I had a parent-teacher conference with my 5 year old son's kindergarten 
teacher on Monday, and his mother had her conference yesterday, 
regarding some behavior problems he's experiencing in school.

I'll start out with explaining that his mother and I are going through 
a divorce.  I moved out 5 weeks ago.  The problems are older than the 
divorce, though.  We had a parent-teacher conference a couple of months 
ago in November in which his teacher expressed her concerns about these 
same issues.  It doesn't seem to me the problems are caused by the 
divorce.

I'll go on to explain some things about what he's like in the next 
response.

32 responses total.

Here are some of the things I discussed with his teacher.

1.  John is a compulsive child.
Since he was 2, he's had to have his whole range of blankets (of which 
he has 6 at his mother's house), and which he has named after relatives 
(Grandma blanket, Cousin Heather blanket, etc.)  I've laughed about it 
and called it his nightly inventory.  If one of his blankets is 
missing, in the laundry, can't be found, etc. it results in great 
amounts of crying and trouble getting to sleep.

This is just one example of things he's compulsive about.  At night, 
there's a ritual we have to go through, and there can't be any 
variations.  He has to say "Good night" and get a response, "See you in 
the morning" and get a response, "I love you" and get a response, and 
then three times, "See you later, alligator" to which I or his mother 
must respond "In a while, crocodile".

2.  Friends
He only has one real friend in school, a girl whom he saw over the 
summer at a library reading group.  He got obsessive about her; he 
wouldn't let her play with other kids in kindergarten, for example.  
His teacher put them into separate groups when this problem became 
apparent, and it's become less of a problem since then.  He still 
hasn't made any other friends.

3. Not getting his way
He gets *very* upset when he doesn't get his way about some things.  
Some of them are predictable.  If we're going out to dinner, he wants 
to go to a particular buffet-style Chinese restaurant.  There, he wants 
to get wonton soup and rice; this never varies.  If we aren't going 
there, he wants to go to another Chinese restaurant.  If we're not 
going to eat Chinese, he'll usually say he won't eat anything.  
Sometimes he's pretty reasonable about this process, but sometimes he 
gets highly frustrated, adamant and sobs about it for 10 or 15 minutes.

4. Dominating his brother
He pretty thoroughly dominates his 10 year old brother, who generally 
gives in rather than have a conflict.  If he doesn't, John will scream, 
cry or attack with hitting or kicking.

I expected the divorce and me moving out would cause huge problems for 
John because it's a change in routine.  It doesn't seem to have had 
that effect.  As a matter of fact, he says he loves having two homes 
now.  He doesn't bring up any concerns about the divorce, at all.  I've 
asked him about it, and he says he just doesn't have any concerns.

His teacher said she hasn't seen any changes in the last few months 
that could be attributed to the divorce, either.  She said often times, 
kids with problems or doubts about such a situation will go to her 
before their parents.  She said John has never done that.

John is a warm and loving boy.  He hugs his teacher every day.  He hugs 
me and his mother, and his brother.  I took him to a reading group last 
week; the reader read 4 books to the kids.  At the end of that, he 
hugged the reader.

His maternal grandmother is his special person; he spends a lot of time 
with her, and says he'd like to spend all of his time with her.  She's 
very accommodating to him, never criticizing and always doing the 
things he wants to do when he's there.  Sometimes he'll scream and yell 
when leaving her house because he's not ready to go.

His teacher says he's doing well academically in school.  He can count 
to 100, recognizes all his colors, does well at units of money, etc.  
He can write his name.  He knows his address and phone number at his 
mother's house.  (I haven't been too concerned with teaching him these 
things for my apartment; it's hard enough to learn one set of such 
information.)  He doesn't like to do art much.  He doesn't like 
coloring much.

He's a good kid.

His teacher and the school psychologist have recommended we take him to 
his pediatrician with an eye to getting him referred to a psychologist 
for further evaluation.  His teacher thinks he might have obsessive-
compulsive disorder (OCD).  He's having enough trouble in school that 
they're concerned about him going on to 1st grade.  Academically he's 
fine, but the other issues are making it hard for him to fit in.  
They're concerned that, if nothing is done, he won't get over these 
problems and will have a rough time in school.

When his teacher raised these concerns for the first time in November, 
his mother called his doctor, who recommended we wait until June when 
he's due for a physical anyway.  However, it seems like we need to go 
ahead and take some kind of action now.

