Perseveration

what form does the perseverating take? This might make it easier for others to suggest solutions…

It takes the form of a total fascination with watching the a/c fans go around outside the classrooms. Sometimes he will hold up his hand in a rigid sort of position to immitate a shape of something he’s seen in the fan (perhaps one of the metal parts). He used to do this last year but it had subsided - now suddenly it’s back and I”m not sure why, there has been no change in school, meds or anything. THanks!

The first and simplest approach would be to remove the stimulus, ie block his vison of the fans. This could be accomplished by changing seating or by a partition (please, something attractive or practical, lie a movable blackboard, not one of these cardboard boxes around the desk). This would not exactly cure the problem, although if you’re lucky the symptoms may die out over time if the stimulus is gone.

Odd, this kind of behaviour reminds me of my young adult student, never specifically diagnosed; he perseverates all the time and makes odd gestures. Definitely something to try to deal with in the formative years!

I’m maybe way off here, but given that he MAY be fascinated with the fans in an ‘engineer brain’ type of way — have you asked him WHY he is so interested? Is this part of an obsession that might have some value — but a behaviour that needs to be modified — so that perhaps discussing the problem would now be effective? Or helpful in finding a solution?

I work (and have worked for many years) with engineer-types who are high on visual spatial intelligence, and sometimes a bit lacking in the ‘social mores’ that keep us from looking ‘weird’. But have brains that can visualize things like the workings of fans, and details of their design, from a rough sketch that means little to a wordy-type like me. Sometimes the line between creative obsession and perseveration is pretty thin, I think — perhaps there is something reasonably fascinating in the workings of the fan, in a ‘beautiful mind’ sort of way, that many of us would not see or care to explore.

Could it be that he is now ‘learning’ or ‘exploring’ this phenomenon (the workings of the fan) and that is why it is still present, when meds and behaviour are reasonably on track — 8 is still pretty young…he may lapse into ‘imaginative exploration’ and need help to remember that we can’t always lose ourselves in our imaginations when in public…hope this makes sense.

How is the light in the room? ceiling fans (you say a/c fans so I’m assuming ceiling fans) often cause problems with light disturbances. It depends on where the lights are in relation to the fans. think blinking fluorescent light and you get the picture.

Try getting permission for a ball cap on the head forwards, if it is just the fan. It is the light, it’s a bigger problem-some people get severe problems with dizziness, vision, all sorts of things.

Good luck, you sound like have made some great strides over the year.

I agree on the lights; I am also sensitive to fluourescent flickers, and so is my daughter. And yes, fans can create some really sickening flickers. A seat near a window with sunlight can help a lot. A partition, as I suggested above, can also be placed to block flickering light if you work on it.
I would NOT go for the ball cap, which is just asking for trouble.

sounds like a compulsion - I know aspergers kids can be obsessed with fans/lights,and the hand thing sounds like some sort of compulsive gesture. I’m wondering if the stimulant medication is bringing this out in him. ?

I agree with Karen that this sounds like OCD from stimulant meds. Talk to your child and his doctor and see if this is a possibility. My child can’t take any stimulants because of this. Jan

Just a word of caution to parents: stimulants do not cause OCD in children who are not already susceptible to it. As others have pointed out, however, stimulants should be used cautiously in children with pre-existing anxiety disorders or those with a family history of such disorders, including OCD. In that population, stimulants can unearth OCD behaviors.

Guest is exactly correct! My child does have an underlying anxiety disorder.Unfortunately we didn’t know it previous to starting stimulant meds. I’d ck with your docotor. Jan

Guest, with all due respect, I am concerned about your comments being misleading. I am pretty familiar with the literature on ADHD and medication, and I know of NO study that looks at the presence of OCD before and after taking stimulants. It is very possible that non-anxious children may become anxious on stimulants, and that anxious children may become more anxious. There have been very few long-term studies on stimulants, and essentially NONE studying side effects over more than about 8 weeks duration that I am aware of.

