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Separation can have strong impact on behavior
Tuesday, May 17, 2005
BY KENDALL SPROTT

QUESTION:

My husband's son, who lives in Ohio, is getting a divorce. He has two boys, ages 5 and 7. We've had the boys for eight months because neither parent can take care of them now. The older boy is in first grade, the younger boy is in kindergarten. Both are extremely active. The older boy has been having some problems with blurting out things in class. When some tests were done, the only thing that was indicated was a slightly low thyroid hormone level. The pediatrician wants to send him to an endocrinologist and to do an MRI of his pituitary gland. She told me not to worry, but this is kind of scary. The appointment with the endocrine specialist is a month away and I don't know if it's something that should be taken care of sooner. What do you suggest?

ANSWER:

The activity level of children at ages 5 and 7 is very high. Brothers around the same age typically play and "fight," competing with each other in and for games/toys. Divorce and separation can be a traumatic event in a child's life, which frequently leads to a sense of abandonment, when one parent is suddenly gone or is absent for long periods.

Depression and anger are commonly seen and can persist for long periods, if not identified and addressed.

Your grandsons have the complicating factors of a significant move to another state, with separation from both parents. Not only do they have to deal with the parental loss, but also the loss of familiar surroundings and friends. They have to adapt to a new house, grandparents that now play the role of parents, new neighborhood, friends, school, etc.

The period leading up to the separation also is difficult, often because arguments occur and children can feel responsible for part of their parents' problems. It would be unusual for the boys not to have adjustment problems, and counseling is frequently needed and helpful.

As far testing is concerned, in certain circumstances, I like to repeat tests and possibly do additional testing to confirm an abnormality before referring to a specialist. The thyroid hormone regulates the metabolism, so an elevated level might be associated with a child thought to be hyperactive.

The child also would likely show other signs and symptoms consistent with the problem. A child with a low thyroid level would present very differently. Your grandson's thyroid level is abnormal and low, which is inconsistent with his activity level. I would repeat the level and also perform additional blood tests to determine if the thyroid and its regulation are normal. I suspect that the repeat testing might be reassuring, but if it isn't, a referral to a pediatric endocrinologist would be in order.

Since the endocrine appointment is a month away, results from repeat testing should be available to determine if the appointment needs to be kept. If everything is normal, the MRI also would not be necessary. It might be helpful for both boys to have evaluations by a developmental specialist to assess their learning skills and behavior. Although some children adapt to new situations easily, others need more time and assistance to deal with their feelings of trust, anger, sadness and fear associated with parental separation.

Write to Dr. Kendall Sprott, at Children's Hospital of New Jersey at Newark Beth Israel Medical Center, 166 Lyons Ave., Newark, N.J. 07112. Or e-mail him at [log in to unmask]

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