Because we're going through a divorce, and all problems are escalated a 
level or two, it's something his mother and I are going to have to find 
a way to work out.  Who takes him to the doctor, how to decide what 
kind of treatment he needs, etc.  We're working on that.

If anyone here has any experience with these types of issues, I'd be 
interested in hearing more about it.

From my searches on the WWW for information about OCD, it doesn't seem 
that's what John has.  The sites talk about compulsive hand-washing 
because of fear one's hands ar edirty (young kids) or a germ might be 
present (older kids and adults).  Also about worry that someone is 
going to get hurt; Daddy might get in an accident on the way to work, 
etc.  John's not like that.

I'm trying to remember back to when you announced John's birth
and wasn't there an issue with a difficult birth and some 
resulting problems, at least early on?  I may be misremembering
here.

Birthing problems have a way of coming back in odd behavioral
issues.  If so, the teacher may be right on, this may not be
self-correcting, and early intervention would be imperative.
I'm glad you're both open to following-up. 

Yes, John's mother had high blood pressure during the pregnancy, and so 
his labor was induced at about 7 1/2 months.  He was born chalk-blue, 
he had underdeveloped lungs, and was in neonatal intensive care at 
Henry Ford Hospital for 9 days, with tubes in his chest and for part of 
the time, in an oxygen tent.  I have a picture of him in the NICU above 
my desk.

He was a little slow in some things such as turning over (I think it 
was at about 9 or 10 months when he could do that; most kids do so 
within the first 6 months); and crawling and walking.  He hasn't got 
any visible physical or mental problems to speak of.  He's not 
athletic, but neither is his older brother.  Nor was I athletic.

He does often seem confused and overwhelmed in new activities or when 
things are not like he expects.  For another example, he played soccer 
in the fall and looked visibly confused on the field during games.  He 
rarely kicked the ball, and usually ran around behind the other kids 
without any idea what he was supposed to do.  Practices for kids at his 
age usually involve drills; the actual games don't work the same way as 
practices.  It always seemed like he was baffled by the games.

Sorry if I seem to be rambling a bit in this item.  I'm using it to jot 
down the things I want to talk to his doctor about, so I don't forget 
to mention some things.

Actually, a lot of those behavior problems on your list sound like
normal behavior for a younger kid.  Arlo does most of these things in a
less intense manner.  Seems to me that a whole variety of developmental
problems could cause more juvenile behavior patterns to be embroidered
instead of discarded, and a OCD diagnosis is premature.  Not that I
actually know anything about it.

A psychologist did once suggest that I might have a mild obsessive-
compulsive disorder.  He said that it is commonly associated with things
like obsessive handwashing, but that it was more complex than that.  He
gave me some photocopied pages out of a book that described a lot of
other behavior patterns that seemed somewhat relevant to me, but I've
pretty much forgotten what was on it.

I don't have any obsessive behavior patterns.  The biggest issue I have
is that I occasionally just get stuck on something.  The example that I
discussed a lot at that time was a research paper I'd written.  I'd
spent about two years working on it, getting it into good form.  It was
accepted for a publication in a good journal.  They needed me to send a
one paragraph "biosketch" describing myself before they could publish
it.  I didn't do it.  Can't exactly say why not. I wrote such things
routinely.  But I was busy at the time, and then it seemed kind of late,
and I never got around to it and the paper never appeared.  It got to be
one of those things that my mind just turned away from.  Less severe
examples of that kind of thing are moderately common for me, though they
are usually less of an issue now that I'm not alone.

I think obsessive-compulsives are supposed to be obsessive about
controling their environment and have everything work the usual way. 
I'm almost the opposite of that.  I'm always willing to let others do
what they want and simply adapt.  However, I always feel like that's
something I've chosen - let go of control, adapt instead - as a
conscious rejection of the urge to control.  Ultimately, its a kind of a
different form of control-freakiness.  Believing that I can adapt to
whatever happens around me is another form of maintaining ultimate
control of myself, by ensuring that I am not deeply effected by the
actions of others.

And, of course, I'm capable of focusing vary narrowly on certain tasks,
and sometimes putting disproportionate amounts of work into fairly
random things.  These can be useful attributes, if kept within reason.

So I never really decided if I really am obsessive-compulsive or not.  I
never had issues like John does, even as a child.  I am what I am, and I
wouldn't really change it much if I could.  Every strength becomes a
weakness in some circumstances, every weakness, if turned the right way,
becomes a strength.  It doesn't always balance out (in fact, it often
doesn't even come close), but I'm very happy with the life I live, and I
won't complain about the mental oddities that make it possible. 

