Dear Dr. Gott: My 38-year-old granddaughter is convinced that because she has polycystic ovarian syndrome (PCOS), she cannot lose weight. She is grossly overweight, and I am concerned about her future. She sees an endocrinologist about once a year, and takes thyroid medication and niacin for cholesterol. Can she be helped? Thank you for your consideration of this serious problem.
Dear Reader: PCOS is a hormonal disorder that commonly begins when a female begins menstruation; however, it can develop later in life.
Obesity presents in nearly half of all patients with PCOS and is often the initial complaint. Abnormalities in the menstrual cycle, infertility, pre or type II diabetes and the presence of polycystic ovaries diagnosed through ultrasound are but a few of the other symptoms. It should be noted, however, that having polycystic ovaries is not a firm indication of PCOS.
There is no specific testing for diagnosis. Rather, it is one of exclusion, meaning that a physician will rule out a number of related possibilities prior to deciding on PCOS. The disorder makes other conditions, such as type II diabetes, hypertension and sleep apnea, more likely to occur.
Only you and your granddaughter can determine the sequence of events. When was she diagnosed? Could the PCOS be a result of her obesity? Is that issue under control? I cannot tie in high-cholesterol levels with her excess weight; however, thyroid disorders are often linked with obesity, elevated cholesterol and menstruation abnormalities.
There is help and hope that focuses primarily on her major symptoms. She should exercise and become involved with a regular weight-control program.
Diet modification appears essential. There is some initial evidence of success on a low-carbohydrate diet without discrimination between carbs on either end of the glycemic index. Her caloric intake should be reduced. She should avoid simple carbohydrates such as soda, sugary drinks, doughnuts, cakes and pastries. Any carb intake might focus on choices high in fiber, such as brown rice, whole-grain breads, fortified cereals and beans.
Her physician might decide to place her on low-dose birth control as a means of regulating her menstrual cycles.
She should continue to see her primary-care physician and endocrinologist on a regular basis.
Dear Dr. Gott: My son has oppositional defiant disorder (ODD), and he seems to scheme to upset the peace in our home. Once there is a blowup, he gets a little half smile on his face. What is a parent to do to fix this?
Dear Reader: All children and teens have moments when they can be difficult, moody and/or argumentative. This is perfectly normal. However, when tantrums, arguing and angry or disruptive behaviors (especially toward the parent/guardian and other authority figures) become regular occurrences, ODD may be the reason.
Symptoms are hard to distinguish from normal behaviors of strong-willed or emotional people. In fact, the symptoms of ODD are the same as behaviors expected during certain stages of a child’s development. When these behaviors become persistent, are clearly disruptive to the family, home or school, and have lasted at least six months, ODD must be considered.
Negativity, defiance, hostility toward authority figures and disobedience are common with ODD and lead to temper tantrums, academic problems, anger, resentment, argumentative, spiteful or vindictive behavior with adults and aggressiveness toward peers. There may be deliberate annoyance of others, blaming others for mistakes, difficulty maintaining friendships, easy annoyance, acting irritably and refusal to comply with adult rules or requests. ODD often accompanies other problems, such as depression, anxiety and attention deficit/hyperactivity disorder (ADHD).
There is no clear cause, but it is thought that is it likely the result of a combination of inherited and environmental factors.
Possible risk factors include having a parent with a mood or substance-abuse disorder; exposure to violence; lack of supervision; being abused or neglected; having parents with a severely troubled marriage; family financial problems; inconsistent or harsh discipline; lack of positive parental involvement; parents with a history of ADHD, ODD or conduct issues; and family instability, such as multiple moves, school changes or the use of childcare providers.
Diagnosis is not made through blood or other physical testing. A child must meet certain criteria set by the American Psychiatric Association. In order to have a positive diagnosis, the child must show a pattern of abnormal behavior for six or more months (as compared to what is typical for the child’s peers) and meet at least four of the eight criteria. The behavior must also cause significant problems at work, home or school; must occur on its own rather than as part of another mental disorder; and must not meet the diagnostic criteria for conduct disorder or antisocial personality disorder (in those over age 18).
Treatment of ODD typically involves several types of psychotherapy and training for the child and parents. Medication to treat any associated conditions, such as ADHD, may also be used. Individual and family therapy can help the child manage anger and express feelings, as well as helping the family understand how the child is feeling and provide a safe, neutral environment to discuss concerns, and learn how to cope and work together. Parent-child interaction therapy (PCIT) teaches parents how to interact with their children in order to bring out their best behavior without stressing the parent and straining the (likely) already tenuous relationship. Training may include social-skills training, which teach the child how to interact with others in a positive manner; parent training similar to PCIT; and cognitive problem-solving training, which aids the child in identifying patterns that lead to behavioral problems and thus change them.
I believe the best approach to the situation is for your entire family to seek out some or all of the treatment options I’ve detailed. In this way, everyone can come to understand what is happening and how best to handle problems when they arise.