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Question 78: I have one student, labelled with a developmental disability, who deeply wants to be part of the regular grade 6 scene but has great difficulty with anyone or anything which blocks or delays his general wish of being included. I spoke to his father at length in December about your reference to disinhibition difficulties and he did seem open to the idea that something like that could be going on with his son. Is a medical workup the place to start in case medication would help? Or is there another point of entry that you would recommend? R.A. (special education teacher), ON, Canada.

Certainly if you think diagnoses above and beyond the intellectual limitations covered by the Deveopmental Disability (still formally recognized as Mental Retardation) diagnosis may be present and the parents agree, getting an appointment with a professional who can diagnose a disinhibition disorder like TS, ADHD, OCD etc. would be the important first step, yes.

-A pediatrician, neurologist or psychiatrist (all medical doctors) can do so, and are covered by the Ontario Health Insurance Plan (OHIP), but the wait-lists can be formidable and usually a family doctor has to give a referral (many parents can tell you stories of instances where their general practitioner has been sometimes reluctant to do so).

-On the other hand a Psychologist can also diagnose, does not need a referral, and the wait-lists (if they exist at all) are typically shorter. The shortcoming here is that Psychologists are not covered by OHIP (although most work insurance policies include at least some coverage for Psychologists).

After the diagnosis is made, if medication is warranted only a medical doctor can prescribe in most parts in Canada (although some Psychologists in remote northern areas of Canada are given special permission to do so). Psychologists can recommend medications in their reports, however, and with your permission send a copy of the report to your family doctor or pediatrician to provide a prescription.

The best of luck to the family! And may I take my hat off to such a diligent, invested, and caring teacher. Thank you for doing what you do sir.

I hope this helps,

Dr. Dunc.

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