Friday, May 18, 2007

Mad kids

Oooh... I've had a bit of a blog hiatus haven't I? I must be more efficient at turning my night-time mind blog posts in actual post the next day.

I've got rather bad insomnia at the moment and so other than late night Wikipedia editing, I've been devouring my copy of New Scientist magazine as soon as it lands on my door mat. It is the source of many a night time mind blog post but this time I'm managed to hold on to my rant and I'm actually going to get it down on electronic paper.

First of all a caveat. I take mental illness very seriously, it is real, extremely distressing condition that deserves as much, if not more attention and support as physical illness. I also believe that children can suffer from mental illness - although I believe the approach to treatment, particularly with medication, should be approached even more cautiously than it is in adults.

Both the editorial and an article were concerned with the massive increase in diagnosis rates for bi-polar disorder (manic depression) in children in the US. In 1996, 13 out of every 100,000 children were diagnosed as having bi-polar disorder, in 2004 that rate was 74 out of ever 100,000 - a more than five fold rise. In 1994 the DSM-IV official psychiatric manual definition of bi-polar disorder was significantly widened to include three new forms of the disease - including one that is "bi-polar not otherwise specified" i.e. doesn't fit into the other definitions but we still think its bi-polar.

The article tells the story of Rebecca Riley, diagnosed at 2 with ADHD, at 3 bipolar disorder and by 4 she was dead - from an overdose of prescribed clonidine. She was also taking valproate and quetiapine fumarate.

I get the sense that western societies are increasingly medicalising their way out of newly perceived "problems" with our children. I don't see any other explanation for the massive rise in diagnoses of bi-polar disorder in the US, and of I get the increasing sense that generally western societies are increasingly trying to medicalise with ADHD, autistic-spectrum disorders etc. in the US and around the world. I went to school with a kid with Aspergers, he had it bad enough that it was very obvious and most likely needed a lot of support. My cousin-in-law was diagnosed with Aspergers a couple of years ago, and although he may tick some of the diagnostic boxes, does this label actually help him? He is shy, only eats chips, and can flip his lid sometimes. But he is also perfectly able to have a decent conversation, has friends and is living in a very unusual and stressful household - so I can see why any person would flip their lid occasionally, and for God's sake, he's a teenager after all. A generation ago he wouldn't have been labelled as anything except a bit quiet.

How can you diagnose bi-polar disorder in a 3 year old? They haven't even got a lot of their sense of identity or how they relate to the world around them fixed yet. And even if you think something may be wrong - should we medicate them with serious drugs which have all sorts of side effects and can severely shorten life span? I think not - could we just not support the parents and the child instead?

I am a big fan of the BBC programme "House of Tiny Tearaways". It is a purpose built house where families come to spend a week with their kids and a clinical psychologist. They deal with the whole range of behavioural problems by helping the parents see how they can change their child's behaviour by changing their own behaviour. They have started the week with some real terrors and some terrible problems, but with the intensive support and guidance in almost all cases they've made amazing progress by the end of the week. In other circumstances, in other countries I'm sure some of these kids would have been diagnosed with bi-polar disorder and medicated - but shouldn't this be the absolutely last resort?

Kids will be kids, and some will act a lot stranger and be far more unruly than others, but they are only part formed and we should help them develop, not label them and medicate them.


doctor/woman said...

Bipolar disorder? In a 3 year old? what??!!! I have no concept of how that could possibly be diagnosed. For the record, the ICD-10, which is the classification system mostly used in this country and in Europe, is much stricter on the classification of diseases like ADHD, which I agree are hugely overdiagnosed. A lot of parents actively seek a diagnosis of ADHD for their child, because then it's not bad parenting, it's a disease...

AdventuringJen said...

At last I got a chance to read this :)
My brain is a bit floobly this morning so I've not got anything to add, but good read.