Why Isn’t My Son Getting Better? Part I of III

By Dr. James Feinberg,
Child Clinical Psychologist

More and more boys are being referred to me because they have not benefited from prior mental health treatment. Are these boys really untreatable or is something else amiss?

In my experience, many so called “treatment failures” can be traced back to an inadequate evaluation. Because most parents don’t know what constitutes an inadequate evaluation, a few examples will suffice.

Solely using a rating scale, completed by parents and teachers, to generate a diagnosis (e.g. ADHD) and then writing a prescription(s) or rendering another modality of treatment (e.g. social skills group), is an example of an inadequate evaluation and one that often results in a poor treatment outcome.

Rating scales may be objective instruments but those individuals filling them out are not. In fact, even when psychologists are extensively trained in how to rate a certain behavior (e.g. hyperactivity), correlation rates (i.e. agreement) among them rarely exceed 80 %. This is why the results from rating scales must be interpreted cautiously, and why they are merely one of many components of an evaluation.

Another example of an inadequate evaluation is jumping to conclusions after only one 45-minute contact with a boy and his parents. Contextual variables greatly influence what is observed in a first interview. For example, meeting a new doctor for the first time often creates anxiety and restlessness in many boys leading some to erroneously believe that the boy is suffering from ADHD or an anxiety disorder, when he isn’t. The purpose of a first contact should be to establish rapport, gather history, and formulate hypotheses, and nothing more.

In contrast, a comprehensive evaluation is a time intensive process that requires many face-to-face contacts with parents and their son as well as with their son individually in addition to consulting with teachers, coaches, and prior mental health providers.

The prime objective of a comprehensive evaluation is to gather extensive information about a boy’s behavior or functioning across many settings. The second objective is to integrate all of this information and clarify how this boy is struggling, where he is struggling, and why. The third and last objective is to formulate an accurate assessment (i.e. diagnosis) as well as recommend appropriate modalities of treatment. Successful treatment outcomes are much more likely to occur under such circumstances.

So, if your son has been in psychological and/or psychiatric treatment for more than 3-6 months and he has made minimal or no progress; and/or you have consulted more than 2 mental health practitioners with essentially the same outcome, then, it’s clearly time for a comprehensive re-evaluation or 2nd opinion.

To contact Dr. Feinberg & his therapy dog extraordinaire, Grace, please call his office at 314-966-0880 or email them at: drjamesfeinberg@stlouischildpsychologist.com.