosis,” for which he recommends using a child neurologist, psychiatrist or developmental pediatrician.
For ADHD, there are two top groups of ADHD medications: stimulants and non-stimulants. While the drug ingredients available are essentially the same as what has been used for decades, advances in medication delivery technology make these medications far superior to what was prescribed in the past.
Still, Karnik encounters a lot of resistance. “Right from the diagnosis point of view there’s a controversy… medication, that’s a big thing. And there is so much resistance against medication. For the right reason. Who would like to put a child on medication? You know, for non life-threatening situations.”
He warns parents, too, against considering medication to be a quick fix. “Medication is absolutely not a magic bullet. My treatment, my therapy is generally a holistic approach. Which I think is a better approach.”
In addition to possible use of medication, he recommends behavior therapy, nutritional supplements such as omega-3 fatty acids, magnesium and zinc (administered with medical guidance), possible dietary changes and school accommodations to provide an optimal learning environment.
He warns, too, that if there is a co-existing condition such as anxiety a stimulant will make that worse. For example, “If you treat just ADHD and leave anxiety, you’re not going to get good results. That’s where expertise is very important. That’s where experience comes in.”
For those who are resistant, Karnik emphasizes the data that backs up the argument for treatment. Statistics are clear that a child with ADHD who receives treatment will have a much better outcome.
At the same time, he would say that probably fewer than half his patients are good candidates for medication. Many have a mild form of ADHD that can improve with other modalities. Medication is only a plan B.
“If they suspect that their child has ADHD, I think they need to pursue as soon as possible to get an evaluation. With that help, the child will do much better. And you know, you can change children who are failing into very successful. I have thousands of stories… And there are so many choices. Medication is not the only choice. So many choices. Explore them.”
Dr. Nadia Bening, a psychiatrist at Happy Mental Wellness in Four Points, received her degree from the University of Texas Health Science Center at San Antonio and completed her residency in Austin.
She treats adults and adolescents for a variety of psychiatric disorders.
“The most common mood disorders I treat in adolescents are Panic Disorder, Major Depressive Disorder and Generalized Anxiety Disorder.” These are medical conditions for which medication can be an essential treatment tool.
Symptoms of mood disorders in children and adolescents can include: changes in sleep, energy or appetite; marked irritability and frequent mood swings; aggressive behavior, impulsivity or rage; somatic symptoms such as frequent stomach aches or headaches; truancy, drop in grades, and avoidance of attending school; signs of self-injurious behavior, withdrawal from friends or family, lack of enthusiasm and motivation; and any time there is suspicion or voicing of suicidal ideation.
Bening notes that, “It is worth getting an evaluation if there are red flags for a mood or anxiety disorder. It is often difficult to know when certain behaviors or signs are ‘typical teen behavior’ versus symptoms of a psychiatric disorder, so having a trained mental health professional perform an evaluation can be essential.”
Adolescents are most frequently referred to Bening by their primary care physicians or pediatricians, from inpatient psychiatric hospitals or from their therapists.
“Mental illness usually strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable,” she said.
If parents observe symptoms in their children, Bening encourages taking the first step of informing their primary care physician, who can perform initial diagnostic testing and refer you to a specialist as needed.
As to whether or not medication is an appropriate or necessary treatment tool, she said, “When an adolescent has severe depression or anxiety that is interfering with their ability to function, medication may be an appropriate treatment option. However, while drug treatment can be beneficial, it is by no means the only answer.”
Other treatments and lifestyle changes can offer enormous benefits: talk therapy, exercise, good sleep habits, healthy socialization and exploring spirituality, to name a few.
However, Bening points out a key distinction. “There are times that depression and anxiety reduce functionality and people cannot partake in making these behavioral changes, and this is when medication can be of benefit.”
Regarding overall attitudes toward mental illness and medication, she said, “I think the overall stigmas associated with mental illness have reduced, but I also believe that ultimately parents want their children to be happy and healthy and are therefore willing to do whatever that takes.”
Which may include the use of psychotropic medications. “After discussions of potential risks and benefits of treating with medication, most people agree that the benefits outweigh the risks in severe cases of depression and anxiety,” she adds.
“It is ultimately the parents’ choice whether or not to treat based upon recommendations,” she said.
Psychotropic drugs, especially when used to treat children and adolescents, are not without risks. “When choosing medication the most important thing to be concerned about are potential side effects and withdrawal symptoms. It’s important to have a thorough discussion with your provider about risks and benefits,” she said.
Questions include whether there is a need for drug treatment, if it’s the best option, what non-drug strategies are available, what side effects may occur, and what the potential consequences are if treatment is not pursued.
On this question, Bening is unequivocal. “Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives,” she said.
As with cognitive disabilities, mental illness is nothing more than a treatable medical condition.“Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing.”
According to Bening, there is good news for those diagnosed today with mental illness. “The best treatments for serious mental illnesses today are highly effective. Between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.”
Bening echos Karnik when she reiterates that, “early identification and treatment is of vital importance.”
For these two physicians, who have dedicated their professional lives to improving mental wellness, it is no longer a debate about whether or not these are treatable medical conditions the same as other diseases of the body. They encourage instead an open dialogue, honest debate and, at the forefront, the best interests of their patients.