What would you do if your 10-year-old daughter said to you,
“I can’t take it anymore. I don’t want to be me. I don’t want to feel anymore.
Why aren’t you doing anything about this?” Or if your normally loving son
threatened to slit you open with a knife? Naturally, you would want to do
anything in your power to make your children better, but what if that meant
giving your six-year-old lithium? Or sending your 10-year-old away to a
therapeutic residential school?
In deference to the many parents who face these challenges
day after day, I highly recommend Jennifer Egan’s piece on bipolar disorder in
children. She traces several families’ struggles to cope with children who rage
against the world from the time that they can talk, and offers a comprehensive
portrait of the uncertainties surrounding bipolar diagnoses in kids.
Until relatively recently, it was believed that bipolar disorder only affected adults. Now nearly all leading
child psychiatry experts agree that children can suffer from the disease—but
they mostly all disagree about how to diagnose childhood bipolar disorder. Most experts believe that it is over-diagnosed, in part because managed care
usually only pays for one brief psychiatric evaluation a year and because of
the highly questionable yet widely popular book The Bipolar Child.
Diagnosing mental health problems in children is further complicated by the fact that many of the symptoms of bipolar disorder overlap with the
symptoms of ADHD (Attention Deficit Hyperactivity Disorder). And mania is not as
clear-cut in children as in it adults--it's often normal for children to act grandiose or have
terrible temper tantrums.
James, one of the kids Egan writes about, was diagnosed with
ADHD, OHD (Oppositional Defiant Disorder), and bipolar disorder by the time he
was eight. With so much uncertainty about the disease, even parents whose
children have seemingly clear-cut episodes of mania—stealing strangers’ cell
phones or wearing outlandish clothing—followed by clear episodes of depression
remain uncertain about their children’s treatment.
Once a child is diagnosed with bipolar disorder, he and she
is prescribed strong medication with harsh side effects. Making the decision to
give such drugs to kids is a huge weight of responsibility on a parent’s
shoulder—and this decision requires trusting a doctor whose personal biases
will inevitably influence her diagnosis and prescribed treatment.
At the very least, I hope that Egan's article will bring greater awareness to this issue. As one of the mothers interviewed said of her son's horrible temper tantrums, "It's like a dirty little secret. It's like having a husband who beats you, only it's a kid. It's your own."
Image: New York Times
