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The Difficult Parent: A Reflective Pediatrician's Response

2004; American Academy of Pediatrics; Volume: 114; Issue: Supplement_6 Linguagem: Inglês

10.1542/peds.2004-1721s

1098-4275

Martin T. Stein, Michael S. Jellinek, Robert D. Wells,

Adolescent and Pediatric Healthcare

CASE Mr and Mrs Floyd, the parents of Leroy, an 8-yearold child with Asperger syndrome, recently moved from out of state and contacted Dr Stonehill, a primary care pediatrician with experience in developmental-behavioral problems. Dr Stonehill planned for an extended initial office visit. Leroy demonstrated many of the behaviors characteristic of children with Asperger syndrome. He avoided eye contact and was preoccupied with his Yu-Gi-Oh cards. He startled easily and was impulsive and oppositional, particularly during his physical examination. Mrs Floyd informed Dr Stonehill that Leroy had been prescribed a “ton of meds, and none had worked well.” She also brought a long list of specialists whom she had consulted and informed Dr Stonehill that each one had failed to be of any help. She seemed very needy, and initially she responded well to Dr Stonehill’s patient and supportive manner. At the end of the visit, she expressed extreme gratitude for his time and agreed to follow his advice regarding behavioral management. During the next several months, Mrs Floyd made weekly acute visit appointments with Dr Stonehill to address the cascade of behavioral problems that Leroy demonstrated at home and school. She seemed desperate, and Dr Stonehill reluctantly prescribed a series of psychopharmacologic agents to reduce Leroy’s extreme impulsivity, temper outbursts, and obsessive rigidity. Although Mrs Floyd was initially grateful and deferential to Dr Stonehill, over time, her attitude changed, and she became demanding of Dr Stonehill and his staff. She became enraged when prescriptions were not ready on time or when she had to wait to get an appointment. She frequently called his exchange during off hours and insisted that he do something to help her control Leroy’s complicated behavioral problems. On a few occasions, she yelled at Dr Stonehill’s office staff, who now tried to avoid interacting with her during frequent clinic visits. Dr Stonehill believed that, no matter how hard he tried, he could not please her and that her demands on his time and patience were excessive. He considered telling her that he would no longer serve as her pediatrician, but he worried that there were no other good alternatives in town and that Leroy indeed needed help.