I've been digging through old papers lately, as I get ready to move to
our new house.  I had an idea which box those photocopied pages might be
in, and sure enough, when I looked they were there.

This is hunks out of the middle of a book chapter on OCD.  The doctor
marked parts the thought relevant.  I'm going to type in some of those
parts and some others that seem relevant.

There is a section discussion how fears are acquired and maintained in
phobic disorders and obsessive compulsive disorders.  There is a
two-stage learning theory invented by someone named Mowrer.

  Mowrer's theory holds that relatively neutral stimuli become
  associated with fear or anxiety through a process of respondent
  conditioning by becoming paired with events that are by nature
  noxious or anxiety producing.   Thus, in obsessive-compulsive
  disorder, previously neutral objects and thoughts become conditioned
  stimuli capable of provoking anxiety or discomfort.  The second stage
  of symptom development is complete when avoidance or escape behaviors
  are established to reduce the discomfort attached to the obsessional
  thought and maintained by anxiety reduction. In obsessive compulsive
  disorder, active avoidance strategies in the form of compulsions or
  ritualistic behaviors are developed to control anxiety.  Gradually,
  because of their efficacy in reducing a painful secondary drive (the
  anxiety), the avoidance strategies become fixed as learned patterns
  of compulsive behavior.

This learning theory of OCD seems to only partially explain things. 
There is a lot of discussion of what things in the brain could actually
drive OCD in these pages, but I don't see any point in typing it in. 
Here's some from "Clinical Signs and Symptoms"

  Because of the relative rarity of the obsessive-compulsive disorder
  and the paucity of patients adequately studied, it is difficult to
  make categorical statements about the natural history of this anxiety
  disorder.  All statements about its course, prognosis, and etiology
  must be considered as only tentative and perhaps only applicable to
  selected patients rather than to the syndrome itself.

  ONSET.   The onset of obsessive-compulsive disorder occurs
  predominately in adolescense or early adulthood.  The symptoms first
  appear in approximately two-thirds of the patients by the time they
  are 25 years of age, with 15 percent having an onset before the age
  of 10.  Less than 5 percent of patients have symptoms starting for
  the first time after the fourth decade of life.  [...]

This doesn't really match with John.  Might back up my feeling that what
you are looking at is a childhood development thing, not a OCD.

There's a section on symptoms, which is mostly the kind of ritualized
behavior and thoughts we've talked about.  Didn't think it added much
and it was very long, so I'm not typing it.

  CHARACTER TRAITS.  A great deal has been written about the nature of
  obsessive-compulsive character traits, and the person who exhibits
  them has been described variously in the literature as having an
  obsessional character, an anal personality, or an anancastic
  personality.  All these terms refer to a group of behavioral
  phenomena characterized by control, in constrast to a hysterical
  personality, in which a tendency toward flamboyant expression of
  fantasies and feelings predominates.
    As they are observed and experienced by others, individuals with
  obsessional personality traits are seen to exercise a marked measure
  of control over both themselves and their environment.  They are
  cautious, deliberate, thoughtful and rational in their approach to
  life and its problems and may appear dry and pedantic when those
  traits are carried to an extreme.  They emphasize reason and logic
  at the expense of feeling and intuition, and they do their best to
  be objective and to avoid being carried away by subjective
  enthusiasms.  As a result, these individuals often appear sober and
  emotionally distant, but at the same time they are found to possess
  great steadiness of purpose, reliability, and earnest
  conscientiousness.  What they lack in flexibility, imagination, and
  inventiveness, they make up for in a conservative cautiousness about
  change that provides for a healthy balance to the transient but
  violent enthusiasms of others.
    In addition to their need to restrain themselves and their emotions,
  persons with obsessional personality traits like to feel that they
  have control of their environment as well.  They subscribe to the
  dictum, "A place for everything, and everything in its place," and
  neatness, orderliness, and tidiness characterize their arrangement
  of space, just as punctuality marks their management of time.  They
  like people and institutions to behave predictably and to conform to
  their predilections.  They can be surprisingly obstinate and stubborn
  when challenged or contradicted.  These individuals greatly value
  justice and honesty, have a strong sense of property rights, manage
  their own resources with frugality, and do not easily part with their
  possessions.

