Kids in the Mix

There are an increasing number of children coming into our practice with overlapping conditions. These children have been diagnosed with ADHD, Bipolar Disorder, Learning Disability, Tourette’s, and/or Asperger’s. Many of these children also experience depression, anxiety, and obsessive thoughts and compulsive behaviors. Often they are defiant and oppositional. No single diagnosis seems to apply to these children, so we say they are in the “syndrome mix.”

Assessment and treatment of these children cannot be accomplished by any single provider. These children require a multi-disciplinary assessment and multi-modal intervention. A complete evaluation may include the following: psychological (which would likely include educational and neuropsychological tests), medical, neurological, and psychiatric evaluations. Many of these children also need to be evaluated by speech and language, physical, and occupational therapists. Treatment will most likely include psychotherapy, medication management, and educational interventions. Many of these children also require language therapy, social skills training, physical therapy, and occupational therapy. The most successful kids are those whose parents are willing to take an active case management and advocacy role. Providers can help by supporting and counseling these parents.

Most children in the “syndrome mix” experience deficits in executive functioning. Most definitions suggest executive functioning is the ability to formulate a plan, initiate the plan, and carry it through to the end. Executive functioning is sometimes compared to the conductor of an orchestra. Almost every human endeavor requires executive functioning. A short list of the regulatory functions carried out by executive functioning includes: perceiving, initiating, inhibiting, modulating/adjusting, gauging, shifting, manipulating, organizing, storing, retrieving, pacing, time sense, focusing attention, focusing effort, sustaining attention, stopping, anticipating, time management, monitoring, and correcting. Deficits in executive functioning will impair most aspects of daily life, from getting out of bed, to completing homework, to responding to a simple command.

A proper assessment and treatment plan will evaluate various aspects of executive functioning. Parents, teachers, and others may need to continue to assist the individual with various aspects of executive function well into adulthood. An excellent resource is the book Kids In The Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar, and More! By Martin L. Kutscher, MD.