I would ask that you provide a scientific basis for your statement. If you can’t, I would ask that you not make this kind of statement. It really does not help anyone and can cause confusion for parents who are already getting enough confusing information from people with their own agendas. Stimulants can be very helpful in the short term, but there ARE side effects, and it does no one any favors to try and minimize that fact.

Steve,
You know you could be right! I hadn’t thought about it like that. Perhaps my child didn’t have anxiety problems before stimulants. It’s been such a journey of med after med that I’m just about ready to throw my hands up. We are now on Wellbutrin SR and Imipramine. I can’t see that it has done ANYTHING. Ritalin is the only thing that ever seemed to help my child’s handwriting and other ADHD behaviors. That worked about 6 mos. before he started having side effects. If we didn’t home school I could not make it and he would be failing school although he is gifted LD.Any words of wisdom would be appreciated. Jan

My 2 cents:

Very often behaviors associated with OCD, ADD, anxiety etc fall on a spectrum and many people may have mild traits without a diagnosis. I suspect ( can’t prove!) that stimulants can really exacerbate traits that might normally be nowhere the level of a disorder . In other words, I dont’ think we need to get hung up on whether the anxiety pre-existed the stimulants. If stimulant meds makes you anxious or OCD to the point its a problem then its a problem whether you had the problem or were aware of the problem before. Hope that makes sense!

[quote=”Steve”]Guest, with all due respect, I am concerned about your comments being misleading. I am pretty familiar with the literature on ADHD and medication, and I know of NO study that looks at the presence of OCD before and after taking stimulants. It is very possible that non-anxious children may become anxious on stimulants, and that anxious children may become more anxious. There have been very few long-term studies on stimulants, and essentially NONE studying side effects over more than about 8 weeks duration that I am aware of.

I would ask that you provide a scientific basis for your statement. If you can’t, I would ask that you not make this kind of statement. It really does not help anyone and can cause confusion for parents who are already getting enough confusing information from people with their own agendas. Stimulants can be very helpful in the short term, but there ARE side effects, and it does no one any favors to try and minimize that fact.[/quote]

Just for starters:

http://www.cnsspectrums.com/pdf/art_377.pdf
http://ajp.psychiatryonline.org/cgi/content/full/160/1/183
Kotsopoulos S, Spivak M
Obsessive-compulsive symptoms secondary to methylphenidate treatment.
Can J Psychiatry (Canada), Feb 2001, 46(1) p89

Guegant G, Crochette A
[Methylphenidate, tics and compulsions]
Encephale (France), Mar-Apr 2000, 26(2) p45-7

http://www.additudemag.com/experts.asp?DEPT_NO=901&ARTICLE_NO=19&ARCV=1

Steve i wonder why you did not ask for research proof from the persons who said that stimulants caused OCD but did from the person who said that it only uncovered it. My doc says that it is ok for me to have adderall even tho I have ocd.

‘Different Guest’, if you have dx’d OCD, co-morbid with ADD or ADHD, that is not what was referred to. In a person with no previous dx of OCD, when OCD-like symptoms appear, it is important to eliminate the stimulants as a possible trigger of the OCD symptoms — and the observation that ‘meds won’t bring on OCD symptoms but will only bring out what was already there’ is NOT accurate. There may be old studies or articles purporting this view, but it is NOT accurate.

If the side effects of a med produce a quality of life that is WORSE than the original condition unmedicated, it is pretty clear that the meds are NOT appropriate, despite their possible benefits. For this reason, parents need to judge side effects and possible causes of symptoms, very, very carefully, and compare them to the benefits provided by the medicine. It’s a very individual choice, made by each individual, or by parents on behalf of individuals under the age of majority.