Actually, that describes some other people in my family a lot better
than it does me.  I have all those tendancies, some in spades, but also
a counterbalancing sloppy, what-the-heck attitude that counterbalances
it.  I may be just too lazy for proper obsessive compulsive behavior.

  The presence of obsessional character traits is not in itself,
  however, an indication of obsessive-compulsive disorder.  On the
  contrary, those traits may be a great asset to their owners, and
  society owes much of its stability and efficiency to its more
  obsessional members.  Rather, those traits become a liability only
  when they are carried to an extreme or when the balance between
  control and impulse expression leads to paralysis.  Furthermore there
  is no necessarily connection between obsessional character traits and
  obsessive-compulsive symptoms.  [...]  In fact, there is no history
  of prior obsessional character traits in 20 to 30 percent of patients
  with obsessive-compulsive disorder.

So all this personality stuff doesn't necessarily have anything to do
with anything.  However I can see where I might get classified as one of
those personalities that only occasionally drifts over the line to real
problems.

  COURSE AND DIAGNOSIS

  Accurate statements about the course and prognosis of obsessive-
  compulsive disorder are precluded by the lack of detailed knowledge
  of the natural history of the syndrome.  [...]

  When first consulting a physician for their difficulty, two-thirds
  of the patients give a history of prior episodes of obsessive-
  compulsive symptoms, some 15 percent having first experienced them
  before the age of 10.  The large majority of patients have had only
  one such prior attack, although a good number, roughly 30 percent,
  have experienced two or three episodes. In 85 percent of these
  attacks, the duration was less than a year, although some attacks
  lasted 4 to 5 years.

This really doesn't sound like John.  It seems to typically be very
episodic and narrow, not effecting broad patterns of behavior, often
starting in times of stress, persisting for a while, and vanishing.

There's some more here, but I'm running out of time.  My guess is that
the teachers are using the term "obsessive-compulsive" a bit informally
and that you'd not get that as a diagnosis.  I wouldn't be surprised if
the doctors decided to perscribe some kind of anxiety reducing drug to
try to cut back on the anxiety that drives these kinds of behavior
patterns, though even if the anxiety were magically removed their would
still be a need to break the behavior habits.  But again, I'm very far
from being an expert on this kind of thing.  A few xeroxed pages does
not an M.D. make.

Heh.  It's more than I've read previously, up to this point.  Did you 
type all that in by hand?

Hastily, beause I'm about to leave, it boils down to this for John, 
he's not fitting in well with his class, and his teacher is concerned 
he will have additional problems when he's in school for whole days.  
He doesn't behave normally for a 5 year old.  His teacher has 20 years 
of experience but says she's never seen another student much like him.  
That's not cause for panic, but it's reason for alarm, and we need to 
find out if there's a problem about which we need to do something.

I'll log on later to discuss further.

Well, yes, of course I typed it in by hand.  We obsessive-compulsives do
things like that.  :-)

I certainly think that some kind of intervention is called for, and
professional advice should be sought.  You're doing the right thing.

I appreciate the effort!  I'm a little taken aback by it, though.  I'll 
get over that.  (-:

John's kindergarten teacher heard about OCD on a news show.  She was 
kind of apologetic about it when she told me that.  I told her not to 
worry about her sources.  She knows more than I know, I assured her.  
She is an experienced, smart kindergarten teacher doing her best and 
going beyond what she has to do because she cares.  I appreciated 
that.  She wasn't making a diagnosis, it will take a mental health 
expert to do that.

It sounds like you're an example of an obsessive compulsive type of 
person who has both made it work for you and who hasn't been bothered 
by it.  One can hardly call it a disorder in your case.  If you can 
adjust to your exceptions, they aren't disorders.  John isn't doing 
quite that well, but I'm hoping with some help at an early age, he can 
either come to live a good life within his personality the way you 
have, or to find a way to change himself enough so he can have a good 
life.

The part about seeking help for him which scares me is the possibility 
of medication.  I don't believe in drugging kids into sitting still in 
the classroom.  That's a straw man in a way; not many really believe in 
doing that.  I would prefer to see methods other than drugs used first 
for my son, though.

It seems to me there are too many ties into doctors offices from the 
pharmaceutical companies.  Mary, if you're still there and could 
comment about this, I'd appreciate hearing what you have to say.  Maybe 
the articles I've read over the past dozen years are paranoid, and 
maybe they aren't, but they have made me suspicious about medications 
such as the media favorite villain, Ritalin.

