Many adolescents have severe, unremitting headaches; hormones and stress add to their woes, it is a very tough time of life. Tougher now than in the 1960’s and 70’s, I do believe. With kids who have severe headaches, “it takes a village” to help them…we recruit other villagers, such as psychotherapists(most important), physical therapists, etc.. The question comes up as to whether they should go to school, or is homebound/tutors ok. In the 1980’s and 90’s I took a tough love stance, saying: “ is my job to be here as a doctor, it is your job to go to school, no matter what, you just have to get up and go..”…Over the years I softened this stance, gradually adopting a more nuanced policy. Some kids just have too much anxiety(and sometimes depression as well) to go to school; they funtion, at least for periods of time, better at home. Adolescents’ brains are awake at nite, asleep in the morning, and yet we make them get up at 6 or 7am. We often ease them back into school, eliminating gym, sometimes allowing late starts/early finishes, as long as they go. Each child is different, and approaches vary depending on the kid, the school, and the parent’s situation. Many parents cannot provide for tutoring, homebound, and need the kid to just go to school. I like to lighten their load, and make up credits in the summer; the idea is to go from A to B, A being freshman year, and B being graduating, even if it takes doing the GED, which is one way to go for some kids. We never “give up” on kids; many adolescents who look horrible psychologically are doing great at age 20 or 25; Yes, if the kid is no better at age 28, acting out, drugs, police, borderline personality behavior, then we may be stuck. But there is “plasticity of the brain”, which means someone who is acting as a personality disorder, at age 18 or 20, may “heal” and do much better into their 20’s.

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