[quote=”Elizabeth TO”]’Different Guest’, if you have dx’d OCD, co-morbid with ADD or ADHD, that is not what was referred to. In a person with no previous dx of OCD, when OCD-like symptoms appear, it is important to eliminate the stimulants as a possible trigger of the OCD symptoms — and the observation that ‘meds won’t bring on OCD symptoms but will only bring out what was already there’ is NOT accurate. There may be old studies or articles purporting this view, but it is NOT accurate.

[/quote]

Turn about being fair play, what is the scientific basis on which you base your assertion that stimulants do trigger OCD symptoms in individuals not already at risk for them?

[quote=”Elizabeth TO”]’There may be old studies or articles purporting this view, but it is NOT accurate.

[/quote]

This is in fact an inaccurate description of the information I posted, all of which involved studies of quite recent vintage.

Sorry to get into my own opinions here, but it is really important to clarify the way I see scientific method working on these issues. Having been trained as a chemist, I can tell you that the scientific method is excellent for proving things UNTRUE, but is not very effective for proving things TRUE. When you come up with a hypothesis, such as “OCD is only caused by stimulants in cases where there is a preexisting anxiety disorder”, the onus is on YOU as the experimentor to test this hypothesis. You test this by trying to prove the hypothesis WRONG in every way you can think of (what other explanations exist, how can I eliminate them, if there were another cause, what would I see as a result, etc.) If it stands up to that testing, only then can it be regarded as a legitimate theory, and even so, it is still subject to being disproven as more evidence is put together. If a person takes a medication and afterwards develops certain symptoms, a much simpler and easier to test hypothesis is that the medication is the cause. Elizabeth has identified the very simple test - remove the medication and see if the symptoms resolve. To prove THIS hypothesis wrong, you would have to eliminate any other situation where these OCD behaviors were observable without medication, but since the situation doesn’t have as many variables, it is very easy to check that in an individual child. To prove that OCD is caused by stimulant medications IN GENERAL is a much larger hypothesis and requires a whole set of experiments that none of us are prepared to engage in. The criticism of my statement is proper to that extent - it is not proven to what extent OCD in general can be attributable to medications, and I might very well have mentioned that. I have heard some anecdotal information about that, but again have not seen any real studies looking at the probability of seeing such effects. However, I think it is easy to resolve the question for this particular child by doing what was suggested, so I didn’t feel any particular need to comment. I DID feel compelled to comment about making a diagnostic assumption about a child none of us know based on an unproven hypothesis that “children who develop OCD on meds must have had an underlying vulnerablilty” when there is no data that I know of to suggest that this is an true statement. The first post gave a practical approach to test a workable hypothesis, the second was purely speculative and perhaps misleading, hence my desire to comment on the latter as opposed to the former.

Hope that clears up my reasoning.

The continued dependence on ‘scientific studies’ to inform ALL areas of childrearing is quite ludicrous, IMO. My child is my heart’s blood — I will do ANYTHING to improve his quality of life. However, my choices are informed by far more than ‘scientific studies’.

When I post for information, I HOPE to get opposing viewpoints and references to the reactions of real live children — then I will make choices for my child based on the risks and benefits I perceive. My choices are also informed by my own upbringing and experiences, my moral code, and my beliefs about the best way to bring up MY child. In making my choices, I am also influenced by anecdotal evidence, and I don’t CARE whether it is ‘scientifically supported’ or not. I am actually MORE interested in the experiences and opinions of other parents than I am in ANYTHING that is considered to be ‘scientifically proven’!

Scientific studies are useful, and I sometimes refer to those posted. But starting a ‘scientific evidence’ battle is useless to me, and I bet most parents who post here would agree.

I make choices for MY child based on MY assessment of risks and benefits. Sometimes my choices are also influenced by scientific evidence, the advice of professionals, etc. BUT: why criticize the choices of others, or information presented by others, who are simply seeking information, or offering it, to help other parents raise their children with the best quality of life possible? If you are a parent and don’t agree — ignore the information! If you are not a parent (or a teacher of children, who also have valid reason to participate in this forum) then why post?