Mild OCD is actually fairly common among intelligent children.  (I just 
have to count all the steps between....just kidding.)  Part of it is 
wanting to control your environment.  

One thing is -- you and Andrea have to work at socializing him more.  
Every weekend, invite over a different child to play, or do something 
special.  Are there playgrounds?  The zoo?  If there is a child he 
likes, and you see the two of them playing well, you can periodically 
repeat them.  But I'd have **every** suitable child over at some 
point.  (Suitable meaning, where they live, or if there is a boy/girl 
preference.)  I wanted to see for myself how the bully treated my 
child -- and then we practiced how to deal with it via playacting.  

You have to pattern to him how to make friends and interact.

It should be easier for Andrea to do this, because she can do it in the 
daytime.  But don't be discouraged when you start calling.  All 
families are busy, and you might have to try 5 kids to get one to come 
over.  Show him where that OCD comes from, by golly :)

Maybe the two of you can join Boy Scouts or something like that (if 
sports aren't of interest to John).

The other thing is that you can't keep giving into him.  That's where 
little Johnny Talebans come from.  Its going to be tough, but kids want 
some boundaries.  I prefer time-outs, but we also do things like "write 
10 times" or take away priviledges.  You can't let him kick his 
brother, though.  That's not fair to David to have to pacify him.  
Other kids don't want to play with kids who can't cooperate.

If my child pitches a fit in a public place -- like taking off all 
clothes on a winter day when ** was two --  I take the child out 
immediately to a bathroom or car, and explain that this behavior is 
unacceptable.  If we are in a store -- we leave immediately, and no 
toys or food or whatever is bought.  We don't have fits any more, but 
we still have a very strong-willed child, and I am always prepared to 
postpone, if needed.

Even if you and Andrea end up with different styles, children cope well 
with different environments and rules.  They learn **fast** what 
grandmother will do, or not do.

And boys always socialize later.  Heck, in Texas, they usually keep 
them back in first grade so they'll be bigger for football. :)

re #13: You don't sound like Mary Remmers in that response.

I agree it's not fair to David to have to deal with being dominated by 
John.  Unfortunately, due to the circumstances of the divorce, I'm not 
going to be around David much any more.  I've encouraged David to stand 
up for himself, and stopped John from physical attacks.  There's not 
much more for me to say about it now, since there's little I can do 
about it now.

I'm thinking about asking John if he's interested in Tiger Cub Scouts 
when he's old enough, in the fall.  He plays soccer in the fall, and 
will play either soccer or t-ball in the spring.  It's going to be 
*really* hard just now for me to invite his friends over, as I'm living 
in a different town than where he goes to school.  We do go to the 
swimming pool on weekends when he's with me, and a library reading 
group on Tuesdays when he's with me, and will spend time in parks and 
such when it's later in the year and not dark when I get home.  I'm not 
much of a socializer and neither is his mother; maybe he's just picking 
up our behavior.

Jep, I just wanted to say that I think you are doing the right thing by
having this checked out.  There is a lot more to OCD than handwashing,
and some of the things you've mentioned sound compulsive.  I knew a guy
who counted every step he took, how many times he chewed his food, etc.
and it always had to be in a multiple of four.  I would never have known
he did this stuff if he hadn't told me, it wasn't something you'd notice,
it was more an inner turmoil.  He could tell me how many steps it took to
get from point A to point B and how many flights of stairs each building
had and how many stairs each flight had.  The whole blanket counting thing
and the three times saying the exact same thing three times each night as
a ritual could very well be an indication.  It also could be just a kid
thing.
I also suggest that you and John's mother (and I know communication isn't at
it's best right now) be very pro-active in stopping him from beating up on
or kicking his brother.  There should be a consequence for that.  It shouldn't
be up to David to stand up for himself it should be up to his parents to try
and stop that behavior so he doesn't use it on other children later on. 
(that sounded very judgemental and it wasn't meant that way).  I think you
are a good dad and are doing all you can to help your kids.

I too would be concerned if the doctor who evaluates John is quick to
start him on medication.  I'd feel more comfortable with someone willing
to do a thorough work-up and evaluation including testing for everything
from hearing loss to dyslexia.  Any one or combination of things could be
behind the behaviors you are describing, not just brain chemistry, which
is the primary target of pharmacopia. 

