Hi and thank you for your blog/website. I was wondering what the best treatment is for managing self-regulatory behavioral issues in a 22 yr old with a h/o encephalitis as a toddler? In our case, "mood" meds have not been very helpful and we've tried many. Stimulants help with the ADHD-like behaviors but then it can be tricky to deal with rebound related issues. Suggestions?

Thanks-!
Terry

Dr. Nilsson - Schools and other folks will often recommend using "sticker charts" or other similar methods to try to "improve the child's behavior". Do you have thoughts on explaining WHY this isn't the most effective thing for kids with neurological damage? And how this can cause even more anxiety leading to more problems, because the child may not even be able to control certain aspects of their behavior. Thanks!

Me again. :-) I just read your post on using medication as part of treatment. I resisted medication for my child for a long time, but I can truly see the benefits of it now, and he's been taking it for a year.

My question relates to "how long" and "thinking long term". If the medication is helping, and behaviors and other things improve, does this mean he is really improving and learning self control, and can eventually (hopefully) stop taking it? Or, does medication just "mask" other problems that then don't get addressed because they're not as visible?

Or, is the medication hopefully allowing the brain to continue to develop and mature, and that over time he can learn the skills of self-regulation that he needs without having to use medication?

Thanks! :-)

Great questions! For both, I will write a Blog as I think it will be of interest to a lot of parents.
Thanks!

Dr. Nilsson- A couple of thoughts that I have...I loved your post on medication. The anti-anxiety medication that my son takes has made the most amazing difference. I too was hesitant to medicate my son, but I see how much more able he is to control his emotions, his body, and handle his surroundings. A question- In regards to IEPs- what are some accommodations that may be helpful to children with brain injuries to ask for? I have my sons' IEP meeting for 1st grade coming up in 2 weeks and am at a loss what is even possible to help him. Another question- we have my son going to a psychiatrist closer to home to help with his medication- he thought it might be helpful to try him on a stimulant on school days. Having read your post on Adult ADHD- I'm curious what your take is on this for children with brain injury. Is it helpful- or harmful?

Your questions are excellent. Let me address the question of IEP’s. The ideal is to follow-up with the neuropsychologist who has evaluated your child. He will be in a position to lay out a specific plan, with specific recommendation, provide it to the school, and then advocate for your child. It is important that school personnel “Understand the Logic” of your son’s behavior and learning. The IEP or other support should build upon that logic. Many neuropsychologists collaborate with educators (e.g., teachers, school psychologists) who can help parents write an IEP, asking for specific adaptations and accommodations of benefit to their child.

Medications are not always carefully planned. If a child has anxiety, it is treated with an anti-anxiety/anti-depressant medication, adjusting an optimal dose of medication may mean experimenting with the dose. Increasing the anxiety medication may improve attention. If that does not help, consideration might be given a dose of a stimulant. For some children, a stimulant medication may intensify anxiety, an undesired side effect. Others do well with both. Trial-and-error is a reasonable process with two basic rules. First, accept NO negative side effects. They will be obvious. Second, continue a course of medication only if there is obvious therapeutic benefit! There are some rare exceptions and should be discussed with his physician.
Thanks for your questions!

Have you seen other patients that acquired allergies and asthma after a brain injury? My injury is a brain tumor, removal, chemo and radiation.

In the course of my practice, I have had many patients reporting variations of the symptoms you describe - allergies, asthma, others - to varying degrees of severity and diversity. The the research suggests that the inflammation secondary to brain injury
may be the culprit. Many patients report a variety of symptoms commonly associated with the immune system. For some, the symptoms are short-lived; for others, they appear to be a permanent condition. The immune system is part of the nervous system and as such
it makes sense that it would be affected by injury to the brain. You should discuss them with your physician such that they are aware of the symptoms and can participate with you in monitoring them, intervening with treatment prn. Dr. Nilsson

My little one is now 6. I have had him on medication for over a year. I have noticed things changing, progressivly getting worse. I have started to look into other problems than just the ADHD I was told was his problem. I have found from one web site some
basic information on autism. He seems to fit most of what i read. But is it common for people to miss some of those behaviors until they are this old? Im very worried that his behavior is going to get someone hurt. He hasn't had too much trouble with the violence
part Ive read about, but lately its been getting worse.I have him on so much medicine right now and its still not got his behavior under control. Im limited though as to my resourses, he is on state aid. Sometimes I have to give him a 100 mg of trazadone a
day to keep him semi balanced and able to sleep at night. I hate to give him so much medicine. He takes 3 different doses of adderal, and remron and trazadone. And yet, two weeks ago, in the middle of class when his teacher was trying to teach, he broke into
song. He started singing from a commercial, a preview for the Simpsons move, the song "Spider-Pig". She said its not the first time he has gotten so, um, off track. One time he blurted out that he needed a cape so he could fly. Im scared. I don't know anything
about autism, and don't know what to believe. Im trying to get him into a center that does the neruopsychological evaluations, but it could take months. The school is trying to get him on an iep, but Im feeling very helpless. It seems like everything is taking
so long. I want to help him now. Can you help me know where to at least start to help him now? I don't know what to suggest for a change in medication even until we can get the eval done. Can you help? Please? Barb

You are in a situation commonly seen in many of my patients. It appears that you are taking the right steps in getting help for your son. It would be most helpful to work with your son at self-calming strategies. I can offer these blog posts as suggestions
for areas that you can work on while you are waiting. What is Arousal? What is Neurogenic Irritability? Self-Calming Step One: Developing Awareness Best Regards, Dr. Nilsson