They Say: Bipolar Children Are an “American Phenomenon”

Hannah Tennant-Moore — Fri, 10 Apr 2009 16:56:00 GMT

In a fiery interview with Northwestern professor Christopher Lane, journalist Phillip Dawdy explains his belief that parents need to stop trusting that the doctor knows best when it comes to mental health diagnoses of young children. I offer his arguments here for discussion’s sake, with the caveat that neither I nor Dawdy are pediatric psychiatrists—but he at least has spent many years researching the field.

In 2005, at least 2.2 million American children were being treated for mental health disorders, a number that has skyrocketed in the last decade and a half. And in 2007, 23 babies less than one-year-old were prescribed antipsychotics. “The drugs are known to cause huge problems in adults, so why the heck would a doctor give them to little kids, especially infants?” Dawdy asks. Remember the tragedy of four-year-old Rebecca Riley, who died of an overdose of antipsychotic drugs after she was diagnosed bipolar at the age of two?

Dawdy argues that there is no solid research to support early intervention for kids at risk of psychosis: “[T]he PRIME study at Yale—which sought to identify kids at risk of psychosis and then gave them Zyprexa to prevent psychosis from ever arising—was an epic failure and certainly raised questions about the ethics of giving kids dangerous drugs for disorders that they, at least in some of the cases, didn't even have.”

Zyprexa is a drug used to treat bipolar disorder. Dawdy blames pharmaceutical companies pushing the drug for the marked increase in diagnoses of what’s known as bipolar II disorder. Unlike true manic depression, which involves episodes of extreme mania, anyone who experiences depression with “bursts of energy” can now be diagnosed with bipolar II (and prescribed Zyprexa). That sounds to Dawdy (and to me, someone who has struggled with depression) a lot more like simple depression than manic depression, a serious diagnosis that can lead to social ostracizing and inability to find a job.

Much of Dawdy’s distrust of the increased medication of children and teens is rooted in cross-cultural comparison. “In France and Italy, ADHD is rarely diagnosed and it's difficult to see where French and Italian culture have suffered as a result. As for bipolar disorder in kids (meaning pre-teens and younger), it's simply not an issue in the rest of the world. The bipolar child is a purely American phenomenon.”

Do you have any experience with children who have benefited or suffered from early mental health treatment?

Image: patriciaebauer.com

Bipolar Disorder: A Family Secret

Hannah Tennant-Moore — Sat, 13 Sep 2008 20:55:00 GMT

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

Strollerderby : antipsychotic drugs

They Say: Bipolar Children Are an “American Phenomenon”

Bipolar Disorder: A Family Secret