If the doctor does see drug treatment as an urgent first intervention, 
well, I'd see another doctor.  I don't necessarily think some doctors
go this way as a form of repayment for vendor perks as much as they
have found them a convenient and quick way to get visible results from
a host of symptoms.  Besides, lots of parents, given the choice between
months of testing and therapy, or a prescription, tend to prefer the Rx
route.

re #15: There's no question about having it checked out.  Neither 
Andrea nor I has any hesitation about that.

I can't do a darned thing about John beating up on his brother.  I'm 
not around David much.  His mother doesn't want me to be.  The 
decisions about what to do for him are out of my hands.

re #16: When we've discussed these types of issues in the past, Andrea 
and I have agreed we'd prefer to use methods other than drugs.  It'll 
be interesting to see how that's changed now with the divorce going 
on.  It'll be really interesting if we don't agree how to proceed, but 
we'll have to cross that bridge later if we need to.

I spent a lot of time on this yesterday.  Here's how things went.

We had the doctor visit, and the doctor discussed things such as ADD.  
He also mentioned obsessive-compulsive disorder.  He didn't have a huge 
amount to say about it.  He couldn't even give us a referral, though he 
did mention the names of a couple of psychiatrists he knows or knows 
about.  The next step, he told us, was to call MCARE and go through 
their psychiatric treatment process.

I did this.  At first they recommended I make an appointment at Chelsea 
hospital, since there are longer wait times for U-M hospital.  When I 
told Andrea, she didn't like it; she's heard bad things about Chelsea's 
hospital.  Fine, I changed the appointment to U-M hospital.  They said 
I could get in with a social worker to do an evaluation in a week or 
two, or I could get an appointment with a psychiatrist in 2-3 months.  
They really wanted me to take the social worker, so I did.  Andrea 
didn't like that, either; she insisted on someone with a medical 
background, not a socialism background.  I *really* want us to be able 
to cooperate on medical care issues, and so I called back and told them 
we want a psychiatrist and are willing to wait.

Question: is this reasonable?  She said she thought a social worker 
would be more likely to diagnose a social problem, rather than a 
physical one.  I hope she's not just reacting against a comment I made 
that I'd prefer to avoid drugs.  It takes a psychiatrist to prescribe 
drugs for behavior problems.  I am not too familiar with the mental 
health profession.

Anyway, they'll call me early next week to give me the time for the 
appointment with the psychiatrist.

I go to a divorce recovery workshop on Thursdays.  John was scheduled 
to be with me; normally he'd go to his mother's house when I have an 
appointment, but this time she had other plans.  So ohn had to go to 
the child care at the workshop.

It was an unfamiliar setting and place, and so I didn't think he'd want 
to go, and I didn't think he'd do well there.  He surprised me once in 
that he did want to go.  Then I got another surprise at the end of the 
night; the teenagers who watch the kids were very impressed with how 
well he did.  Several of them made a point of telling me that.  He had 
a *great* time.

I'm not sure how this fits into the rest of the picture for him.

This response has been erased.

(For obsessive-compulsive behavior carried to the max, see item 171
in the Enigma conference.  <item:enigma,171>.)

re #20: I've heard about blue babies; my understanding is they were 
usually stillborn or not going to live long.  That might have been a 
long time ago, though.

I'm certain John would not have lived through his first week without 
modern medicine.  His lungs didn't work on their own; they were 
underdeveloped.  He had to have a tube in his chest.

re #21: Maybe John can be your co-fw someday?

The concept of the "blue baby" typically refers to a baby with a
congenital heart defect that prevents normal oxygenation of the blood,
resulting in the baby being blue in color until the heard defect can be
repaired. While historically a blue baby would likely have a very short
life, I believe that doctors can now repair some common heart defects
in utero.

I don't share Andrea's concerns about having John evaluated by a MSW at
UM. I understand that to be their standard practice - a MSW does an
evaluation, perhaps an hour or two in length, and toward the end a
psychiatrist comes in to review the history and any provisional diagnosis.

I agree with Mary's suggestion that a full medical examination is in order
to rule out physical issues. Diagnostic studies of the brain may be
appropriate - PET or EEG, for example - particularly if there were
questions of anoxia associated with John's medical crisis after birth.
Obviously, that's something you would discuss with his pediatrician or
psychiatrist.

