15 Sep 2014
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Patch Instagram photo by cdcva
Patch Instagram photo by cdcva
Patch Instagram photo by jwgartin
Patch Instagram photo by jwgartin

Ask Dr. Mike: September

The psychiatrist responds to questions from the community.

Ask Dr. Mike: September

Money and Secrets

Dr. Mike,
My parents have rented a beach house for our entire family for many years now. This year my husband, our children and I spent several days with them, as did my brother and my sister and their spouses and children. My parents have always paid for the beach house without complaint, but this year I offered to chip in and paid half … without telling my husband. I purposely avoided telling my husband because he would have immediately expected my siblings to contribute equally. The problem is that my husband and I make very sizable incomes and my siblings do not. More to the point, my siblings have pretty much relied on the free beach week from our parents for their family summer vacation for years now. If my husband were more sensitive to their needs and the situation, I wouldn’t have had to lie. Anyway, I finally told my husband what I did, and he is furious with me. We haven’t spoken for days, and I don’t know what to do. I don’t think I owe him an apology. I feel he is wrong and is being pig headed. Your thoughts are appreciated.

T in Loudoun County

T,
I think you do owe your husband an apology. Keeping financial secrets from your husband with your parents, or anyone for that matter, is never a good idea. I also think that the bigger issue here is for you to understand your motivation. You write that your parents have paid for the beach house year after year and without an expectation of payment from you or your siblings, yet you felt compelled to pay half of the cost this year. Why has accepting your parents’ very generous annual gift suddenly become difficult for you? Are you feeling guilty over your parents’ generosity? Do you feel badly for having greater financial success than your siblings? If your generosity was rooted in guilt or emotional conflict, you (and your husband) should know this about yourself and address it. If, however, your generosity was just a gesture of gratitude, you could have included your husband in advance so that the gift could have been something you did together and felt good about together. For example, you and your husband could have agreed to purchase a nice thank you gift for your parents after this year’s beach week. Perhaps you could have paid for a weekend get-away for your parents as a couple. It seems that your husband might have felt better about giving a gift that was from you both directly and free and clear of having anything to do with your siblings. In summary, once you close in on why you did what you did, I recommend you calmly apologize to your husband for not including him in your decision and then explain your reasoning. You should also encourage your husband to open up about why he became so upset — is he upset about the money, the deception, your siblings or something else? The two of you need to come to some agreement on what happened and then discuss how you will remain united in supporting each other’s ideas and needs in the future.

School-Recommended Evaluations

Dr. Mike,
My husband and I were told by our son’s first grade teacher to have him evaluated over the summer. Our son is 8 and struggled badly with writing and reading and with focusing and paying attention this past year. We feel like his teacher was politely telling us that our son has a learning disorder or ADHD and to fix him before he returns to school. We went to our pediatrician who then told us that we needed a “psycho-educational evaluation” and that pediatricians do not do that. We called around to several testing practices, including Ashburn Psychological Services, and discovered that psycho-educational testing is quite expensive when done privately. We didn’t end up doing any testing. We feel strongly that we shouldn’t have to absorb the cost for private testing and that the school should be addressing his learning and attention problems. Your assistance is appreciated.

E in Loudoun County

E,
As parents, negotiating your way through moments like this can be very frustrating and upsetting, so I would like to provide you with a roadmap here on how to handle your situation. First, it is not clear to me from your letter if your son is attending a private or public school. If he is attending a private school, I recommend you express your concerns directly to the head of the school as soon as possible. You should also request to have your son’s first and second grade teachers present at the meeting with the school head to discuss your son’s struggles and to come up with an action plan for this year. They may wish to simply increase structure and provide some in-class supports and accommodations to start. By coordinating your efforts as parents with an involved school staff, your son may do just fine this year and testing would not be needed. If he continues to struggle with writing and reading, and if his attention problems persist, even with increased support and structure, you may need to have your son tested. As parents, you typically would incur the cost for testing and not the school. Your approach would be similar if your son attends a public school. I would start by notifying the school of your son’s problems last year and then schedule a meeting with his teachers and the involved school staff to assess the problem for this year. If the school deems that your son’s problems are impacting his learning and education, the school psychologist is obligated to test your son at school and free of charge. You will then have a meeting to review the school psychologist’s findings and report with the involved staff at the school. If your son then meets criteria for a learning disorder or ADHD, he would be afforded the appropriate educational supports and accommodations under the Individuals with Disabilities Education Act (IDEA). If, as parents, you are displeased with the testing results, you may also request an Independent Educational Evaluation (IEE) to be done privately. The school system typically pays the full fee to have your son assessed by a private psychologist. You could return to Ashburn Psychological Services for that testing or another Northern Virginia testing practice.