This is a rhetorical question, for which I don’t expect answers. But I hope we all THINK before we post in opposition. It is one thing to post ‘my experience and opinion is different’, and if you really think someone is wrong it is fine to say so — ONCE. But these ‘scientific evidence’ wars are really quite silly, and serve to make anyone posting as ‘guest’ or ‘other guest’ or any other pseudo-nickname, look as if they live under a bridge…

[quote=”Elizabeth TO”]The continued dependence on ‘scientific studies’ to inform ALL areas of childrearing is quite ludicrous, IMO. My child is my heart’s blood — I will do ANYTHING to improve his quality of life. However, my choices are informed by far more than ‘scientific studies’.

When I post for information, I HOPE to get opposing viewpoints and references to the reactions of real live children — then I will make choices for my child based on the risks and benefits I perceive. My choices are also informed by my own upbringing and experiences, my moral code, and my beliefs about the best way to bring up MY child. In making my choices, I am also influenced by anecdotal evidence, and I don’t CARE whether it is ‘scientifically supported’ or not. I am actually MORE interested in the experiences and opinions of other parents than I am in ANYTHING that is considered to be ‘scientifically proven’!

Scientific studies are useful, and I sometimes refer to those posted. But starting a ‘scientific evidence’ battle is useless to me, and I bet most parents who post here would agree.

I make choices for MY child based on MY assessment of risks and benefits. Sometimes my choices are also influenced by scientific evidence, the advice of professionals, etc. BUT: why criticize the choices of others, or information presented by others, who are simply seeking information, or offering it, to help other parents raise their children with the best quality of life possible? If you are a parent and don’t agree — ignore the information! If you are not a parent (or a teacher of children, who also have valid reason to participate in this forum) then why post?

This is a rhetorical question, for which I don’t expect answers. But I hope we all THINK before we post in opposition. It is one thing to post ‘my experience and opinion is different’, and if you really think someone is wrong it is fine to say so — ONCE. But these ‘scientific evidence’ wars are really quite silly, and serve to make anyone posting as ‘guest’ or ‘other guest’ or any other pseudo-nickname, look as if they live under a bridge…[/quote]

This message illustrates one of the pitfalls of these kinds of message boards. It may be quite attractive to parents seeking the sense of community and support that represents the best of the internet special interest boards, to rely on the “good advice” of fellow “parents” who may or may not be who they say they are. Whether you write your name or not, we are all essentially anonymous strangers on the internet whose own experience may or may not represent the norm and may or may not be accurately reported.

Of course, a parent must ultimately decide whether to continue a particular medication in the face of adverse effects. Of course, even if a medication does not cause a symptom in most children, it may cause that symptom in an individually-susceptible child. That kind of individual experience, however, provides very little in the way of reliable, useful guidance for a parent trying to make choices about treatment options for their children. Mother may know best as to her own child, but she does not necessarily know best with respect to the neighbor’s child or most children.

That is true of all manner of treatments, not just medication choices. Before parents invest precious time and money on a particular treatment, they should have access to objective information about whether most children respond positively just as they should be aware of the adverse effects experienced by some children and how rare or common those adverse effects are. It is useful to know that a particular child experienced a particular adverse effect. Logic tells us, however, that it is a lot more useful to learn, for example, that 85 out of 100 people respond well to a particular treatment and do not experience that or other serious adverse effects.

More information is better than less, of course, and both scientific studies and anecdotal reports from individuals have their place. However, because our individual perception of the effectiveness of particular treatments can be highly subjective, even when we think we are being objective, the experience of one parent and one child with a particular method does not represent the most reliable information and should not form the primary basis for decision-making. A parent who reads a horror story posting by another parent describing an extremely rare event may reject an approach that would otherwise have been very helpful to his or her child. A parent who reads of the miracle cure of another person’s child as a result of a particular treatment may choose that treatment over other treatments that might have been better, safer and more reliable.