There are some online resources relating to the diagnosis and treatment
of psychological conditions in children, and medication:

http://www.nimh.nih.gov/publicat/childqa.cfm
http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec1.html

I don't want to play armchair psychiatrist, so I'll leave it at that.

I wasn't concerned about who did the initial evaluation, either; it 
seemed to me a social worker would be able to make some guesses about 
sources of John's problems, and if needed, get further help from a 
psychiatrist.  She said she was concerned a social worker would be more 
likely to attribute his problems to non-physiological causes.

At times our divorce is pretty bitter.  She may have been reacting 
against me saying I'd rather try such solutions before medication.  Or 
she may have thought I'd pushed for a social worker because I thought 
they'd be less likely to use medication.  It seemed better to go along 
with her and get John in for an evaluation that she would agree to, 
rather than try to make unilateral decisions without her approval.  
I'll probably regret that if a psychiatrist really is more likely to 
prescribe medication rather than try other solutions first.  Sigh.

Thanks for the links!  I'll check them out.

John's psychiatric exam was today.

They said John doesn't have obsessive-compulsive disorder.  They think 
his symptoms are similar to Asperger's Disorder, which is a mild form 
of autism.  It's not exactly Asperger's.  The psychiatrist recommended 
he be evaluated by the school.  They will be able to put him in an 
individualized instruction program of some sort, but perhaps not until 
1st grade.  He should go on to 1st grade.  His IQ is above average, 
according to the psychiatrist who evaluated him.

Medication might help him but since his mother and I both preferred 
social solutions, they said he doesn't have to get a prescription right 
now.  If he did, it would be an SSRI (selective seratonin reuptake 
inhibitor) such as Zoloft (which I'm takingfor depression) or Prozac.  
I forget the one they said they usually prescribe; it started with 
an "S".  Maybe he said "sertraline", which would make me mad, as that's 
just the generic name for Zoloft (which isn't sold generically).

I know someone I am sure would have been diagnosed with Aspergers if 
anyone had bothered to figure out why he was "just a little bit weird". 
I have read a lot about it and it is an interesting disorder. The good 
news is that most folks with Aspergers lead pretty normal lives and I 
think I have read that there is a lot of success with non medication 
types of therapy. 

Some websites:

http://www.udel.edu/bkirby/asperger/
http://www.autism.org/asperger.html 
http://www.aspergerssyndrome.org/

Here's another one:

http://www.aspergers.com/

Basically it's a Pervasive Developmental Disorder, like autism.  It's 
kind of a mild sort of autism.

Now I'm interested in what the school comes up with for him.

re #25; Serzone?

I don't remember if that was it.  According to a quick WWW site, 
Serzone is for treatment of depression, and John's not depressed.  
Serzone is another selective seratonin reuptake inhibititor like Zoloft 
and Prozac.

I asked the psychiatrist if they might be prescribing Zoloft, because I 
saw several items advertising Zoloft in his office.  He said they 
usually prescribe something else.  I should have written down what he 
said it was.  Oh, well.  Right now, John doesn't have a prescription.

A lot of time has passed, and some things have been decided.

First of all, some of John's behavior is a little more normal than it 
used to be.  He still doesn't have many friends.  He's physically 
capable when he's around adults or by himself, but put him in a group 
situation like a soccer game and he's completely baffled.

The school district did some testing on him, and on Friday his mother 
and I attended a meeting of most of the professionals who'd been 
involved.  He's been assessed by the school district as "autistic 
impaired".  (Asperger's Disorder would have been in this category, but 
he doesn't have exactly the symptoms of Asperger's.)  This is a school 
district thing that means he's going to be in some special education 
classes, which will take 1 to 1.5 hours per week of his school time.  
He'll be working with a social worker on his social skills; with a 
physical therapist on some of his physical activity, and with another 
person who will help him with classwork type activities.

The school is in the process of hiring a social worker so he won't 
start that program for a month or so.

All agreed, when he's around adults, he's very confident and capable.  
When he's around other kids, he's not.

He doesn't have to take any medication.  As long as there are 
reasonable alternatives, I am very much against having him taking pills.

Some of the details of his special education will be worked out.  We're 
going to see what results we get after a year, but a few of the people 
with whom we met felt he could be helped a fair amount by some 
individualized instruction.

Brooke Edmunds sent me a link to an article which describes my son as 
well as anything else I've seen in print.  It's available here:

http://www.washingtonpost.com/wp-dyn/articles/A52269-2003Jan13.html

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