So, why is psycho-educational testing so costly? Psycho-educational testing is not covered by any insurance companies. This is because insurance companies take the position that psycho-educational testing is not a medical issue but rather an educational one, so the cost should fall to the parents. Private psycho-educational testing requires a high level of expertise and the process is lengthy. When testing privately, you are paying for both the expertise and the time. Typically, a private psychologist conducting this service interviews the parents and teachers, then spends 5 to 7 hours administering measures face-to-face with the child or teen, and then spends several more hours conducting record review, scoring and interpreting data and writing up the report. The psychologist then meets with the parents to review the findings and may spend even more time discussing things with teachers or meeting with involved school staff. If it turns out that your son has a learning disorder and/or ADHD, there are things the school can and should do to support him educationally. Schools cannot, however, treat conditions, and there would be things you would then need to do to support your son as parents — your son may need tutoring, a behavioral psychologist for therapy, or a consultation with a child psychiatrist or your pediatrician to determine if medication is warranted.       

Mr. Right and Medication

Dr. Mike,
I’ve been dating a great guy for several months now, and I think he could be the one for me. I am embarrassed to admit though that I snooped through his medicine cabinet and found a pill bottle for the medication, valproic acid. The prescription is a recent one. I did my research to find that valproic acid can be used to treat different things, ranging from seizure disorders to bipolar disorder. I know I shouldn’t have snooped, and I feel badly about it, but I found what I found and the situation is scary to me. I told my sister and couple of my friends, and they are all unsettled by the discovery. I was hoping for some of your wise direction here.

G in Loudoun County

G,
Yes, valopric acid is a medication that is used to treat several conditions, including the ones you mentioned. I suppose in any relationship there comes a time when larger, personal issues need to be discussed, including those involving health problems. It appears that your snooping has brought you to that moment now. While I appreciate the compliment, I do not think wisdom is needed here, but rather, complete honesty. I would simply start by telling your boyfriend that you care about him and that you have a serious topic to discuss. I would then let him know that you discovered the medication in his medicine cabinet and that you know it is used to treat a variety of conditions — both mental and medical. I would also let him know that you feel badly for snooping. I would then just listen closely to what he has to say in response. If he truly is “the one” as you note, then there really should not be any big secrets between the two of you, and something like this should not be a deal-breaker on its own. Gauge your thoughts and your feelings during and after the talk. Perhaps you will feel reassured, or maybe you and your boyfriend might need to slow things down a little as a couple. I would caution you from reacting or making any irreversible changes though inasmuch as Mr. Right does not come along everyday … and Mr. Right will never be perfect!

Death and Therapy

Dr. Mike,
I discovered that my son’s previous therapist recently passed away. I am not sure if and how I should share the news with him. We are currently seeing a new therapist and had no intention of returning to his previous therapist. I just want to be honest with my boy and feel he would appreciate knowing this.

Y in Loudoun County

Y,
I do not see any benefit in telling your son that his previous therapist has died. Your son had a professional relationship with that therapist and then the relationship ended. The previous therapist served his or her role for your son for a period of time, and the things your son learned in that work are what matters most. I am not suggesting you lie to your son, and I appreciate the importance you place on being honest with him. In this situation, however, I think keeping the news from him seems the right thing to do. Based on what you wrote, I am assuming your son has a good relationship with his current therapist and is addressing the things he needs to work on for himself presently in that relationship.

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