Talking about the scientific basis for a particular assertion is an important means of gathering objective information about how most individuals respond. Up until Elizabeth’s post above, the conversation in this thread to date has not involved personal attacks of treatment decisions or otherwise. Neithe has there been any sort of a “war” of scientific studies. To the original poster wrote of troubling behavior by a child taking stimulants. Other posters responded by suggesting that the behavior might be a sign of OCD. Further posts exchanged anecdotal reports and the results of research bearing on the question. Individuals might disagree about how to assess that information, but that is hardly the same thing as asserting that “dependence on scientific studies” should “inform ALL areas of child-rearing.” No one (except for Elizabeth TO) was advocating for a particular choice on whether or not to give the medication. Instead, information was exchanged that may prove helpful to the intial poster and may educate the many individuals who read but do not post.

Elizabeth apparently believes that the best, most reliable information is the anecdotal reports of other parents. Professionals would not agree with her. I do not agree with her. Nonetheless, I certainly think she should be free to express that opinion. She, however, finds my point of view objectionable and seeks to silence it with name-calling and unwarranted attacks. That kind of bad behavior is precisely the reason I never post my name or identify myself in anyway.

To cover one’s eyes and ears to avoid hearing particular information is a personal choice. To insist that others must cover their mouths so that no one can hear the message is something that should give us all pause.

Just so everyone is clear, I think people make decisions using a lot of different bases, including plain old parental intuition. I am not suggesting that scientific studies be the basis of all decision making. I am simply suggesting that stating “facts” such as “everyone who develops OCD symptoms while taking stimulants had an underlying anxiety disorder before starting the meds” is harmful unless the basis of such statements is included in the information. I think anecdotal information is extremely important, especially if your child may be having a relatively rare reaction to a medication that is not generally known or may not even have been recognized. Look at how long it took the scientific community to accept that SSRIs can cause suicidal or aggressive behavior in non-suicidal or non-aggressive people in a small but not insignificant number of cases (this has been in the news a lot lately so I am assuming people are familiar with this issue). There were scientists warning of this back as far as the late 1980’s, but they were dismissed as crackpots because “everyone knew” that such things didn’t happen, since most people did not have this kind of experience. It was only large numbers of people sharing their anecdotal information that eventually flushed out the fact that these drugs could be very dangerous for a small subset of all people who take them.

So keep on sharing those stories! Just be careful about making generalizations without appropriate factual support, or you may be hearing from me!

It is important to beware of what I call the 80% — 90% fallacy. Someone reads or hears in class that 80% or 90% or 99% of people in situation X are also Y. They then make sweeping (false) statements that ALL people in X are Y. This is anything from insulting to dangerous. The other 10% to 20%, or even if it’s 99%, the other 1%, are real people, we exist, and being written off is not good.
Random examples:
A program to raise awareness of sexual abuse at my daughter’s schools where they *only* talked about family abusers because those are 80% of the perpetrators, leader made sweeping statements that those are “all” the bad guys — even though the stranger minority are far more likely to be violent …
Being a woman who not only has good spatial and logical talents, but teaches 3-D claculus, and being told that “all” girls need different teaching in math and should be segregated into classes that teach us poor things verbally because we can’t do spatial work …
Having severe celiac disease and being in the odd subset that gains rather than loses weight with digestive problems, and having doctors dismiss my case because they don’t see the more typical symptoms …
My daughter having an eye problem due to retinal damage, which glasses can do nothing for, and having the school teachers force her to wear glasses for two years because they refused to believe the doctors’ reports, “everybody” needs glasses to see better …

So it is important to get the scientific reports and the large-scale studies for the averages and trends, and it is also important to look at the anecdotal evidence and see if there are sub-groups that are not represented in the bulk averages.
Just remember that anecdotal evidence is only as good as the person reporting it, so especially on the internet where you have no in-person knowledge, be extremely skeptical.